|
TRASTUZUMAB-DKST 420 MG IV SOLR [170110]
|
Facility
|
IP
|
$3,150.06
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
67457084744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.03 |
| Max. Negotiated Rate |
$1,575.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.03
|
|
|
TRASTUZUMAB-DKST 420 MG IV SOLR [170110]
|
Facility
|
OP
|
$3,150.06
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
67457084744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$2,047.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,732.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.43
|
| Rate for Payer: Aetna Government |
$44.43
|
| Rate for Payer: Brighton Health Commercial |
$1,890.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,575.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,811.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$44.43
|
| Rate for Payer: EmblemHealth Commercial |
$1,575.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.43
|
| Rate for Payer: Group Health Inc Commercial |
$44.43
|
| Rate for Payer: Group Health Inc Medicare |
$44.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.76
|
| Rate for Payer: Healthfirst QHP |
$44.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,047.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.54
|
|
|
TRASTUZUMAB-DKST 420 MG IV SOLR [170110]
|
Facility
|
IP
|
$3,150.06
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
67457084550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.03 |
| Max. Negotiated Rate |
$1,575.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.03
|
|
|
TRASTUZUMAB-DKST 420 MG IV SOLR [170110]
|
Facility
|
OP
|
$3,150.06
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
67457084550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$2,047.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,732.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.43
|
| Rate for Payer: Aetna Government |
$44.43
|
| Rate for Payer: Brighton Health Commercial |
$1,890.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,575.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,811.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$44.43
|
| Rate for Payer: EmblemHealth Commercial |
$1,575.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.43
|
| Rate for Payer: Group Health Inc Commercial |
$44.43
|
| Rate for Payer: Group Health Inc Medicare |
$44.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.76
|
| Rate for Payer: Healthfirst QHP |
$44.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,047.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.54
|
|
|
TRASTUZUMAB-DTTB 150 MG IV SOLR [173122]
|
Facility
|
OP
|
$1,589.59
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
78206014701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$1,033.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$874.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.94
|
| Rate for Payer: Aetna Government |
$38.94
|
| Rate for Payer: Brighton Health Commercial |
$953.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$794.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$914.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.94
|
| Rate for Payer: EmblemHealth Commercial |
$794.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.94
|
| Rate for Payer: Group Health Inc Commercial |
$38.94
|
| Rate for Payer: Group Health Inc Medicare |
$38.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.10
|
| Rate for Payer: Healthfirst QHP |
$38.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,033.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.15
|
|
|
TRASTUZUMAB-DTTB 150 MG IV SOLR [173122]
|
Facility
|
IP
|
$1,589.59
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
78206014701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$794.80 |
| Max. Negotiated Rate |
$794.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.80
|
|
|
TRASTUZUMAB-DTTB 420 MG IV SOLR [173239]
|
Facility
|
OP
|
$4,450.85
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
78206014801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$2,893.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,447.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.94
|
| Rate for Payer: Aetna Government |
$38.94
|
| Rate for Payer: Brighton Health Commercial |
$2,670.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,225.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,559.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.94
|
| Rate for Payer: EmblemHealth Commercial |
$2,225.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.94
|
| Rate for Payer: Group Health Inc Commercial |
$38.94
|
| Rate for Payer: Group Health Inc Medicare |
$38.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,225.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.10
|
| Rate for Payer: Healthfirst QHP |
$38.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,893.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.15
|
|
|
TRASTUZUMAB-DTTB 420 MG IV SOLR [173239]
|
Facility
|
IP
|
$4,450.85
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
78206014801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.42 |
| Max. Negotiated Rate |
$2,225.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,225.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.42
|
|
|
TRASTUZUMAB-PKRB 150 MG IV SOLR [171650]
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$1,093.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$925.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.31
|
| Rate for Payer: Aetna Government |
$40.31
|
| Rate for Payer: Brighton Health Commercial |
$1,009.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$841.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$967.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.31
|
| Rate for Payer: EmblemHealth Commercial |
$841.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.31
|
| Rate for Payer: Group Health Inc Commercial |
$40.31
|
| Rate for Payer: Group Health Inc Medicare |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$841.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$841.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.26
|
| Rate for Payer: Healthfirst QHP |
$40.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,093.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.25
|
|
|
TRASTUZUMAB-PKRB 150 MG IV SOLR [171650]
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$841.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$841.50
|
|
|
TRASTUZUMAB-PKRB 420 MG IV SOLR [171628]
|
Facility
|
IP
|
$4,712.40
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.20 |
| Max. Negotiated Rate |
$2,356.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,356.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,356.20
|
|
|
TRASTUZUMAB-PKRB 420 MG IV SOLR [171628]
|
Facility
|
OP
|
$4,712.40
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$3,063.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,591.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.31
|
| Rate for Payer: Aetna Government |
$40.31
|
| Rate for Payer: Brighton Health Commercial |
$2,827.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,356.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,709.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,356.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.31
|
| Rate for Payer: Group Health Inc Commercial |
$40.31
|
| Rate for Payer: Group Health Inc Medicare |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,356.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,356.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.26
|
| Rate for Payer: Healthfirst QHP |
$40.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,063.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.25
|
|
|
TRASTUZUMAB-PKRB 420 MG IV SOLR [171628]
|
Facility
|
OP
|
$4,712.40
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$3,063.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,591.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.31
|
| Rate for Payer: Aetna Government |
$40.31
|
| Rate for Payer: Brighton Health Commercial |
$2,827.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,356.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,709.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,356.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.31
|
| Rate for Payer: Group Health Inc Commercial |
$40.31
|
| Rate for Payer: Group Health Inc Medicare |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,356.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,356.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.26
|
| Rate for Payer: Healthfirst QHP |
$40.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,063.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.25
|
|
|
TRASTUZUMAB-PKRB 420 MG IV SOLR [171628]
|
Facility
|
IP
|
$4,712.40
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
63459030547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.20 |
| Max. Negotiated Rate |
$2,356.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,356.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,356.20
|
|
|
TRASTUZUMAB-QYYP 150 MG IV SOLR [177299]
|
Facility
|
OP
|
$1,453.32
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$944.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$799.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.37
|
| Rate for Payer: Aetna Government |
$16.37
|
| Rate for Payer: Brighton Health Commercial |
$871.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$726.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$835.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.37
|
| Rate for Payer: EmblemHealth Commercial |
$726.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.37
|
| Rate for Payer: Group Health Inc Medicare |
$16.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.91
|
| Rate for Payer: Healthfirst QHP |
$16.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$944.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.09
|
|
|
TRASTUZUMAB-QYYP 150 MG IV SOLR [177299]
|
Facility
|
IP
|
$1,453.32
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.66 |
| Max. Negotiated Rate |
$726.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.66
|
|
|
TRASTUZUMAB-QYYP 420 MG IV SOLR [171634]
|
Facility
|
IP
|
$4,069.30
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.65 |
| Max. Negotiated Rate |
$2,034.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,034.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,034.65
|
|
|
TRASTUZUMAB-QYYP 420 MG IV SOLR [171634]
|
Facility
|
OP
|
$4,069.30
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$2,645.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,238.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.37
|
| Rate for Payer: Aetna Government |
$16.37
|
| Rate for Payer: Brighton Health Commercial |
$2,441.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,034.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,339.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.37
|
| Rate for Payer: EmblemHealth Commercial |
$2,034.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.37
|
| Rate for Payer: Group Health Inc Medicare |
$16.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,034.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,034.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.91
|
| Rate for Payer: Healthfirst QHP |
$16.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,645.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.09
|
|
|
TRASTUZUMAB-QYYP 420 MG IV SOLR [171634]
|
Facility
|
IP
|
$4,069.30
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.65 |
| Max. Negotiated Rate |
$2,034.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,034.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,034.65
|
|
|
TRASTUZUMAB-QYYP 420 MG IV SOLR [171634]
|
Facility
|
OP
|
$4,069.30
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
00069030601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$2,645.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,238.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.37
|
| Rate for Payer: Aetna Government |
$16.37
|
| Rate for Payer: Brighton Health Commercial |
$2,441.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,034.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,339.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.37
|
| Rate for Payer: EmblemHealth Commercial |
$2,034.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.37
|
| Rate for Payer: Group Health Inc Medicare |
$16.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,034.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,034.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.91
|
| Rate for Payer: Healthfirst QHP |
$16.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,645.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.09
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$28,613.70
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$12,815.30 |
| Max. Negotiated Rate |
$28,613.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,036.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,052.65
|
| Rate for Payer: Aetna Government |
$28,052.65
|
| Rate for Payer: Brighton Health Commercial |
$21,670.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,613.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,808.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,298.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,650.02
|
| Rate for Payer: EmblemHealth Commercial |
$12,815.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,052.65
|
| Rate for Payer: Group Health Inc Commercial |
$28,052.65
|
| Rate for Payer: Group Health Inc Medicare |
$28,052.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,052.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,044.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,052.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,052.65
|
| Rate for Payer: Wellcare Medicare |
$26,650.02
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$20,313.59
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,783.53 |
| Max. Negotiated Rate |
$20,313.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,384.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,915.28
|
| Rate for Payer: Aetna Government |
$19,915.28
|
| Rate for Payer: Brighton Health Commercial |
$13,161.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,313.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,675.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,935.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,919.52
|
| Rate for Payer: EmblemHealth Commercial |
$7,783.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,915.28
|
| Rate for Payer: Group Health Inc Commercial |
$19,915.28
|
| Rate for Payer: Group Health Inc Medicare |
$19,915.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,915.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,260.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,915.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,915.28
|
| Rate for Payer: Wellcare Medicare |
$18,919.52
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$26,104.41
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$11,294.10 |
| Max. Negotiated Rate |
$26,104.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,420.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,592.56
|
| Rate for Payer: Aetna Government |
$25,592.56
|
| Rate for Payer: Brighton Health Commercial |
$19,097.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,104.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,745.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,770.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,312.93
|
| Rate for Payer: EmblemHealth Commercial |
$11,294.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,592.56
|
| Rate for Payer: Group Health Inc Commercial |
$25,592.56
|
| Rate for Payer: Group Health Inc Medicare |
$25,592.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,592.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,900.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,592.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,592.56
|
| Rate for Payer: Wellcare Medicare |
$24,312.93
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$26,660.30
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$11,631.10 |
| Max. Negotiated Rate |
$26,660.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,000.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,137.55
|
| Rate for Payer: Aetna Government |
$26,137.55
|
| Rate for Payer: Brighton Health Commercial |
$19,667.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,660.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,423.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,330.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,830.67
|
| Rate for Payer: EmblemHealth Commercial |
$11,631.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,137.55
|
| Rate for Payer: Group Health Inc Commercial |
$26,137.55
|
| Rate for Payer: Group Health Inc Medicare |
$26,137.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,137.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,153.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,137.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,137.55
|
| Rate for Payer: Wellcare Medicare |
$24,830.67
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$39,622.55
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$18,063.22 |
| Max. Negotiated Rate |
$39,622.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,512.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,845.64
|
| Rate for Payer: Aetna Government |
$38,845.64
|
| Rate for Payer: Brighton Health Commercial |
$32,955.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,622.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,248.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,389.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,903.36
|
| Rate for Payer: EmblemHealth Commercial |
$19,489.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,845.64
|
| Rate for Payer: Group Health Inc Commercial |
$38,845.64
|
| Rate for Payer: Group Health Inc Medicare |
$38,845.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,845.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,063.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,845.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,845.64
|
| Rate for Payer: Wellcare Medicare |
$36,903.36
|
|
