|
LW PROF GAP PLATE SMALL
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$368.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$307.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.05
|
| Rate for Payer: EmblemHealth Commercial |
$307.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.70
|
| Rate for Payer: Group Health Inc Commercial |
$307.00
|
| Rate for Payer: Group Health Inc Medicare |
$214.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.10
|
|
|
LW PROF GAP PLATE SMALL
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.00
|
|
|
LWR XTR VASC STUDY BILAT
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
41301525
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
LWR XTR VASC STUDY BILAT
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
41301525
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
LYME DISEASE W/RFX
|
Facility
|
OP
|
$42.58
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40618089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$31.94
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
LYME DISEASE W/RFX
|
Facility
|
OP
|
$42.58
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
40728089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.03
|
| Rate for Payer: Aetna Government |
$17.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.92
|
| Rate for Payer: Brighton Health Commercial |
$31.94
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$17.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Group Health Inc Commercial |
$17.03
|
| Rate for Payer: Group Health Inc Medicare |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.03
|
| Rate for Payer: Healthfirst QHP |
$17.03
|
| Rate for Payer: Humana Medicare |
$17.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.62
|
| Rate for Payer: Wellcare Medicare |
$15.33
|
|
|
LYME DISEASE W/RFX
|
Facility
|
IP
|
$42.58
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
40728089
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$17.03
|
|
|
LYME DISEASE W/RFX
|
Facility
|
IP
|
$42.58
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40618089
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.49
|
|
|
LYME SEROLOGY
|
Facility
|
OP
|
$38.73
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40728098
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$29.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
LYME SEROLOGY
|
Facility
|
IP
|
$38.73
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40728098
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$15.49
|
|
|
LYME, TOTAL AB TEST/REFLEX
|
Facility
|
OP
|
$42.58
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
40729350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.03
|
| Rate for Payer: Aetna Government |
$17.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.92
|
| Rate for Payer: Brighton Health Commercial |
$31.94
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$17.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Group Health Inc Commercial |
$17.03
|
| Rate for Payer: Group Health Inc Medicare |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.03
|
| Rate for Payer: Healthfirst QHP |
$17.03
|
| Rate for Payer: Humana Medicare |
$17.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.62
|
| Rate for Payer: Wellcare Medicare |
$15.33
|
|
|
LYME, TOTAL AB TEST/REFLEX
|
Facility
|
IP
|
$42.58
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
40729350
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.03
|
|
|
LYME, WESTERN BLOT, SERUM
|
Facility
|
IP
|
$38.73
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40729349
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.49
|
|
|
LYME, WESTERN BLOT, SERUM
|
Facility
|
OP
|
$38.73
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
40729349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$29.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$52,636.69
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$17,800.77 |
| Max. Negotiated Rate |
$52,636.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,912.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,281.23
|
| Rate for Payer: Aetna Government |
$38,281.23
|
| Rate for Payer: Brighton Health Commercial |
$32,365.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,046.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,546.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,809.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,367.17
|
| Rate for Payer: EmblemHealth Commercial |
$19,140.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,281.23
|
| Rate for Payer: Group Health Inc Commercial |
$38,281.23
|
| Rate for Payer: Group Health Inc Medicare |
$38,281.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,281.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,800.77
|
| Rate for Payer: Humana Medicare |
$52,636.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,281.23
|
| Rate for Payer: United Healthcare Commercial |
$44,389.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,281.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,281.23
|
| Rate for Payer: Wellcare Medicare |
$36,367.17
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$125,372.17
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$42,398.59 |
| Max. Negotiated Rate |
$125,372.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89,158.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91,179.76
|
| Rate for Payer: Aetna Government |
$91,179.76
|
| Rate for Payer: Brighton Health Commercial |
$87,677.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93,003.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104,420.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86,172.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$86,620.77
|
| Rate for Payer: EmblemHealth Commercial |
$51,850.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$91,179.76
|
| Rate for Payer: Group Health Inc Commercial |
$91,179.76
|
| Rate for Payer: Group Health Inc Medicare |
$91,179.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91,179.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42,398.59
|
| Rate for Payer: Humana Medicare |
$125,372.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91,179.76
|
| Rate for Payer: United Healthcare Commercial |
$120,250.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91,179.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91,179.76
|
| Rate for Payer: Wellcare Medicare |
$86,620.77
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,696.78
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$10,622.70 |
| Max. Negotiated Rate |
$33,696.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,266.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,506.75
|
| Rate for Payer: Aetna Government |
$24,506.75
|
| Rate for Payer: Brighton Health Commercial |
$17,962.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,996.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,392.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,654.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,281.41
|
| Rate for Payer: EmblemHealth Commercial |
$10,622.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,506.75
|
| Rate for Payer: Group Health Inc Commercial |
$24,506.75
|
| Rate for Payer: Group Health Inc Medicare |
$24,506.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,506.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,395.64
|
| Rate for Payer: Humana Medicare |
$33,696.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,506.75
|
| Rate for Payer: United Healthcare Commercial |
$24,636.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,506.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,506.75
|
| Rate for Payer: Wellcare Medicare |
$23,281.41
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$40,078.73
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$13,492.80 |
| Max. Negotiated Rate |
$40,078.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,201.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,148.17
|
| Rate for Payer: Aetna Government |
$29,148.17
|
| Rate for Payer: Brighton Health Commercial |
$22,815.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,731.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,172.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,424.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,690.76
|
| Rate for Payer: EmblemHealth Commercial |
$13,492.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,148.17
|
| Rate for Payer: Group Health Inc Commercial |
$29,148.17
|
| Rate for Payer: Group Health Inc Medicare |
$29,148.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,148.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,553.90
|
| Rate for Payer: Humana Medicare |
$40,078.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,148.17
|
| Rate for Payer: United Healthcare Commercial |
$31,292.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,148.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,148.17
|
| Rate for Payer: Wellcare Medicare |
$27,690.76
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$69,665.98
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$23,559.77 |
| Max. Negotiated Rate |
$69,665.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46,081.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50,666.17
|
| Rate for Payer: Aetna Government |
$50,666.17
|
| Rate for Payer: Brighton Health Commercial |
$45,315.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51,679.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53,969.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44,537.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$48,132.86
|
| Rate for Payer: EmblemHealth Commercial |
$26,798.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$50,666.17
|
| Rate for Payer: Group Health Inc Commercial |
$50,666.17
|
| Rate for Payer: Group Health Inc Medicare |
$50,666.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50,666.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,559.77
|
| Rate for Payer: Humana Medicare |
$69,665.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50,666.17
|
| Rate for Payer: United Healthcare Commercial |
$62,150.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50,666.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50,666.17
|
| Rate for Payer: Wellcare Medicare |
$48,132.86
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$52,651.97
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$17,805.94 |
| Max. Negotiated Rate |
$52,651.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,924.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,292.34
|
| Rate for Payer: Aetna Government |
$38,292.34
|
| Rate for Payer: Brighton Health Commercial |
$32,377.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,058.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,559.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,821.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,377.72
|
| Rate for Payer: EmblemHealth Commercial |
$19,147.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,292.34
|
| Rate for Payer: Group Health Inc Commercial |
$38,292.34
|
| Rate for Payer: Group Health Inc Medicare |
$38,292.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,292.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,805.94
|
| Rate for Payer: Humana Medicare |
$52,651.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,292.34
|
| Rate for Payer: United Healthcare Commercial |
$44,405.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,292.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,292.34
|
| Rate for Payer: Wellcare Medicare |
$36,377.72
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$95,916.45
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$32,437.20 |
| Max. Negotiated Rate |
$95,916.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66,380.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69,757.42
|
| Rate for Payer: Aetna Government |
$69,757.42
|
| Rate for Payer: Brighton Health Commercial |
$65,277.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71,152.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77,743.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64,157.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$66,269.55
|
| Rate for Payer: EmblemHealth Commercial |
$38,603.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$69,757.42
|
| Rate for Payer: Group Health Inc Commercial |
$69,757.42
|
| Rate for Payer: Group Health Inc Medicare |
$69,757.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69,757.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,437.20
|
| Rate for Payer: Humana Medicare |
$95,916.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69,757.42
|
| Rate for Payer: United Healthcare Commercial |
$89,529.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69,757.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69,757.42
|
| Rate for Payer: Wellcare Medicare |
$66,269.55
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,699.75
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$11,073.80 |
| Max. Negotiated Rate |
$34,699.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,041.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,236.18
|
| Rate for Payer: Aetna Government |
$25,236.18
|
| Rate for Payer: Brighton Health Commercial |
$18,725.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,740.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,301.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,403.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,974.37
|
| Rate for Payer: EmblemHealth Commercial |
$11,073.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,236.18
|
| Rate for Payer: Group Health Inc Commercial |
$25,236.18
|
| Rate for Payer: Group Health Inc Medicare |
$25,236.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,236.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,734.82
|
| Rate for Payer: Humana Medicare |
$34,699.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,236.18
|
| Rate for Payer: United Healthcare Commercial |
$25,682.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,236.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,236.18
|
| Rate for Payer: Wellcare Medicare |
$23,974.37
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$30,409.53
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$9,144.38 |
| Max. Negotiated Rate |
$30,409.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,724.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,116.02
|
| Rate for Payer: Aetna Government |
$22,116.02
|
| Rate for Payer: Brighton Health Commercial |
$15,462.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,558.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,415.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,197.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,010.22
|
| Rate for Payer: EmblemHealth Commercial |
$9,144.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,116.02
|
| Rate for Payer: Group Health Inc Commercial |
$22,116.02
|
| Rate for Payer: Group Health Inc Medicare |
$22,116.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,116.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,283.95
|
| Rate for Payer: Humana Medicare |
$30,409.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,116.02
|
| Rate for Payer: United Healthcare Commercial |
$21,207.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,116.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,116.02
|
| Rate for Payer: Wellcare Medicare |
$21,010.22
|
|
|
LYSIS OF ADHESIONS, INTESTINES
|
Facility
|
OP
|
$3,669.80
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
40019983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,284.43 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,018.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,298.66
|
| Rate for Payer: Aetna Government |
$1,298.66
|
| Rate for Payer: Brighton Health Commercial |
$2,752.35
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,834.90
|
| Rate for Payer: Group Health Inc Medicare |
$1,284.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,834.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,834.90
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
LYSIS OF ADHESIONS,TUBES, OVARIES
|
Facility
|
OP
|
$2,418.55
|
|
|
Service Code
|
HCPCS 58740
|
| Hospital Charge Code |
40059982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.49 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,330.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,102.98
|
| Rate for Payer: Aetna Government |
$1,102.98
|
| Rate for Payer: Brighton Health Commercial |
$1,813.91
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.28
|
| Rate for Payer: Group Health Inc Medicare |
$846.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,209.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.28
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
