|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
IP
|
$22,822.84
|
|
|
Service Code
|
MS-DRG 290
|
| Min. Negotiated Rate |
$8,791.09 |
| Max. Negotiated Rate |
$22,822.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,116.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,375.33
|
| Rate for Payer: Aetna Government |
$22,375.33
|
| Rate for Payer: Brighton Health Commercial |
$14,865.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,822.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,738.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,463.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,256.56
|
| Rate for Payer: EmblemHealth Commercial |
$8,791.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,375.33
|
| Rate for Payer: Group Health Inc Commercial |
$22,375.33
|
| Rate for Payer: Group Health Inc Medicare |
$22,375.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,375.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,404.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,375.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,375.33
|
| Rate for Payer: Wellcare Medicare |
$21,256.56
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
OP
|
$119.08
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
40603008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$74.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.63
|
| Rate for Payer: Aetna Government |
$47.63
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.63
|
| Rate for Payer: EmblemHealth Commercial |
$47.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.39
|
| Rate for Payer: Group Health Inc Commercial |
$47.63
|
| Rate for Payer: Group Health Inc Medicare |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.63
|
| Rate for Payer: Healthfirst QHP |
$47.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$38.10
|
| Rate for Payer: Wellcare Medicare |
$42.87
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
IP
|
$39,094.94
|
|
|
Service Code
|
MS-DRG 835
|
| Min. Negotiated Rate |
$17,822.69 |
| Max. Negotiated Rate |
$39,094.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,962.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,328.37
|
| Rate for Payer: Aetna Government |
$38,328.37
|
| Rate for Payer: Brighton Health Commercial |
$32,414.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,094.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,604.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,858.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,411.95
|
| Rate for Payer: EmblemHealth Commercial |
$19,169.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,328.37
|
| Rate for Payer: Group Health Inc Commercial |
$38,328.37
|
| Rate for Payer: Group Health Inc Medicare |
$38,328.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,328.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,822.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,328.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,328.37
|
| Rate for Payer: Wellcare Medicare |
$36,411.95
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$96,689.13
|
|
|
Service Code
|
MS-DRG 834
|
| Min. Negotiated Rate |
$39,511.67 |
| Max. Negotiated Rate |
$96,689.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82,557.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84,971.33
|
| Rate for Payer: Aetna Government |
$84,971.33
|
| Rate for Payer: Brighton Health Commercial |
$81,185.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86,670.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96,689.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79,792.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$80,722.76
|
| Rate for Payer: EmblemHealth Commercial |
$48,011.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$84,971.33
|
| Rate for Payer: Group Health Inc Commercial |
$84,971.33
|
| Rate for Payer: Group Health Inc Medicare |
$84,971.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84,971.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39,511.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84,971.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84,971.33
|
| Rate for Payer: Wellcare Medicare |
$80,722.76
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$27,445.34
|
|
|
Service Code
|
MS-DRG 836
|
| Min. Negotiated Rate |
$10,266.80 |
| Max. Negotiated Rate |
$27,445.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,654.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,907.20
|
| Rate for Payer: Aetna Government |
$26,907.20
|
| Rate for Payer: Brighton Health Commercial |
$17,360.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,445.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,382.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,121.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,561.84
|
| Rate for Payer: EmblemHealth Commercial |
$10,266.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,907.20
|
| Rate for Payer: Group Health Inc Commercial |
$26,907.20
|
| Rate for Payer: Group Health Inc Medicare |
$26,907.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,907.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,511.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,907.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,907.20
|
| Rate for Payer: Wellcare Medicare |
$25,561.84
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$25,596.62
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$10,986.30 |
| Max. Negotiated Rate |
$25,596.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,891.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,094.73
|
| Rate for Payer: Aetna Government |
$25,094.73
|
| Rate for Payer: Brighton Health Commercial |
$18,577.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,596.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,125.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,258.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,839.99
|
| Rate for Payer: EmblemHealth Commercial |
$10,986.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,094.73
|
| Rate for Payer: Group Health Inc Commercial |
$25,094.73
|
| Rate for Payer: Group Health Inc Medicare |
$25,094.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,094.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,669.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,094.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,094.73
|
| Rate for Payer: Wellcare Medicare |
$23,839.99
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$18,005.16
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$6,384.09 |
| Max. Negotiated Rate |
$18,005.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,977.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,652.12
|
| Rate for Payer: Aetna Government |
$17,652.12
|
| Rate for Payer: Brighton Health Commercial |
$10,795.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,005.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,856.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,609.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,769.51
|
| Rate for Payer: EmblemHealth Commercial |
$6,384.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,652.12
|
| Rate for Payer: Group Health Inc Commercial |
$17,652.12
|
| Rate for Payer: Group Health Inc Medicare |
$17,652.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,652.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,208.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,652.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,652.12
|
| Rate for Payer: Wellcare Medicare |
$16,769.51
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
IP
|
$20,388.55
|
|
|
Service Code
|
MS-DRG 281
|
| Min. Negotiated Rate |
$7,828.98 |
| Max. Negotiated Rate |
$20,388.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,462.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,988.77
|
| Rate for Payer: Aetna Government |
$19,988.77
|
| Rate for Payer: Brighton Health Commercial |
$13,238.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,388.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,766.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,011.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,989.33
|
| Rate for Payer: EmblemHealth Commercial |
$7,828.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,988.77
|
| Rate for Payer: Group Health Inc Commercial |
$19,988.77
|
| Rate for Payer: Group Health Inc Medicare |
$19,988.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,988.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,294.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,988.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,988.77
|
| Rate for Payer: Wellcare Medicare |
$18,989.33
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
IP
|
$29,915.01
|
|
|
Service Code
|
MS-DRG 280
|
| Min. Negotiated Rate |
$13,604.20 |
| Max. Negotiated Rate |
$29,915.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,392.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,328.44
|
| Rate for Payer: Aetna Government |
$29,328.44
|
| Rate for Payer: Brighton Health Commercial |
$23,004.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,915.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,397.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,609.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,862.02
|
| Rate for Payer: EmblemHealth Commercial |
$13,604.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,328.44
|
| Rate for Payer: Group Health Inc Commercial |
$29,328.44
|
| Rate for Payer: Group Health Inc Medicare |
$29,328.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,328.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,637.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,328.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,328.44
|
| Rate for Payer: Wellcare Medicare |
$27,862.02
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
IP
|
$17,631.73
|
|
|
Service Code
|
MS-DRG 282
|
| Min. Negotiated Rate |
$6,157.71 |
| Max. Negotiated Rate |
$17,631.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,588.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,286.01
|
| Rate for Payer: Aetna Government |
$17,286.01
|
| Rate for Payer: Brighton Health Commercial |
$10,412.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,631.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,400.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,233.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,421.71
|
| Rate for Payer: EmblemHealth Commercial |
$6,157.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,286.01
|
| Rate for Payer: Group Health Inc Commercial |
$17,286.01
|
| Rate for Payer: Group Health Inc Medicare |
$17,286.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,286.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,037.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,286.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,286.01
|
| Rate for Payer: Wellcare Medicare |
$16,421.71
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
IP
|
$17,937.26
|
|
|
Service Code
|
MS-DRG 284
|
| Min. Negotiated Rate |
$6,342.93 |
| Max. Negotiated Rate |
$17,937.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,906.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,585.55
|
| Rate for Payer: Aetna Government |
$17,585.55
|
| Rate for Payer: Brighton Health Commercial |
$10,725.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,937.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,773.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,541.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,706.27
|
| Rate for Payer: EmblemHealth Commercial |
$6,342.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,585.55
|
| Rate for Payer: Group Health Inc Commercial |
$17,585.55
|
| Rate for Payer: Group Health Inc Medicare |
$17,585.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,585.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,177.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,585.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,585.55
|
| Rate for Payer: Wellcare Medicare |
$16,706.27
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
IP
|
$35,359.34
|
|
|
Service Code
|
MS-DRG 283
|
| Min. Negotiated Rate |
$16,119.70 |
| Max. Negotiated Rate |
$35,359.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,068.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,666.02
|
| Rate for Payer: Aetna Government |
$34,666.02
|
| Rate for Payer: Brighton Health Commercial |
$28,585.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,359.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,044.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,094.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,932.72
|
| Rate for Payer: EmblemHealth Commercial |
$16,904.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,666.02
|
| Rate for Payer: Group Health Inc Commercial |
$34,666.02
|
| Rate for Payer: Group Health Inc Medicare |
$34,666.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,666.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,119.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,666.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,666.02
|
| Rate for Payer: Wellcare Medicare |
$32,932.72
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
IP
|
$14,386.93
|
|
|
Service Code
|
MS-DRG 285
|
| Min. Negotiated Rate |
$4,190.60 |
| Max. Negotiated Rate |
$14,386.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,205.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14,104.83
|
| Rate for Payer: Aetna Government |
$14,104.83
|
| Rate for Payer: Brighton Health Commercial |
$7,086.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14,386.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,439.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,964.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13,399.59
|
| Rate for Payer: EmblemHealth Commercial |
$4,190.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,104.83
|
| Rate for Payer: Group Health Inc Commercial |
$14,104.83
|
| Rate for Payer: Group Health Inc Medicare |
$14,104.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,558.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14,104.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,104.83
|
| Rate for Payer: Wellcare Medicare |
$13,399.59
|
|
|
ACYCLOVIR 1000 MG/20 ML INJ
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
41653580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.06
|
| Rate for Payer: SOMOS Essential |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ACYCLOVIR 1000 MG/20 ML INJ
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
41643580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
ACYCLOVIR 1000 MG/20 ML INJ
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
41653580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
ACYCLOVIR 1000 MG/20 ML INJ
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
41643580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.06
|
| Rate for Payer: SOMOS Essential |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ACYCLOVIR 200 MG CAP
|
Facility
OP
|
$0.07
|
|
| Hospital Charge Code |
41643514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ACYCLOVIR 200 MG CAP
|
Facility
OP
|
$0.07
|
|
| Hospital Charge Code |
41653514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ACYCLOVIR 400 MG TAB
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41651746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
|
|
ACYCLOVIR 400 MG TAB
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41641746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
|
|
ACYCLOVIR 400 MG TAB
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41641746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.70
|
|
|
ACYCLOVIR 400 MG TAB
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41651746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.70
|
|
|
ACYCLOVIR 40 MG/ML SUSP
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41641595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
|
|
ACYCLOVIR 40 MG/ML SUSP
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
41641595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
