|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$3.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$1.96
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7261172525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$3.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7261172525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KIDNEY AND URINARY TRACT MALIGNANCY
|
Facility
|
OP
|
$238.99
|
|
|
Service Code
|
EAPG 00721
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$238.99 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.57
|
| Rate for Payer: Healthfirst Commercial |
$238.99
|
|
|
Kidney transplant
|
Facility
|
IP
|
$164,943.00
|
|
|
Service Code
|
APR-DRG 4401
|
| Min. Negotiated Rate |
$43,198.13 |
| Max. Negotiated Rate |
$164,943.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$97,195.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97,195.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43,198.13
|
| Rate for Payer: Amida Care Medicaid |
$43,198.13
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$97,195.79
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$43,198.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43,198.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51,837.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43,198.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43,198.13
|
| Rate for Payer: Healthfirst Commercial |
$164,943.00
|
| Rate for Payer: Healthfirst Essential Plan |
$97,195.79
|
| Rate for Payer: Healthfirst QHP |
$74,003.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43,198.13
|
| Rate for Payer: SOMOS Essential |
$97,195.79
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$97,195.79
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$97,195.79
|
| Rate for Payer: United Healthcare Medicaid |
$43,198.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43,198.13
|
|
|
Kidney transplant
|
Facility
|
IP
|
$284,677.00
|
|
|
Service Code
|
APR-DRG 4404
|
| Min. Negotiated Rate |
$95,398.51 |
| Max. Negotiated Rate |
$284,677.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$214,646.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$214,646.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95,398.51
|
| Rate for Payer: Amida Care Medicaid |
$95,398.51
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$214,646.65
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$95,398.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95,398.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114,478.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95,398.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95,398.51
|
| Rate for Payer: Healthfirst Commercial |
$284,677.00
|
| Rate for Payer: Healthfirst Essential Plan |
$214,646.65
|
| Rate for Payer: Healthfirst QHP |
$140,549.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95,398.51
|
| Rate for Payer: SOMOS Essential |
$214,646.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$214,646.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$214,646.65
|
| Rate for Payer: United Healthcare Medicaid |
$95,398.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$95,398.51
|
|
|
Kidney transplant
|
Facility
|
IP
|
$194,434.00
|
|
|
Service Code
|
APR-DRG 4403
|
| Min. Negotiated Rate |
$58,568.80 |
| Max. Negotiated Rate |
$194,434.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$131,779.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$131,779.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$58,568.80
|
| Rate for Payer: Amida Care Medicaid |
$58,568.80
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$131,779.80
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$58,568.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58,568.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70,282.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58,568.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58,568.80
|
| Rate for Payer: Healthfirst Commercial |
$194,434.00
|
| Rate for Payer: Healthfirst Essential Plan |
$131,779.80
|
| Rate for Payer: Healthfirst QHP |
$92,736.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58,568.80
|
| Rate for Payer: SOMOS Essential |
$131,779.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$131,779.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$131,779.80
|
| Rate for Payer: United Healthcare Medicaid |
$58,568.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58,568.80
|
|
|
Kidney transplant
|
Facility
|
IP
|
$168,510.00
|
|
|
Service Code
|
APR-DRG 4402
|
| Min. Negotiated Rate |
$50,541.10 |
| Max. Negotiated Rate |
$168,510.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$113,717.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$113,717.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50,541.10
|
| Rate for Payer: Amida Care Medicaid |
$50,541.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$113,717.48
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$50,541.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50,541.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60,649.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50,541.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50,541.10
|
| Rate for Payer: Healthfirst Commercial |
$168,510.00
|
| Rate for Payer: Healthfirst Essential Plan |
$113,717.48
|
| Rate for Payer: Healthfirst QHP |
$81,081.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50,541.10
|
| Rate for Payer: SOMOS Essential |
$113,717.48
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$113,717.48
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$113,717.48
|
| Rate for Payer: United Healthcare Medicaid |
$50,541.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50,541.10
|
|
|
Kidney & urinary tract infections
|
Facility
|
IP
|
$70,374.91
|
|
|
Service Code
|
APR-DRG 4634
|
| Min. Negotiated Rate |
$16,775.00 |
| Max. Negotiated Rate |
$70,374.91 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$70,374.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$70,374.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,277.74
|
| Rate for Payer: Amida Care Medicaid |
$31,277.74
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$70,374.91
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,277.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,277.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,533.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,277.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,277.74
|
| Rate for Payer: Healthfirst Commercial |
$33,206.00
|
| Rate for Payer: Healthfirst Essential Plan |
$70,374.91
|
| Rate for Payer: Healthfirst QHP |
$16,775.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,277.74
|
| Rate for Payer: SOMOS Essential |
$70,374.91
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$70,374.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$70,374.91
|
| Rate for Payer: United Healthcare Medicaid |
$31,277.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,277.74
|
|
|
Kidney & urinary tract infections
|
Facility
|
IP
|
$43,100.28
|
|
|
Service Code
|
APR-DRG 4632
|
| Min. Negotiated Rate |
$7,081.00 |
| Max. Negotiated Rate |
$43,100.28 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,100.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,100.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,155.68
|
| Rate for Payer: Amida Care Medicaid |
$19,155.68
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,100.28
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,155.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,155.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,986.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,155.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,155.68
|
| Rate for Payer: Healthfirst Commercial |
$12,176.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,100.28
|
| Rate for Payer: Healthfirst QHP |
$7,081.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,155.68
|
| Rate for Payer: SOMOS Essential |
$43,100.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,100.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,100.28
|
| Rate for Payer: United Healthcare Medicaid |
$19,155.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,155.68
|
|
|
Kidney & urinary tract infections
|
Facility
|
IP
|
$49,377.26
|
|
|
Service Code
|
APR-DRG 4633
|
| Min. Negotiated Rate |
$9,981.00 |
| Max. Negotiated Rate |
$49,377.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$49,377.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49,377.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,945.45
|
| Rate for Payer: Amida Care Medicaid |
$21,945.45
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$49,377.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,945.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,945.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,334.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,945.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,945.45
|
| Rate for Payer: Healthfirst Commercial |
$17,568.00
|
| Rate for Payer: Healthfirst Essential Plan |
$49,377.26
|
| Rate for Payer: Healthfirst QHP |
$9,981.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,945.45
|
| Rate for Payer: SOMOS Essential |
$49,377.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$49,377.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49,377.26
|
| Rate for Payer: United Healthcare Medicaid |
$21,945.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,945.45
|
|
|
Kidney & urinary tract infections
|
Facility
|
IP
|
$40,755.87
|
|
|
Service Code
|
APR-DRG 4631
|
| Min. Negotiated Rate |
$5,883.00 |
| Max. Negotiated Rate |
$40,755.87 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$40,755.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$40,755.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,113.72
|
| Rate for Payer: Amida Care Medicaid |
$18,113.72
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$40,755.87
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,113.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,113.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,736.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,113.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,113.72
|
| Rate for Payer: Healthfirst Commercial |
$10,218.00
|
| Rate for Payer: Healthfirst Essential Plan |
$40,755.87
|
| Rate for Payer: Healthfirst QHP |
$5,883.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,113.72
|
| Rate for Payer: SOMOS Essential |
$40,755.87
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$40,755.87
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$40,755.87
|
| Rate for Payer: United Healthcare Medicaid |
$18,113.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,113.72
|
|
|
Kidney & urinary tract malignancy
|
Facility
|
IP
|
$58,448.86
|
|
|
Service Code
|
APR-DRG 4613
|
| Min. Negotiated Rate |
$14,288.00 |
| Max. Negotiated Rate |
$58,448.86 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$58,448.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$58,448.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,977.27
|
| Rate for Payer: Amida Care Medicaid |
$25,977.27
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$58,448.86
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$25,977.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25,977.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,172.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25,977.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25,977.27
|
| Rate for Payer: Healthfirst Commercial |
$23,888.00
|
| Rate for Payer: Healthfirst Essential Plan |
$58,448.86
|
| Rate for Payer: Healthfirst QHP |
$14,288.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25,977.27
|
| Rate for Payer: SOMOS Essential |
$58,448.86
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$58,448.86
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$58,448.86
|
| Rate for Payer: United Healthcare Medicaid |
$25,977.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25,977.27
|
|
