|
DICYCLOMINE 10 MG CAP
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41644051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DICYCLOMINE 10 MG CAP
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41654051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DICYCLOMINE 10 MG/ML INJ
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
41653411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$32.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.52
|
|
|
DICYCLOMINE 10 MG/ML INJ
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
41643411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$42.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.99
|
| Rate for Payer: Aetna Government |
$32.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.89
|
| Rate for Payer: Group Health Inc Commercial |
$32.52
|
| Rate for Payer: Group Health Inc Medicare |
$22.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.48
|
| Rate for Payer: SOMOS Essential |
$26.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.28
|
|
|
DICYCLOMINE 10 MG/ML INJ
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
41653411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$42.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.99
|
| Rate for Payer: Aetna Government |
$32.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.89
|
| Rate for Payer: Group Health Inc Commercial |
$32.52
|
| Rate for Payer: Group Health Inc Medicare |
$22.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.48
|
| Rate for Payer: SOMOS Essential |
$26.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.28
|
|
|
DICYCLOMINE 10 MG/ML INJ
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
41643411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$32.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.52
|
|
|
DICYCLOMINE 20 MG TAB
|
Facility
OP
|
$0.28
|
|
| Hospital Charge Code |
41653485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
DICYCLOMINE 20 MG TAB
|
Facility
OP
|
$0.28
|
|
| Hospital Charge Code |
41643485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
DIDANOSINE 125 MG DR CAP
|
Facility
OP
|
$5.40
|
|
| Hospital Charge Code |
41652931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.70
|
| Rate for Payer: Aetna Government |
$2.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.67
|
| Rate for Payer: Group Health Inc Commercial |
$2.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.51
|
|
|
DIDANOSINE 125 MG DR CAP
|
Facility
OP
|
$5.40
|
|
| Hospital Charge Code |
41642931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.70
|
| Rate for Payer: Aetna Government |
$2.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.67
|
| Rate for Payer: Group Health Inc Commercial |
$2.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.51
|
|
|
DIDANOSINE 200 MG DR CAP
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41642811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
DIDANOSINE 200 MG DR CAP
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41652811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
DIDANOSINE 250 MG DR CAP
|
Facility
OP
|
$11.33
|
|
| Hospital Charge Code |
41653803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.66
|
| Rate for Payer: Aetna Government |
$5.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.70
|
| Rate for Payer: Group Health Inc Commercial |
$5.66
|
| Rate for Payer: Group Health Inc Medicare |
$3.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.36
|
|
|
DIDANOSINE 250 MG DR CAP
|
Facility
OP
|
$11.33
|
|
| Hospital Charge Code |
41643803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.66
|
| Rate for Payer: Aetna Government |
$5.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.70
|
| Rate for Payer: Group Health Inc Commercial |
$5.66
|
| Rate for Payer: Group Health Inc Medicare |
$3.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.36
|
|
|
DIDANOSINE 400 MG DR CAP
|
Facility
OP
|
$17.70
|
|
| Hospital Charge Code |
41652812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.85
|
| Rate for Payer: Aetna Government |
$8.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.50
|
|
|
DIDANOSINE 400 MG DR CAP
|
Facility
OP
|
$17.70
|
|
| Hospital Charge Code |
41642812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.85
|
| Rate for Payer: Aetna Government |
$8.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.50
|
|
|
DIFFERENTIAL-MANUAL
|
Facility
OP
|
$9.50
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
40621533
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.80
|
| Rate for Payer: Aetna Government |
$3.80
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$3.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.80
|
| Rate for Payer: Healthfirst QHP |
$3.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.04
|
| Rate for Payer: Wellcare Medicare |
$3.42
|
|
|
DIFFUSER AIR MEDTRONIC MIDAS REX
|
Facility
OP
|
$64.38
|
|
| Hospital Charge Code |
64904174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.53 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.19
|
| Rate for Payer: Aetna Government |
$32.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.78
|
| Rate for Payer: Group Health Inc Commercial |
$32.19
|
| Rate for Payer: Group Health Inc Medicare |
$22.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.19
|
|
|
DIFFUSING CAPACITY
|
Facility
OP
|
$173.43
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Hospital Charge Code |
30305588
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.72
|
| Rate for Payer: Aetna Government |
$86.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.19
|
| Rate for Payer: Group Health Inc Commercial |
$86.72
|
| Rate for Payer: Group Health Inc Medicare |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.10
|
|
|
DIFFUSION CAPACITY TEST
|
Facility
OP
|
$173.43
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Hospital Charge Code |
40402912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.72
|
| Rate for Payer: Aetna Government |
$86.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.19
|
| Rate for Payer: Group Health Inc Commercial |
$86.72
|
| Rate for Payer: Group Health Inc Medicare |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.10
|
|
|
DIFIBRILLATOR, C6TR01 VIVA CRT-P
|
Facility
OP
|
$22,868.02
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
40005902
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,640.47 |
| Max. Negotiated Rate |
$24,011.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,577.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,640.47
|
| Rate for Payer: Aetna Government |
$3,640.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,434.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,149.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,011.42
|
| Rate for Payer: Group Health Inc Commercial |
$11,434.01
|
| Rate for Payer: Group Health Inc Medicare |
$8,003.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,434.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,434.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,864.21
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
IP
|
$24,424.03
|
|
|
Service Code
|
MS-DRG 375
|
| Min. Negotiated Rate |
$10,275.40 |
| Max. Negotiated Rate |
$24,424.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,668.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,945.13
|
| Rate for Payer: Aetna Government |
$23,945.13
|
| Rate for Payer: Brighton Health Commercial |
$17,375.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,424.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,693.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,077.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,747.87
|
| Rate for Payer: EmblemHealth Commercial |
$10,275.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,945.13
|
| Rate for Payer: Group Health Inc Commercial |
$23,945.13
|
| Rate for Payer: Group Health Inc Medicare |
$23,945.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,945.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,134.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,945.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,945.13
|
| Rate for Payer: Wellcare Medicare |
$22,747.87
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
IP
|
$37,164.18
|
|
|
Service Code
|
MS-DRG 374
|
| Min. Negotiated Rate |
$16,942.49 |
| Max. Negotiated Rate |
$37,164.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,949.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,435.47
|
| Rate for Payer: Aetna Government |
$36,435.47
|
| Rate for Payer: Brighton Health Commercial |
$30,435.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,164.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,247.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,913.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,613.70
|
| Rate for Payer: EmblemHealth Commercial |
$17,998.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,435.47
|
| Rate for Payer: Group Health Inc Commercial |
$36,435.47
|
| Rate for Payer: Group Health Inc Medicare |
$36,435.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,435.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,942.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,435.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,435.47
|
| Rate for Payer: Wellcare Medicare |
$34,613.70
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$20,083.00
|
|
|
Service Code
|
MS-DRG 376
|
| Min. Negotiated Rate |
$7,643.76 |
| Max. Negotiated Rate |
$20,083.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,143.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,689.22
|
| Rate for Payer: Aetna Government |
$19,689.22
|
| Rate for Payer: Brighton Health Commercial |
$12,925.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,083.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,393.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,703.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,704.76
|
| Rate for Payer: EmblemHealth Commercial |
$7,643.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,689.22
|
| Rate for Payer: Group Health Inc Commercial |
$19,689.22
|
| Rate for Payer: Group Health Inc Medicare |
$19,689.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,689.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,155.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,689.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,689.22
|
| Rate for Payer: Wellcare Medicare |
$18,704.76
|
|
|
DIGESTIVE SYS-LIPS(40490-40799)
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
42201725
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
