|
INDOMETHACIN 50 MG PO CAPS [3898]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 31722054301
|
| Hospital Charge Code |
31722054301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.41
|
|
|
INDOMETHACIN 50MG SUPP
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
41648857
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Brighton Health Commercial |
$13.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
INDOMETHACIN 50MG SUPP
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
41658857
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Brighton Health Commercial |
$13.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
INDOMETHACIN SODIUM 1 MG IV SOLR [10267]
|
Facility
|
IP
|
$634.73
|
|
|
Service Code
|
NDC 63323065903
|
| Hospital Charge Code |
63323065903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.36 |
| Max. Negotiated Rate |
$317.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.36
|
|
|
INDOMETHACIN SODIUM 1 MG IV SOLR [10267]
|
Facility
|
OP
|
$634.73
|
|
|
Service Code
|
NDC 63323065903
|
| Hospital Charge Code |
63323065903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$666.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.36
|
| Rate for Payer: Aetna Government |
$317.36
|
| Rate for Payer: Brighton Health Commercial |
$380.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$364.97
|
| Rate for Payer: EmblemHealth Commercial |
$317.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$666.47
|
| Rate for Payer: Group Health Inc Commercial |
$317.36
|
| Rate for Payer: Group Health Inc Medicare |
$222.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$412.57
|
|
|
INDUCED ABORTION BY D & C
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59840
|
| Hospital Charge Code |
30105191
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
INDUCED ABORTION BY D & C
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59840
|
| Hospital Charge Code |
30105191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$100,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,250.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,250.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,000.00
|
| Rate for Payer: Amida Care Medicaid |
$1,000.00
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100,000.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,000.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,000.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,050.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,000.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,250.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$1,000.00
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,000.00
|
| Rate for Payer: SOMOS Essential |
$1,000.00
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$2,250.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,100.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,000.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
INDUCTION OF VOMITING
|
Facility
|
OP
|
$83.20
|
|
|
Service Code
|
HCPCS 99175
|
| Hospital Charge Code |
30305957
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.42
|
| Rate for Payer: Aetna Government |
$15.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.60
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IN DURA INTRATHECAL CATHETER
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,300.00 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,300.00
|
|
|
IN DURA INTRATHECAL CATHETER
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$11,130.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,830.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,095.00
|
| Rate for Payer: EmblemHealth Commercial |
$5,300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,130.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,300.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,710.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,890.00
|
|
|
IN DURA INTRATHECAL CATHETER
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40202334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.00 |
| Max. Negotiated Rate |
$695.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.00
|
|
|
IN DURA INTRATHECAL CATHETER
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40202334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,459.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$764.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$834.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$695.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$799.25
|
| Rate for Payer: EmblemHealth Commercial |
$695.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,459.50
|
| Rate for Payer: Group Health Inc Commercial |
$695.00
|
| Rate for Payer: Group Health Inc Medicare |
$486.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.50
|
|
|
INELIG FOOTWR EVAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2180
|
| Hospital Charge Code |
30300308
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
INFANT BEDSIDE HUMIDIFIER
|
Facility
|
OP
|
$70.88
|
|
| Hospital Charge Code |
40307201
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.44
|
| Rate for Payer: Aetna Government |
$35.44
|
| Rate for Payer: Brighton Health Commercial |
$53.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.20
|
| Rate for Payer: Group Health Inc Commercial |
$35.44
|
| Rate for Payer: Group Health Inc Medicare |
$24.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
|
|
INFANTHOOD
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307200
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
INFANTHOOD
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307200
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
INFECT AAGENT ANTIGEN DETECTION
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
40614063
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.98
|
|
|
INFECT AAGENT ANTIGEN DETECTION
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
40614063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$29,002.34
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$8,511.55 |
| Max. Negotiated Rate |
$29,002.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,635.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,092.61
|
| Rate for Payer: Aetna Government |
$21,092.61
|
| Rate for Payer: Brighton Health Commercial |
$14,392.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,514.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,141.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,145.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,037.98
|
| Rate for Payer: EmblemHealth Commercial |
$8,511.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,092.61
|
| Rate for Payer: Group Health Inc Commercial |
$21,092.61
|
| Rate for Payer: Group Health Inc Medicare |
$21,092.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,092.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,808.06
|
| Rate for Payer: Humana Medicare |
$29,002.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,092.61
|
| Rate for Payer: United Healthcare Commercial |
$19,739.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,092.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,092.61
|
| Rate for Payer: Wellcare Medicare |
$20,037.98
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$38,517.10
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$12,790.50 |
| Max. Negotiated Rate |
$38,517.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,993.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,012.44
|
| Rate for Payer: Aetna Government |
$28,012.44
|
| Rate for Payer: Brighton Health Commercial |
$21,628.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,572.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,758.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,256.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,611.82
|
| Rate for Payer: EmblemHealth Commercial |
$12,790.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,012.44
|
| Rate for Payer: Group Health Inc Commercial |
$28,012.44
|
| Rate for Payer: Group Health Inc Medicare |
$28,012.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,012.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,025.78
|
| Rate for Payer: Humana Medicare |
$38,517.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,012.44
|
| Rate for Payer: United Healthcare Commercial |
$29,663.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,012.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,012.44
|
| Rate for Payer: Wellcare Medicare |
$26,611.82
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$22,397.29
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$5,541.17 |
| Max. Negotiated Rate |
$22,397.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,528.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,288.94
|
| Rate for Payer: Aetna Government |
$16,288.94
|
| Rate for Payer: Brighton Health Commercial |
$9,369.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,614.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,159.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,209.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,474.49
|
| Rate for Payer: EmblemHealth Commercial |
$5,541.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,288.94
|
| Rate for Payer: Group Health Inc Commercial |
$16,288.94
|
| Rate for Payer: Group Health Inc Medicare |
$16,288.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,288.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,574.36
|
| Rate for Payer: Humana Medicare |
$22,397.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,288.94
|
| Rate for Payer: United Healthcare Commercial |
$12,850.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,288.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,288.94
|
| Rate for Payer: Wellcare Medicare |
$15,474.49
|
|
|
INFECTIOUS AGENT DETECTION BY NU
|
Facility
|
OP
|
$32.50
|
|
|
Service Code
|
HCPCS U0005
|
| Hospital Charge Code |
40611993
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$24.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.10
|
| Rate for Payer: Group Health Inc Commercial |
$16.25
|
| Rate for Payer: Group Health Inc Medicare |
$11.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.25
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$48,939.47
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$16,550.44 |
| Max. Negotiated Rate |
$48,939.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,053.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,592.34
|
| Rate for Payer: Aetna Government |
$35,592.34
|
| Rate for Payer: Brighton Health Commercial |
$29,553.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36,304.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35,197.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,046.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,812.72
|
| Rate for Payer: EmblemHealth Commercial |
$17,477.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,592.34
|
| Rate for Payer: Group Health Inc Commercial |
$35,592.34
|
| Rate for Payer: Group Health Inc Medicare |
$35,592.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,592.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,550.44
|
| Rate for Payer: Humana Medicare |
$48,939.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,592.34
|
| Rate for Payer: United Healthcare Commercial |
$40,533.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,592.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,592.34
|
| Rate for Payer: Wellcare Medicare |
$33,812.72
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$105,400.69
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$35,644.60 |
| Max. Negotiated Rate |
$105,400.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73,714.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76,655.05
|
| Rate for Payer: Aetna Government |
$76,655.05
|
| Rate for Payer: Brighton Health Commercial |
$72,489.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78,188.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86,332.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$71,245.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$72,822.30
|
| Rate for Payer: EmblemHealth Commercial |
$42,869.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$76,655.05
|
| Rate for Payer: Group Health Inc Commercial |
$76,655.05
|
| Rate for Payer: Group Health Inc Medicare |
$76,655.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76,655.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35,644.60
|
| Rate for Payer: Humana Medicare |
$105,400.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76,655.05
|
| Rate for Payer: United Healthcare Commercial |
$99,421.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76,655.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76,655.05
|
| Rate for Payer: Wellcare Medicare |
$72,822.30
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,525.11
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$14,381.22 |
| Max. Negotiated Rate |
$42,525.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,093.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,927.35
|
| Rate for Payer: Aetna Government |
$30,927.35
|
| Rate for Payer: Brighton Health Commercial |
$24,676.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,545.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,388.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,252.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,380.98
|
| Rate for Payer: EmblemHealth Commercial |
$14,592.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,927.35
|
| Rate for Payer: Group Health Inc Commercial |
$30,927.35
|
| Rate for Payer: Group Health Inc Medicare |
$30,927.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,927.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,381.22
|
| Rate for Payer: Humana Medicare |
$42,525.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,927.35
|
| Rate for Payer: United Healthcare Commercial |
$33,843.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,927.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,927.35
|
| Rate for Payer: Wellcare Medicare |
$29,380.98
|
|
