|
DEXTROSE 5% WATER INFUSION 150 ML
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
DEXTROSE 5% WATER INFUSION 150 ML
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
DEXTROSE 5% WATER INFUSION 150 ML
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
DEXTROSE 5% WATER INFUSION 250 ML
|
Facility
OP
|
$3.81
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.48
|
|
|
DEXTROSE 5% WATER INFUSION 250 ML
|
Facility
OP
|
$3.81
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.48
|
|
|
DEXTROSE 5% WATER INFUSION 250 ML
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
|
|
DEXTROSE 5% WATER INFUSION 250 ML
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
|
|
DEXTROSE 5% WATER INFUSION 25 ML
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
DEXTROSE 5% WATER INFUSION 25 ML
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
DEXTROSE 5% WATER INFUSION 25 ML
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
DEXTROSE 5% WATER INFUSION 25 ML
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
DEXTROSE 5% WATER INFUSION 500 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% WATER INFUSION 500 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% WATER INFUSION 500 ML
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DEXTROSE 5% WATER INFUSION 500 ML
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DEXTROSE 5% WATER INFUSION 50 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% WATER INFUSION 50 ML
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41651449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DEXTROSE 5% WATER INFUSION 50 ML
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DEXTROSE 5% WATER INFUSION 50 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
41641449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.74
|
| Rate for Payer: Aetna Government |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.91
|
| Rate for Payer: SOMOS Essential |
$1.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE/NACL 5-0.2% 1000ML
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41658153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
|
DEXTROSE/NACL 5-0.2% 1000ML
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41648153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
|
DHEA SULFATE
|
Facility
OP
|
$55.58
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
30303370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.23
|
| Rate for Payer: Aetna Government |
$22.23
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.23
|
| Rate for Payer: EmblemHealth Commercial |
$22.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.78
|
| Rate for Payer: Group Health Inc Commercial |
$22.23
|
| Rate for Payer: Group Health Inc Medicare |
$22.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.23
|
| Rate for Payer: Healthfirst QHP |
$22.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.78
|
| Rate for Payer: Wellcare Medicare |
$20.01
|
|
|
DHEA-SULFATE
|
Facility
OP
|
$55.58
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
40609064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.23
|
| Rate for Payer: Aetna Government |
$22.23
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.23
|
| Rate for Payer: EmblemHealth Commercial |
$22.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.78
|
| Rate for Payer: Group Health Inc Commercial |
$22.23
|
| Rate for Payer: Group Health Inc Medicare |
$22.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.23
|
| Rate for Payer: Healthfirst QHP |
$22.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.78
|
| Rate for Payer: Wellcare Medicare |
$20.01
|
|
|
DIABETES WITH CC
|
Facility
IP
|
$20,196.17
|
|
|
Service Code
|
MS-DRG 638
|
| Min. Negotiated Rate |
$7,712.36 |
| Max. Negotiated Rate |
$20,196.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,261.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,800.17
|
| Rate for Payer: Aetna Government |
$19,800.17
|
| Rate for Payer: Brighton Health Commercial |
$13,041.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,196.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,531.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,817.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,810.16
|
| Rate for Payer: EmblemHealth Commercial |
$7,712.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,800.17
|
| Rate for Payer: Group Health Inc Commercial |
$19,800.17
|
| Rate for Payer: Group Health Inc Medicare |
$19,800.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,800.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,207.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,800.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,800.17
|
| Rate for Payer: Wellcare Medicare |
$18,810.16
|
|
|
DIABETES WITH MCC
|
Facility
IP
|
$27,974.36
|
|
|
Service Code
|
MS-DRG 637
|
| Min. Negotiated Rate |
$12,427.70 |
| Max. Negotiated Rate |
$27,974.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,369.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,425.84
|
| Rate for Payer: Aetna Government |
$27,425.84
|
| Rate for Payer: Brighton Health Commercial |
$21,014.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,974.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,027.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,654.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,054.55
|
| Rate for Payer: EmblemHealth Commercial |
$12,427.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,425.84
|
| Rate for Payer: Group Health Inc Commercial |
$27,425.84
|
| Rate for Payer: Group Health Inc Medicare |
$27,425.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,425.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,753.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,425.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,425.84
|
| Rate for Payer: Wellcare Medicare |
$26,054.55
|
|
