|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN
|
Facility
|
IP
|
$14.70
|
|
|
Service Code
|
NDC 7012111891
|
| Hospital Charge Code |
7012111891
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.35
|
|
|
NIVOLUMAB 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
0003377412
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
|
|
NIVOLUMAB 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
0003377412
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$299.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$205.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.96
|
| Rate for Payer: Aetna Government |
$32.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.07
|
| Rate for Payer: Brighton Health Commercial |
$280.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$299.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$254.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.96
|
| Rate for Payer: EmblemHealth Commercial |
$32.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.33
|
| Rate for Payer: Group Health Inc Commercial |
$32.96
|
| Rate for Payer: Group Health Inc Medicare |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.02
|
| Rate for Payer: Healthfirst QHP |
$32.96
|
| Rate for Payer: Humana Medicare |
$33.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.31
|
| Rate for Payer: Wellcare Medicare |
$31.31
|
|
|
NIVOLUMAB 240 MG/24ML IV SOLN
|
Facility
|
OP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
0003373413
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$299.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$205.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.96
|
| Rate for Payer: Aetna Government |
$32.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.07
|
| Rate for Payer: Brighton Health Commercial |
$280.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$299.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$254.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.96
|
| Rate for Payer: EmblemHealth Commercial |
$32.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.33
|
| Rate for Payer: Group Health Inc Commercial |
$32.96
|
| Rate for Payer: Group Health Inc Medicare |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.02
|
| Rate for Payer: Healthfirst QHP |
$32.96
|
| Rate for Payer: Humana Medicare |
$33.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.31
|
| Rate for Payer: Wellcare Medicare |
$31.31
|
|
|
NIVOLUMAB 240 MG/24ML IV SOLN
|
Facility
|
IP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
0003373413
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
|
|
NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING
|
Facility
|
OP
|
$239.06
|
|
|
Service Code
|
EAPG 00627
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$239.06 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.57
|
| Rate for Payer: Healthfirst Commercial |
$239.06
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
OP
|
$180.52
|
|
|
Service Code
|
EAPG 00519
|
| Min. Negotiated Rate |
$180.52 |
| Max. Negotiated Rate |
$180.52 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.52
|
|
|
Non-bacterial infections of nervous system exc viral meningitis
|
Facility
|
IP
|
$70,789.99
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$21,369.00 |
| Max. Negotiated Rate |
$70,789.99 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$70,789.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$70,789.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,462.22
|
| Rate for Payer: Amida Care Medicaid |
$31,462.22
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$70,789.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,462.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,462.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,754.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,462.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,462.22
|
| Rate for Payer: Healthfirst Commercial |
$33,785.00
|
| Rate for Payer: Healthfirst Essential Plan |
$70,789.99
|
| Rate for Payer: Healthfirst QHP |
$21,369.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,462.22
|
| Rate for Payer: SOMOS Essential |
$70,789.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$70,789.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$70,789.99
|
| Rate for Payer: United Healthcare Medicaid |
$31,462.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,462.22
|
|
|
Non-bacterial infections of nervous system exc viral meningitis
|
Facility
|
IP
|
$45,216.07
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$8,912.00 |
| Max. Negotiated Rate |
$45,216.07 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,216.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,216.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,096.03
|
| Rate for Payer: Amida Care Medicaid |
$20,096.03
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,216.07
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,096.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,096.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,115.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,096.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,096.03
|
| Rate for Payer: Healthfirst Commercial |
$14,487.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,216.07
|
| Rate for Payer: Healthfirst QHP |
$8,912.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,096.03
|
| Rate for Payer: SOMOS Essential |
$45,216.07
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,216.07
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,216.07
|
| Rate for Payer: United Healthcare Medicaid |
$20,096.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,096.03
|
|
|
Non-bacterial infections of nervous system exc viral meningitis
|
Facility
|
IP
|
$126,048.04
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$47,280.00 |
| Max. Negotiated Rate |
$126,048.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$126,048.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126,048.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56,021.35
|
| Rate for Payer: Amida Care Medicaid |
$56,021.35
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$126,048.04
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$56,021.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56,021.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67,225.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56,021.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56,021.35
|
| Rate for Payer: Healthfirst Commercial |
$84,048.00
|
| Rate for Payer: Healthfirst Essential Plan |
$126,048.04
|
| Rate for Payer: Healthfirst QHP |
$47,280.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56,021.35
|
| Rate for Payer: SOMOS Essential |
$126,048.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$126,048.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$126,048.04
|
| Rate for Payer: United Healthcare Medicaid |
$56,021.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56,021.35
|
|
|
Non-bacterial infections of nervous system exc viral meningitis
|
Facility
|
IP
|
$55,803.71
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$11,929.00 |
| Max. Negotiated Rate |
$55,803.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,803.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,803.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,801.65
|
| Rate for Payer: Amida Care Medicaid |
$24,801.65
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,803.71
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,801.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,801.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,761.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,801.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,801.65
|
| Rate for Payer: Healthfirst Commercial |
$20,949.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,803.71
|
| Rate for Payer: Healthfirst QHP |
$11,929.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,801.65
|
| Rate for Payer: SOMOS Essential |
$55,803.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,803.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,803.71
|
| Rate for Payer: United Healthcare Medicaid |
$24,801.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,801.65
|
|
|
Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$74,998.66
|
|
|
Service Code
|
APR-DRG 9523
|
| Min. Negotiated Rate |
$27,682.00 |
| Max. Negotiated Rate |
$74,998.66 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$74,998.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$74,998.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33,332.74
|
| Rate for Payer: Amida Care Medicaid |
$33,332.74
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$74,998.66
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$33,332.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33,332.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39,999.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33,332.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33,332.74
|
| Rate for Payer: Healthfirst Commercial |
$46,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$74,998.66
|
| Rate for Payer: Healthfirst QHP |
$27,682.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33,332.74
|
| Rate for Payer: SOMOS Essential |
$74,998.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$74,998.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$74,998.66
|
| Rate for Payer: United Healthcare Medicaid |
$33,332.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33,332.74
|
|
|
Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$45,821.07
|
|
|
Service Code
|
APR-DRG 9521
|
| Min. Negotiated Rate |
$9,694.00 |
| Max. Negotiated Rate |
$45,821.07 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,821.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,821.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,364.92
|
| Rate for Payer: Amida Care Medicaid |
$20,364.92
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,821.07
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,364.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,364.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,437.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,364.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,364.92
|
| Rate for Payer: Healthfirst Commercial |
$15,907.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,821.07
|
| Rate for Payer: Healthfirst QHP |
$9,694.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,364.92
|
| Rate for Payer: SOMOS Essential |
$45,821.07
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,821.07
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,821.07
|
| Rate for Payer: United Healthcare Medicaid |
$20,364.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,364.92
|
|
|
Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$53,054.80
|
|
|
Service Code
|
APR-DRG 9522
|
| Min. Negotiated Rate |
$13,608.00 |
| Max. Negotiated Rate |
$53,054.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,054.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,054.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,579.91
|
| Rate for Payer: Amida Care Medicaid |
$23,579.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$53,054.80
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,579.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,579.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,295.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,579.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,579.91
|
| Rate for Payer: Healthfirst Commercial |
$24,355.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,054.80
|
| Rate for Payer: Healthfirst QHP |
$13,608.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,579.91
|
| Rate for Payer: SOMOS Essential |
$53,054.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,054.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,054.80
|
| Rate for Payer: United Healthcare Medicaid |
$23,579.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,579.91
|
|
|
Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$136,338.46
|
|
|
Service Code
|
APR-DRG 9524
|
| Min. Negotiated Rate |
$60,594.87 |
| Max. Negotiated Rate |
$136,338.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$136,338.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$136,338.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60,594.87
|
| Rate for Payer: Amida Care Medicaid |
$60,594.87
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$136,338.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$60,594.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60,594.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72,713.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60,594.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60,594.87
|
| Rate for Payer: Healthfirst Commercial |
$104,583.00
|
| Rate for Payer: Healthfirst Essential Plan |
$136,338.46
|
| Rate for Payer: Healthfirst QHP |
$68,772.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60,594.87
|
| Rate for Payer: SOMOS Essential |
$136,338.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$136,338.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$136,338.46
|
| Rate for Payer: United Healthcare Medicaid |
$60,594.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$60,594.87
|
|
|
NONINVASIVE VENTILATION SUPPORT
|
Facility
|
OP
|
$238.37
|
|
|
Service Code
|
EAPG 02020
|
| Min. Negotiated Rate |
$238.37 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.37
|
|
|
NON-PRESSURE CHRONIC SKIN ULCERS
|
Facility
|
OP
|
$273.95
|
|
|
Service Code
|
EAPG 00670
|
| Min. Negotiated Rate |
$199.03 |
| Max. Negotiated Rate |
$273.95 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.03
|
| Rate for Payer: Healthfirst Commercial |
$273.95
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION W/O INFARC
|
Facility
|
OP
|
$217.67
|
|
|
Service Code
|
EAPG 00534
|
| Min. Negotiated Rate |
$157.37 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.37
|
| Rate for Payer: Healthfirst Commercial |
$217.67
|
|
|
Nonspecific CVA & precerebral occlusion w/o infarct
|
Facility
|
IP
|
$52,338.98
|
|
|
Service Code
|
APR-DRG 0464
|
| Min. Negotiated Rate |
$11,858.00 |
| Max. Negotiated Rate |
$52,338.98 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$52,338.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52,338.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,261.77
|
| Rate for Payer: Amida Care Medicaid |
$23,261.77
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$52,338.98
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,261.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,261.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,914.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,261.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,261.77
|
| Rate for Payer: Healthfirst Commercial |
$20,421.00
|
| Rate for Payer: Healthfirst Essential Plan |
$52,338.98
|
| Rate for Payer: Healthfirst QHP |
$11,858.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,261.77
|
| Rate for Payer: SOMOS Essential |
$52,338.98
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$52,338.98
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52,338.98
|
| Rate for Payer: United Healthcare Medicaid |
$23,261.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,261.77
|
|
|
Nonspecific CVA & precerebral occlusion w/o infarct
|
Facility
|
IP
|
$51,464.88
|
|
|
Service Code
|
APR-DRG 0463
|
| Min. Negotiated Rate |
$11,545.00 |
| Max. Negotiated Rate |
$51,464.88 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,464.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,464.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,873.28
|
| Rate for Payer: Amida Care Medicaid |
$22,873.28
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,464.88
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,873.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,873.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,447.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,873.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,873.28
|
| Rate for Payer: Healthfirst Commercial |
$19,615.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,464.88
|
| Rate for Payer: Healthfirst QHP |
$11,545.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,873.28
|
| Rate for Payer: SOMOS Essential |
$51,464.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,464.88
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,464.88
|
| Rate for Payer: United Healthcare Medicaid |
$22,873.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,873.28
|
|
|
Nonspecific CVA & precerebral occlusion w/o infarct
|
Facility
|
IP
|
$43,123.14
|
|
|
Service Code
|
APR-DRG 0461
|
| Min. Negotiated Rate |
$7,648.00 |
| Max. Negotiated Rate |
$43,123.14 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,123.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,123.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,165.84
|
| Rate for Payer: Amida Care Medicaid |
$19,165.84
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,123.14
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,165.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,165.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,999.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,165.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,165.84
|
| Rate for Payer: Healthfirst Commercial |
$13,207.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,123.14
|
| Rate for Payer: Healthfirst QHP |
$7,648.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,165.84
|
| Rate for Payer: SOMOS Essential |
$43,123.14
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,123.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,123.14
|
| Rate for Payer: United Healthcare Medicaid |
$19,165.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,165.84
|
|
|
Nonspecific CVA & precerebral occlusion w/o infarct
|
Facility
|
IP
|
$46,937.88
|
|
|
Service Code
|
APR-DRG 0462
|
| Min. Negotiated Rate |
$9,099.00 |
| Max. Negotiated Rate |
$46,937.88 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,937.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,937.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,861.28
|
| Rate for Payer: Amida Care Medicaid |
$20,861.28
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,937.88
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,861.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,861.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,033.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,861.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,861.28
|
| Rate for Payer: Healthfirst Commercial |
$16,008.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,937.88
|
| Rate for Payer: Healthfirst QHP |
$9,099.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,861.28
|
| Rate for Payer: SOMOS Essential |
$46,937.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,937.88
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,937.88
|
| Rate for Payer: United Healthcare Medicaid |
$20,861.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,861.28
|
|
|
Nontraumatic stupor & coma
|
Facility
|
IP
|
$36,472.00
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$3,343.85 |
| Max. Negotiated Rate |
$36,472.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,343.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,343.85
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,343.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,012.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst Commercial |
$36,472.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,523.66
|
| Rate for Payer: Healthfirst QHP |
$6,085.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,343.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,523.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,523.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,343.85
|
| Rate for Payer: SOMOS Essential |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,523.66
|
| Rate for Payer: United Healthcare Medicaid |
$3,343.85
|
|
|
Nontraumatic stupor & coma
|
Facility
|
IP
|
$9,819.00
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$3,343.85 |
| Max. Negotiated Rate |
$9,819.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,343.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,343.85
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,343.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,012.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst Commercial |
$9,819.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,523.66
|
| Rate for Payer: Healthfirst QHP |
$6,085.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,343.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,523.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,523.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,343.85
|
| Rate for Payer: SOMOS Essential |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,523.66
|
| Rate for Payer: United Healthcare Medicaid |
$3,343.85
|
|
|
Nontraumatic stupor & coma
|
Facility
|
IP
|
$13,343.00
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$3,343.85 |
| Max. Negotiated Rate |
$13,343.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,343.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,343.85
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,343.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,343.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,012.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,343.85
|
| Rate for Payer: Healthfirst Commercial |
$13,343.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,523.66
|
| Rate for Payer: Healthfirst QHP |
$6,085.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,343.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,523.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,523.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,343.85
|
| Rate for Payer: SOMOS Essential |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,523.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,523.66
|
| Rate for Payer: United Healthcare Medicaid |
$3,343.85
|
|
