|
MS-DRG 43.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$53,472.02
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$27,760.25 |
| Max. Negotiated Rate |
$53,472.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,789.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,888.74
|
| Rate for Payer: Aetna Government |
$38,888.74
|
| Rate for Payer: Brighton Health Commercial |
$27,760.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,666.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,053.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,945.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,944.30
|
| Rate for Payer: EmblemHealth Commercial |
$38,888.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,888.74
|
| Rate for Payer: Group Health Inc Commercial |
$38,888.74
|
| Rate for Payer: Group Health Inc Medicare |
$38,888.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38,888.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,888.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36,166.53
|
| Rate for Payer: Humana Medicare |
$53,472.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,888.74
|
| Rate for Payer: United Healthcare Commercial |
$38,073.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,888.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,888.74
|
| Rate for Payer: Wellcare Medicare |
$36,944.30
|
|
|
MS-DRG 43.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$99,083.89
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$60,850.70 |
| Max. Negotiated Rate |
$99,083.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63,813.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72,061.01
|
| Rate for Payer: Aetna Government |
$72,061.01
|
| Rate for Payer: Brighton Health Commercial |
$60,850.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73,502.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74,645.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63,448.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$68,457.96
|
| Rate for Payer: EmblemHealth Commercial |
$72,061.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$72,061.01
|
| Rate for Payer: Group Health Inc Commercial |
$72,061.01
|
| Rate for Payer: Group Health Inc Medicare |
$72,061.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72,061.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72,061.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67,016.74
|
| Rate for Payer: Humana Medicare |
$99,083.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72,061.01
|
| Rate for Payer: United Healthcare Commercial |
$83,457.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72,061.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72,061.01
|
| Rate for Payer: Wellcare Medicare |
$68,457.96
|
|
|
MS-DRG 43.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,583.85
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$16,959.20 |
| Max. Negotiated Rate |
$38,583.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,305.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,060.98
|
| Rate for Payer: Aetna Government |
$28,060.98
|
| Rate for Payer: Brighton Health Commercial |
$16,959.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,622.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,803.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,683.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,657.93
|
| Rate for Payer: EmblemHealth Commercial |
$28,060.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,060.98
|
| Rate for Payer: Group Health Inc Commercial |
$28,060.98
|
| Rate for Payer: Group Health Inc Medicare |
$28,060.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,060.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,060.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,096.71
|
| Rate for Payer: Humana Medicare |
$38,583.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,060.98
|
| Rate for Payer: United Healthcare Commercial |
$23,259.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,060.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,060.98
|
| Rate for Payer: Wellcare Medicare |
$26,657.93
|
|
|
MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES
|
Facility
|
OP
|
$212.57
|
|
|
Service Code
|
EAPG 00523
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$212.57 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.06
|
| Rate for Payer: Healthfirst Commercial |
$212.57
|
|
|
Multiple sclerosis & other demyelinating diseases
|
Facility
|
IP
|
$50,919.68
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$9,859.00 |
| Max. Negotiated Rate |
$50,919.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,919.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,919.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,630.97
|
| Rate for Payer: Amida Care Medicaid |
$22,630.97
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,919.68
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,630.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,630.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,157.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,630.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,630.97
|
| Rate for Payer: Healthfirst Commercial |
$17,007.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,919.68
|
| Rate for Payer: Healthfirst QHP |
$9,859.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,630.97
|
| Rate for Payer: SOMOS Essential |
$50,919.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,919.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,919.68
|
| Rate for Payer: United Healthcare Medicaid |
$22,630.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,630.97
|
|
|
Multiple sclerosis & other demyelinating diseases
|
Facility
|
IP
|
$71,730.92
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$18,406.00 |
| Max. Negotiated Rate |
$71,730.92 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$71,730.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71,730.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,880.41
|
| Rate for Payer: Amida Care Medicaid |
$31,880.41
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71,730.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,880.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,880.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,256.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,880.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,880.41
|
| Rate for Payer: Healthfirst Commercial |
$28,142.00
|
| Rate for Payer: Healthfirst Essential Plan |
$71,730.92
|
| Rate for Payer: Healthfirst QHP |
$18,406.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,880.41
|
| Rate for Payer: SOMOS Essential |
$71,730.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71,730.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$71,730.92
|
| Rate for Payer: United Healthcare Medicaid |
$31,880.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,880.41
|
|
|
Multiple sclerosis & other demyelinating diseases
|
Facility
|
IP
|
$45,803.47
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$8,100.00 |
| Max. Negotiated Rate |
$45,803.47 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,803.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,803.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,357.10
|
| Rate for Payer: Amida Care Medicaid |
$20,357.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,803.47
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,357.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,357.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,428.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,357.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,357.10
|
| Rate for Payer: Healthfirst Commercial |
$13,205.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,803.47
|
| Rate for Payer: Healthfirst QHP |
$8,100.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,357.10
|
| Rate for Payer: SOMOS Essential |
$45,803.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,803.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,803.47
|
| Rate for Payer: United Healthcare Medicaid |
$20,357.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,357.10
|
|
|
Multiple sclerosis & other demyelinating diseases
|
Facility
|
IP
|
$136,093.99
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$44,630.00 |
| Max. Negotiated Rate |
$136,093.99 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$136,093.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$136,093.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60,486.22
|
| Rate for Payer: Amida Care Medicaid |
$60,486.22
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$136,093.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$60,486.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60,486.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72,583.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60,486.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60,486.22
|
| Rate for Payer: Healthfirst Commercial |
$80,639.00
|
| Rate for Payer: Healthfirst Essential Plan |
$136,093.99
|
| Rate for Payer: Healthfirst QHP |
$44,630.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60,486.22
|
| Rate for Payer: SOMOS Essential |
$136,093.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$136,093.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$136,093.99
|
| Rate for Payer: United Healthcare Medicaid |
$60,486.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$60,486.22
|
|
|
Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$96,281.26
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$37,901.00 |
| Max. Negotiated Rate |
$96,281.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$96,281.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$96,281.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$42,791.67
|
| Rate for Payer: Amida Care Medicaid |
$42,791.67
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$96,281.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$42,791.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42,791.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42,791.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42,791.67
|
| Rate for Payer: Healthfirst Commercial |
$58,473.00
|
| Rate for Payer: Healthfirst Essential Plan |
$96,281.26
|
| Rate for Payer: Healthfirst QHP |
$37,901.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42,791.67
|
| Rate for Payer: SOMOS Essential |
$96,281.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$96,281.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$96,281.26
|
| Rate for Payer: United Healthcare Medicaid |
$42,791.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42,791.67
|
|
|
Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$59,852.34
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$16,996.00 |
| Max. Negotiated Rate |
$59,852.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$59,852.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59,852.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,601.04
|
| Rate for Payer: Amida Care Medicaid |
$26,601.04
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$59,852.34
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,601.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,601.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,921.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,601.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,601.04
|
| Rate for Payer: Healthfirst Commercial |
$28,553.00
|
| Rate for Payer: Healthfirst Essential Plan |
$59,852.34
|
| Rate for Payer: Healthfirst QHP |
$16,996.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,601.04
|
| Rate for Payer: SOMOS Essential |
$59,852.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$59,852.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$59,852.34
|
| Rate for Payer: United Healthcare Medicaid |
$26,601.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,601.04
|
|
|
Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$47,607.95
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$10,690.00 |
| Max. Negotiated Rate |
$47,607.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,607.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,607.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,159.09
|
| Rate for Payer: Amida Care Medicaid |
$21,159.09
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,607.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,159.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,159.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,390.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,159.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,159.09
|
| Rate for Payer: Healthfirst Commercial |
$17,376.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,607.95
|
| Rate for Payer: Healthfirst QHP |
$10,690.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,159.09
|
| Rate for Payer: SOMOS Essential |
$47,607.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,607.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,607.95
|
| Rate for Payer: United Healthcare Medicaid |
$21,159.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,159.09
|
|
|
Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$47,527.04
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$9,062.00 |
| Max. Negotiated Rate |
$47,527.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,527.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,527.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,123.13
|
| Rate for Payer: Amida Care Medicaid |
$21,123.13
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,527.04
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,123.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,123.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,347.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,123.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,123.13
|
| Rate for Payer: Healthfirst Commercial |
$11,950.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,527.04
|
| Rate for Payer: Healthfirst QHP |
$9,062.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,123.13
|
| Rate for Payer: SOMOS Essential |
$47,527.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,527.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,527.04
|
| Rate for Payer: United Healthcare Medicaid |
$21,123.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,123.13
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
NDC 6846218022
|
| Hospital Charge Code |
6846218022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Brighton Health Commercial |
$1.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
NDC 6846218022
|
| Hospital Charge Code |
6846218022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 5167213120
|
| Hospital Charge Code |
5167213120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Brighton Health Commercial |
$0.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: EmblemHealth Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.74
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 4580211222
|
| Hospital Charge Code |
4580211222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 5167213120
|
| Hospital Charge Code |
5167213120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 0093101042
|
| Hospital Charge Code |
0093101042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 4580211222
|
| Hospital Charge Code |
4580211222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
MUPIROCIN 2 % EX OINT
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 0093101042
|
| Hospital Charge Code |
0093101042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.94
|
| Rate for Payer: Aetna Government |
$1.94
|
| Rate for Payer: Brighton Health Commercial |
$2.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.64
|
| Rate for Payer: EmblemHealth Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.53
|
|
|
MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES
|
Facility
|
OP
|
$1,356.18
|
|
|
Service Code
|
EAPG 00051
|
| Min. Negotiated Rate |
$1,356.18 |
| Max. Negotiated Rate |
$1,356.18 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,356.18
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY
|
Facility
|
OP
|
$271.92
|
|
|
Service Code
|
EAPG 00653
|
| Min. Negotiated Rate |
$196.72 |
| Max. Negotiated Rate |
$271.92 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.72
|
| Rate for Payer: Healthfirst Commercial |
$271.92
|
|
|
Musculoskeletal malignancy & pathol fracture d/t muscskel malig
|
Facility
|
IP
|
$49,561.92
|
|
|
Service Code
|
APR-DRG 3432
|
| Min. Negotiated Rate |
$10,513.00 |
| Max. Negotiated Rate |
$49,561.92 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$49,561.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49,561.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,027.52
|
| Rate for Payer: Amida Care Medicaid |
$22,027.52
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$49,561.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,027.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,027.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,433.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,027.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,027.52
|
| Rate for Payer: Healthfirst Commercial |
$17,595.00
|
| Rate for Payer: Healthfirst Essential Plan |
$49,561.92
|
| Rate for Payer: Healthfirst QHP |
$10,513.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,027.52
|
| Rate for Payer: SOMOS Essential |
$49,561.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$49,561.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49,561.92
|
| Rate for Payer: United Healthcare Medicaid |
$22,027.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,027.52
|
|
|
Musculoskeletal malignancy & pathol fracture d/t muscskel malig
|
Facility
|
IP
|
$99,760.05
|
|
|
Service Code
|
APR-DRG 3434
|
| Min. Negotiated Rate |
$34,814.00 |
| Max. Negotiated Rate |
$99,760.05 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$99,760.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99,760.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44,337.80
|
| Rate for Payer: Amida Care Medicaid |
$44,337.80
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$99,760.05
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$44,337.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44,337.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53,205.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44,337.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44,337.80
|
| Rate for Payer: Healthfirst Commercial |
$51,819.00
|
| Rate for Payer: Healthfirst Essential Plan |
$99,760.05
|
| Rate for Payer: Healthfirst QHP |
$34,814.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44,337.80
|
| Rate for Payer: SOMOS Essential |
$99,760.05
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$99,760.05
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$99,760.05
|
| Rate for Payer: United Healthcare Medicaid |
$44,337.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44,337.80
|
|
|
Musculoskeletal malignancy & pathol fracture d/t muscskel malig
|
Facility
|
IP
|
$46,608.97
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$8,184.00 |
| Max. Negotiated Rate |
$46,608.97 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,608.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,608.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,715.10
|
| Rate for Payer: Amida Care Medicaid |
$20,715.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,608.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,715.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,715.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,858.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,715.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,715.10
|
| Rate for Payer: Healthfirst Commercial |
$14,928.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,608.97
|
| Rate for Payer: Healthfirst QHP |
$8,184.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,715.10
|
| Rate for Payer: SOMOS Essential |
$46,608.97
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,608.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,608.97
|
| Rate for Payer: United Healthcare Medicaid |
$20,715.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,715.10
|
|
