|
DEFEROXAMINE 500 MG INJ
|
Facility
IP
|
$13.66
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
41641400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
|
|
DEFIBRILLATOR
|
Facility
OP
|
$54,607.50
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
64907351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,752.01 |
| Max. Negotiated Rate |
$57,337.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,034.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,752.01
|
| Rate for Payer: Aetna Government |
$4,752.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,303.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,399.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$57,337.88
|
| Rate for Payer: Group Health Inc Commercial |
$27,303.75
|
| Rate for Payer: Group Health Inc Medicare |
$19,112.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,303.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,303.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,494.88
|
|
|
DEFIBRILLATOR
|
Facility
IP
|
$54,607.50
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
64907351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,303.75 |
| Max. Negotiated Rate |
$27,303.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,303.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,303.75
|
|
|
DEFOGGER ST DEROYAL
|
Facility
OP
|
$3.64
|
|
| Hospital Charge Code |
64904849
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.82
|
| Rate for Payer: Aetna Government |
$1.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.48
|
| Rate for Payer: Group Health Inc Commercial |
$1.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.82
|
|
|
DEFTAROLINE 200MG/NS 50ML IVPB
|
Facility
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
DEFTAROLINE 200MG/NS 50ML IVPB
|
Facility
IP
|
$7.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.88
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$41,341.99
|
|
|
Service Code
|
MS-DRG 056
|
| Min. Negotiated Rate |
$18,844.76 |
| Max. Negotiated Rate |
$41,341.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35,299.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40,526.37
|
| Rate for Payer: Aetna Government |
$40,526.37
|
| Rate for Payer: Brighton Health Commercial |
$34,713.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41,336.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41,341.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34,117.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$38,500.05
|
| Rate for Payer: EmblemHealth Commercial |
$20,528.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$40,526.37
|
| Rate for Payer: Group Health Inc Commercial |
$40,526.37
|
| Rate for Payer: Group Health Inc Medicare |
$40,526.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40,526.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,844.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40,526.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40,526.37
|
| Rate for Payer: Wellcare Medicare |
$38,500.05
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
IP
|
$26,756.51
|
|
|
Service Code
|
MS-DRG 057
|
| Min. Negotiated Rate |
$11,689.40 |
| Max. Negotiated Rate |
$26,756.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,100.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,231.87
|
| Rate for Payer: Aetna Government |
$26,231.87
|
| Rate for Payer: Brighton Health Commercial |
$19,766.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,756.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,541.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,427.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,920.28
|
| Rate for Payer: EmblemHealth Commercial |
$11,689.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,231.87
|
| Rate for Payer: Group Health Inc Commercial |
$26,231.87
|
| Rate for Payer: Group Health Inc Medicare |
$26,231.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,231.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,197.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,231.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,231.87
|
| Rate for Payer: Wellcare Medicare |
$24,920.28
|
|
|
DELIVERY OF PLACENTA
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
40052237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.21 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
DELIVERY OF PLACENTA
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
30102503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.21 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
DELIVERY ROOM
|
Facility
OP
|
$921.38
|
|
| Hospital Charge Code |
40250001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$506.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.69
|
| Rate for Payer: Aetna Government |
$460.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$737.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$626.54
|
| Rate for Payer: Group Health Inc Commercial |
$460.69
|
| Rate for Payer: Group Health Inc Medicare |
$322.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$460.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.69
|
|
|
DELTA CER HEAD 12/14 36MM 1.5
|
Facility
IP
|
$8,502.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,251.25 |
| Max. Negotiated Rate |
$4,251.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,251.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,251.25
|
|
|
DELTA CER HEAD 12/14 36MM 1.5
|
Facility
IP
|
$6,802.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40005156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,401.00 |
| Max. Negotiated Rate |
$3,401.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,401.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,401.00
|
|
|
DELTA CER HEAD 12/14 36MM 1.5
|
Facility
OP
|
$6,802.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40005156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,142.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,741.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,401.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,911.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,142.10
|
| Rate for Payer: Group Health Inc Commercial |
$3,401.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,380.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,401.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,401.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,421.30
|
|
|
DELTA CER HEAD 12/14 36MM 1.5
|
Facility
OP
|
$8,502.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$8,927.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,676.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,251.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,888.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,927.62
|
| Rate for Payer: Group Health Inc Commercial |
$4,251.25
|
| Rate for Payer: Group Health Inc Medicare |
$2,975.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,251.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,251.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,526.62
|
|
|
DEMECLOCYCLINE 150 MG TAB
|
Facility
OP
|
$3.57
|
|
| Hospital Charge Code |
41644621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.78
|
| Rate for Payer: Aetna Government |
$1.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.78
|
| Rate for Payer: Group Health Inc Medicare |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.32
|
|
|
DEMECLOCYCLINE 150 MG TAB
|
Facility
OP
|
$3.57
|
|
| Hospital Charge Code |
41654621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.78
|
| Rate for Payer: Aetna Government |
$1.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.78
|
| Rate for Payer: Group Health Inc Medicare |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.32
|
|
|
DENGUE VIRUS IGG AND IGM
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
DENOSUMAB 60 MG/1ML INJ
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41647018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENOSUMAB 60 MG/1ML INJ
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41647018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
|
|
DENOSUMAB 60MG/1ML INJ
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41657018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENOSUMAB 60MG/1ML INJ
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41657018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
IP
|
$20,749.23
|
|
|
Service Code
|
MS-DRG 158
|
| Min. Negotiated Rate |
$8,047.64 |
| Max. Negotiated Rate |
$20,749.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,838.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,342.38
|
| Rate for Payer: Aetna Government |
$20,342.38
|
| Rate for Payer: Brighton Health Commercial |
$13,608.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,749.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,206.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,374.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,325.26
|
| Rate for Payer: EmblemHealth Commercial |
$8,047.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,342.38
|
| Rate for Payer: Group Health Inc Commercial |
$20,342.38
|
| Rate for Payer: Group Health Inc Medicare |
$20,342.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,342.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,459.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,342.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,342.38
|
| Rate for Payer: Wellcare Medicare |
$19,325.26
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
IP
|
$31,619.46
|
|
|
Service Code
|
MS-DRG 157
|
| Min. Negotiated Rate |
$14,414.75 |
| Max. Negotiated Rate |
$31,619.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,169.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,999.47
|
| Rate for Payer: Aetna Government |
$30,999.47
|
| Rate for Payer: Brighton Health Commercial |
$24,751.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,619.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,478.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,326.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,449.50
|
| Rate for Payer: EmblemHealth Commercial |
$14,637.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,999.47
|
| Rate for Payer: Group Health Inc Commercial |
$30,999.47
|
| Rate for Payer: Group Health Inc Medicare |
$30,999.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,999.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,414.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,999.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,999.47
|
| Rate for Payer: Wellcare Medicare |
$29,449.50
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
IP
|
$17,024.93
|
|
|
Service Code
|
MS-DRG 159
|
| Min. Negotiated Rate |
$5,789.84 |
| Max. Negotiated Rate |
$17,024.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,955.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,691.11
|
| Rate for Payer: Aetna Government |
$16,691.11
|
| Rate for Payer: Brighton Health Commercial |
$9,790.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,024.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,660.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,622.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,856.55
|
| Rate for Payer: EmblemHealth Commercial |
$5,789.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,691.11
|
| Rate for Payer: Group Health Inc Commercial |
$16,691.11
|
| Rate for Payer: Group Health Inc Medicare |
$16,691.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,691.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,761.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,691.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,691.11
|
| Rate for Payer: Wellcare Medicare |
$15,856.55
|
|
