|
CIRCUIT ANESTHESIA ADULT
|
Facility
|
OP
|
$9.47
|
|
| Hospital Charge Code |
64902258
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Brighton Health Commercial |
$7.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
|
|
CIRCUIT DISPOSABLE IVENT 201
|
Facility
|
OP
|
$23.40
|
|
| Hospital Charge Code |
64902510
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.70
|
| Rate for Payer: Aetna Government |
$11.70
|
| Rate for Payer: Brighton Health Commercial |
$17.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.91
|
| Rate for Payer: Group Health Inc Commercial |
$11.70
|
| Rate for Payer: Group Health Inc Medicare |
$8.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.70
|
|
|
CIRCUIT INFANT HEATED 4FT RESP
|
Facility
|
OP
|
$19.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$11.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.43
|
| Rate for Payer: EmblemHealth Commercial |
$9.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.87
|
| Rate for Payer: Group Health Inc Commercial |
$9.94
|
| Rate for Payer: Group Health Inc Medicare |
$6.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.92
|
|
|
CIRCUIT INFANT HEATED 4FT RESP
|
Facility
|
IP
|
$19.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.94
|
|
|
CIRCUIT,PEDIATRIC
|
Facility
|
OP
|
$14.99
|
|
| Hospital Charge Code |
64903976
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.19
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
CIRCUIT PEDIATRIC 75
|
Facility
|
OP
|
$682.83
|
|
| Hospital Charge Code |
64903694
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$238.99 |
| Max. Negotiated Rate |
$546.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$341.42
|
| Rate for Payer: Aetna Government |
$341.42
|
| Rate for Payer: Brighton Health Commercial |
$512.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$546.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$464.32
|
| Rate for Payer: Group Health Inc Commercial |
$341.42
|
| Rate for Payer: Group Health Inc Medicare |
$238.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.42
|
|
|
CIRCUIT,VENT,48,NEONA,DUAL HEA
|
Facility
|
OP
|
$19.09
|
|
| Hospital Charge Code |
64901743
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.54
|
| Rate for Payer: Aetna Government |
$9.54
|
| Rate for Payer: Brighton Health Commercial |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.98
|
| Rate for Payer: Group Health Inc Commercial |
$9.54
|
| Rate for Payer: Group Health Inc Medicare |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
|
|
CIRCUIT VENTILATOR
|
Facility
|
OP
|
$5.50
|
|
| Hospital Charge Code |
64902250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.75
|
| Rate for Payer: Aetna Government |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$4.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.74
|
| Rate for Payer: Group Health Inc Commercial |
$2.75
|
| Rate for Payer: Group Health Inc Medicare |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.75
|
|
|
CIRCUIT VENT MONITORING W/ADAPTER
|
Facility
|
OP
|
$2.88
|
|
| Hospital Charge Code |
64902167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.44
|
| Rate for Payer: Aetna Government |
$1.44
|
| Rate for Payer: Brighton Health Commercial |
$2.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.96
|
| Rate for Payer: Group Health Inc Commercial |
$1.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
|
|
CIRCUIT VENT PB7200A
|
Facility
|
OP
|
$5.95
|
|
| Hospital Charge Code |
64901883
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Brighton Health Commercial |
$4.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$51,178.02
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$17,307.48 |
| Max. Negotiated Rate |
$51,178.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,784.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,220.38
|
| Rate for Payer: Aetna Government |
$37,220.38
|
| Rate for Payer: Brighton Health Commercial |
$31,256.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,964.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,225.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,719.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,359.36
|
| Rate for Payer: EmblemHealth Commercial |
$18,484.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,220.38
|
| Rate for Payer: Group Health Inc Commercial |
$37,220.38
|
| Rate for Payer: Group Health Inc Medicare |
$37,220.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,220.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,307.48
|
| Rate for Payer: Humana Medicare |
$51,178.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,220.38
|
| Rate for Payer: United Healthcare Commercial |
$42,868.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,220.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,220.38
|
| Rate for Payer: Wellcare Medicare |
$35,359.36
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$30,699.35
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$9,274.72 |
| Max. Negotiated Rate |
$30,699.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,948.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,326.80
|
| Rate for Payer: Aetna Government |
$22,326.80
|
| Rate for Payer: Brighton Health Commercial |
$15,683.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,773.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,678.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,414.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,210.46
|
| Rate for Payer: EmblemHealth Commercial |
$9,274.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,326.80
|
| Rate for Payer: Group Health Inc Commercial |
$22,326.80
|
| Rate for Payer: Group Health Inc Medicare |
$22,326.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,326.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,381.96
|
| Rate for Payer: Humana Medicare |
$30,699.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,326.80
|
| Rate for Payer: United Healthcare Commercial |
$21,509.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,326.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,326.80
|
| Rate for Payer: Wellcare Medicare |
$21,210.46
|
|
|
CIRCUMCISION
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
40011165
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
CIRCUMCISION
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
40011165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CIRCUMCISION ADULT
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
40123187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CIRCUMCISION ADULT
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
40123187
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$29,734.54
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,840.83 |
| Max. Negotiated Rate |
$29,734.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,202.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,625.12
|
| Rate for Payer: Aetna Government |
$21,625.12
|
| Rate for Payer: Brighton Health Commercial |
$14,949.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,057.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,804.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,692.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,543.86
|
| Rate for Payer: EmblemHealth Commercial |
$8,840.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,625.12
|
| Rate for Payer: Group Health Inc Commercial |
$21,625.12
|
| Rate for Payer: Group Health Inc Medicare |
$21,625.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,625.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,055.68
|
| Rate for Payer: Humana Medicare |
$29,734.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,625.12
|
| Rate for Payer: United Healthcare Commercial |
$20,503.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,625.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,625.12
|
| Rate for Payer: Wellcare Medicare |
$20,543.86
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$46,609.42
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$46,609.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,251.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,897.76
|
| Rate for Payer: Aetna Government |
$33,897.76
|
| Rate for Payer: Brighton Health Commercial |
$27,782.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,575.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,087.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,305.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,202.87
|
| Rate for Payer: EmblemHealth Commercial |
$16,429.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,897.76
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$33,897.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,897.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,762.46
|
| Rate for Payer: Humana Medicare |
$46,609.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,897.76
|
| Rate for Payer: United Healthcare Commercial |
$38,103.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,897.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,897.76
|
| Rate for Payer: Wellcare Medicare |
$32,202.87
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,841.56
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$5,740.96 |
| Max. Negotiated Rate |
$22,841.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,871.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,612.04
|
| Rate for Payer: Aetna Government |
$16,612.04
|
| Rate for Payer: Brighton Health Commercial |
$9,707.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,944.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,561.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,541.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,781.44
|
| Rate for Payer: EmblemHealth Commercial |
$5,740.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,612.04
|
| Rate for Payer: Group Health Inc Commercial |
$16,612.04
|
| Rate for Payer: Group Health Inc Medicare |
$16,612.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,612.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,724.60
|
| Rate for Payer: Humana Medicare |
$22,841.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,612.04
|
| Rate for Payer: United Healthcare Commercial |
$13,314.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,612.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,612.04
|
| Rate for Payer: Wellcare Medicare |
$15,781.44
|
|
|
CISATRACURIUM 10 MG/ML INJ 20 ML
|
Facility
|
OP
|
$547.90
|
|
| Hospital Charge Code |
41642597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$438.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.95
|
| Rate for Payer: Aetna Government |
$273.95
|
| Rate for Payer: Brighton Health Commercial |
$410.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$438.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$372.57
|
| Rate for Payer: Group Health Inc Commercial |
$273.95
|
| Rate for Payer: Group Health Inc Medicare |
$191.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.14
|
|
|
CISATRACURIUM 10 MG/ML INJ 20 ML
|
Facility
|
OP
|
$547.90
|
|
| Hospital Charge Code |
41652597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$438.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.95
|
| Rate for Payer: Aetna Government |
$273.95
|
| Rate for Payer: Brighton Health Commercial |
$410.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$438.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$372.57
|
| Rate for Payer: Group Health Inc Commercial |
$273.95
|
| Rate for Payer: Group Health Inc Medicare |
$191.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.14
|
|
|
CISATRACURIUM 200MG/D5W 100ML INF
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
41647173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 200MG/D5W 100ML INF
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
41657173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 200MG/NS 100ML INF
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
41647178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
