|
PIRFENIDONE 267 MG PO CAPS
|
Facility
|
IP
|
$44.12
|
|
|
Service Code
|
NDC 6909794093
|
| Hospital Charge Code |
6909794093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
|
|
PIRFENIDONE 267 MG PO CAPS
|
Facility
|
OP
|
$44.12
|
|
|
Service Code
|
NDC 6909794093
|
| Hospital Charge Code |
6909794093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$35.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.06
|
| Rate for Payer: Aetna Government |
$22.06
|
| Rate for Payer: Brighton Health Commercial |
$33.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.00
|
| Rate for Payer: EmblemHealth Commercial |
$22.06
|
| Rate for Payer: Group Health Inc Commercial |
$22.06
|
| Rate for Payer: Group Health Inc Medicare |
$15.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.68
|
|
|
Pituitary & adrenal procedures
|
Facility
|
IP
|
$156,232.00
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$68,850.04 |
| Max. Negotiated Rate |
$156,232.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$154,912.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$154,912.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$68,850.04
|
| Rate for Payer: Amida Care Medicaid |
$68,850.04
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$154,912.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$68,850.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68,850.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82,620.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68,850.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68,850.04
|
| Rate for Payer: Healthfirst Commercial |
$156,232.00
|
| Rate for Payer: Healthfirst Essential Plan |
$154,912.59
|
| Rate for Payer: Healthfirst QHP |
$81,621.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68,850.04
|
| Rate for Payer: SOMOS Essential |
$154,912.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$154,912.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$154,912.59
|
| Rate for Payer: United Healthcare Medicaid |
$68,850.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68,850.04
|
|
|
Pituitary & adrenal procedures
|
Facility
|
IP
|
$53,774.12
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$14,650.00 |
| Max. Negotiated Rate |
$53,774.12 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,774.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,774.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,899.61
|
| Rate for Payer: Amida Care Medicaid |
$23,899.61
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$53,774.12
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,899.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,899.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,679.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,899.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,899.61
|
| Rate for Payer: Healthfirst Commercial |
$23,870.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,774.12
|
| Rate for Payer: Healthfirst QHP |
$14,650.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,899.61
|
| Rate for Payer: SOMOS Essential |
$53,774.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,774.12
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,774.12
|
| Rate for Payer: United Healthcare Medicaid |
$23,899.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,899.61
|
|
|
Pituitary & adrenal procedures
|
Facility
|
IP
|
$61,788.74
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$20,601.00 |
| Max. Negotiated Rate |
$61,788.74 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$61,788.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$61,788.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,461.66
|
| Rate for Payer: Amida Care Medicaid |
$27,461.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$61,788.74
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,461.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,461.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32,953.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,461.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,461.66
|
| Rate for Payer: Healthfirst Commercial |
$33,967.00
|
| Rate for Payer: Healthfirst Essential Plan |
$61,788.74
|
| Rate for Payer: Healthfirst QHP |
$20,601.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,461.66
|
| Rate for Payer: SOMOS Essential |
$61,788.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$61,788.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61,788.74
|
| Rate for Payer: United Healthcare Medicaid |
$27,461.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,461.66
|
|
|
Pituitary & adrenal procedures
|
Facility
|
IP
|
$86,518.46
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$38,452.65 |
| Max. Negotiated Rate |
$86,518.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$86,518.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$86,518.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$38,452.65
|
| Rate for Payer: Amida Care Medicaid |
$38,452.65
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$86,518.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$38,452.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38,452.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46,143.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38,452.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38,452.65
|
| Rate for Payer: Healthfirst Commercial |
$61,736.00
|
| Rate for Payer: Healthfirst Essential Plan |
$86,518.46
|
| Rate for Payer: Healthfirst QHP |
$39,928.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38,452.65
|
| Rate for Payer: SOMOS Essential |
$86,518.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$86,518.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$86,518.46
|
| Rate for Payer: United Healthcare Medicaid |
$38,452.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$38,452.65
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
OP
|
$533.81
|
|
|
Service Code
|
NDC 0006432903
|
| Hospital Charge Code |
0006432903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.83 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$293.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$266.90
|
| Rate for Payer: Aetna Government |
$266.90
|
| Rate for Payer: Brighton Health Commercial |
$400.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$362.99
|
| Rate for Payer: EmblemHealth Commercial |
$266.90
|
| Rate for Payer: Group Health Inc Commercial |
$266.90
|
| Rate for Payer: Group Health Inc Medicare |
$186.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.98
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
OP
|
$550.50
|
|
|
Service Code
|
NDC 0006432902
|
| Hospital Charge Code |
0006432902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$440.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.25
|
| Rate for Payer: Aetna Government |
$275.25
|
| Rate for Payer: Brighton Health Commercial |
$412.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.34
|
| Rate for Payer: EmblemHealth Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Medicare |
$192.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.82
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
IP
|
$533.81
|
|
|
Service Code
|
NDC 0006432903
|
| Hospital Charge Code |
0006432903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$266.90 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.90
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
IP
|
$550.50
|
|
|
Service Code
|
NDC 0006432901
|
| Hospital Charge Code |
0006432901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
IP
|
$550.50
|
|
|
Service Code
|
NDC 0006432902
|
| Hospital Charge Code |
0006432902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
OP
|
$550.50
|
|
|
Service Code
|
NDC 0006432901
|
| Hospital Charge Code |
0006432901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$440.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.25
|
| Rate for Payer: Aetna Government |
$275.25
|
| Rate for Payer: Brighton Health Commercial |
$412.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.34
|
| Rate for Payer: EmblemHealth Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Medicare |
$192.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.82
|
|
|
PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
IP
|
$627.54
|
|
|
Service Code
|
NDC 0005200010
|
| Hospital Charge Code |
0005200010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$313.77 |
| Max. Negotiated Rate |
$313.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.77
|
|
|
PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY
|
Facility
|
OP
|
$627.54
|
|
|
Service Code
|
NDC 0005200010
|
| Hospital Charge Code |
0005200010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$502.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$345.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$313.77
|
| Rate for Payer: Aetna Government |
$313.77
|
| Rate for Payer: Brighton Health Commercial |
$470.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$502.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$426.73
|
| Rate for Payer: EmblemHealth Commercial |
$313.77
|
| Rate for Payer: Group Health Inc Commercial |
$313.77
|
| Rate for Payer: Group Health Inc Medicare |
$219.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.90
|
|
|
PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
NDC 0006483701
|
| Hospital Charge Code |
0006483701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
|
|
PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
NDC 0006483703
|
| Hospital Charge Code |
0006483703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
|
|
PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
NDC 0006483701
|
| Hospital Charge Code |
0006483701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$224.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.50
|
| Rate for Payer: Aetna Government |
$140.50
|
| Rate for Payer: Brighton Health Commercial |
$210.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$224.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.08
|
| Rate for Payer: EmblemHealth Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Medicare |
$98.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.65
|
|
|
PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
NDC 0006483703
|
| Hospital Charge Code |
0006483703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$224.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.50
|
| Rate for Payer: Aetna Government |
$140.50
|
| Rate for Payer: Brighton Health Commercial |
$210.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$224.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.08
|
| Rate for Payer: EmblemHealth Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Medicare |
$98.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.65
|
|
|
PODOPHYLLUM RESIN 25 % EX SOLN
|
Facility
|
OP
|
$8.17
|
|
|
Service Code
|
NDC 0574060115
|
| Hospital Charge Code |
0574060115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$6.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.55
|
| Rate for Payer: EmblemHealth Commercial |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$4.08
|
| Rate for Payer: Group Health Inc Medicare |
$2.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.31
|
|
|
PODOPHYLLUM RESIN 25 % EX SOLN
|
Facility
|
IP
|
$8.17
|
|
|
Service Code
|
NDC 0574060115
|
| Hospital Charge Code |
0574060115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.08
|
|
|
Poisoning of medicinal agents
|
Facility
|
IP
|
$41,554.35
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$5,996.00 |
| Max. Negotiated Rate |
$41,554.35 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,554.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,554.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,468.60
|
| Rate for Payer: Amida Care Medicaid |
$18,468.60
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,554.35
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,468.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,468.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,162.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,468.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,468.60
|
| Rate for Payer: Healthfirst Commercial |
$10,352.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,554.35
|
| Rate for Payer: Healthfirst QHP |
$5,996.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,468.60
|
| Rate for Payer: SOMOS Essential |
$41,554.35
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,554.35
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,554.35
|
| Rate for Payer: United Healthcare Medicaid |
$18,468.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,468.60
|
|
|
Poisoning of medicinal agents
|
Facility
|
IP
|
$39,218.74
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$39,218.74 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39,218.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39,218.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,430.55
|
| Rate for Payer: Amida Care Medicaid |
$17,430.55
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$39,218.74
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17,430.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,430.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20,916.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,430.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,430.55
|
| Rate for Payer: Healthfirst Commercial |
$8,781.00
|
| Rate for Payer: Healthfirst Essential Plan |
$39,218.74
|
| Rate for Payer: Healthfirst QHP |
$5,088.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,430.55
|
| Rate for Payer: SOMOS Essential |
$39,218.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39,218.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39,218.74
|
| Rate for Payer: United Healthcare Medicaid |
$17,430.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,430.55
|
|
|
Poisoning of medicinal agents
|
Facility
|
IP
|
$70,469.89
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$21,940.00 |
| Max. Negotiated Rate |
$70,469.89 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$70,469.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$70,469.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,319.95
|
| Rate for Payer: Amida Care Medicaid |
$31,319.95
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$70,469.89
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,319.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,319.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,583.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,319.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,319.95
|
| Rate for Payer: Healthfirst Commercial |
$38,463.00
|
| Rate for Payer: Healthfirst Essential Plan |
$70,469.89
|
| Rate for Payer: Healthfirst QHP |
$21,940.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,319.95
|
| Rate for Payer: SOMOS Essential |
$70,469.89
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$70,469.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$70,469.89
|
| Rate for Payer: United Healthcare Medicaid |
$31,319.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,319.95
|
|
|
Poisoning of medicinal agents
|
Facility
|
IP
|
$48,197.14
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$9,535.00 |
| Max. Negotiated Rate |
$48,197.14 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,197.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,197.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,420.95
|
| Rate for Payer: Amida Care Medicaid |
$21,420.95
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$48,197.14
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,420.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,420.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,705.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,420.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,420.95
|
| Rate for Payer: Healthfirst Commercial |
$16,732.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,197.14
|
| Rate for Payer: Healthfirst QHP |
$9,535.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,420.95
|
| Rate for Payer: SOMOS Essential |
$48,197.14
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,197.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,197.14
|
| Rate for Payer: United Healthcare Medicaid |
$21,420.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,420.95
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
OP
|
$319.99
|
|
|
Service Code
|
EAPG 00851
|
| Min. Negotiated Rate |
$231.43 |
| Max. Negotiated Rate |
$319.99 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.43
|
| Rate for Payer: Healthfirst Commercial |
$319.99
|
|
