|
CHEMICAL PEEL, FACIAL
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 15788
|
| Hospital Charge Code |
30305902
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
CHEMO 1A INFUSION EA ADD'1 HR
|
Facility
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96423
|
| Hospital Charge Code |
40509858
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$54.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
CHEMO ADMIN BOTH INFUSION/OTHER
|
Facility
OP
|
$391.18
|
|
|
Service Code
|
HCPCS Q0085
|
| Hospital Charge Code |
40011323
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$134.78 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$215.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.78
|
| Rate for Payer: Aetna Government |
$134.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$195.59
|
| Rate for Payer: Group Health Inc Medicare |
$136.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.59
|
|
|
CHEMO ADMIN BY INFUSION ONLY
|
Facility
OP
|
$248.19
|
|
|
Service Code
|
HCPCS Q0084
|
| Hospital Charge Code |
40011322
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$86.87 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.12
|
| Rate for Payer: Aetna Government |
$100.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$124.10
|
| Rate for Payer: Group Health Inc Medicare |
$86.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.10
|
|
|
CHEMO ADMIN BY OTH THAN INFUSION
|
Facility
OP
|
$315.63
|
|
|
Service Code
|
HCPCS Q0083
|
| Hospital Charge Code |
40011321
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.20
|
| Rate for Payer: Aetna Government |
$74.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$157.82
|
| Rate for Payer: Group Health Inc Medicare |
$110.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.82
|
|
|
CHEMO ADMINISTRATION / OP
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
40508000
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
CHEMO ADMINISTRATION / OP
|
Facility
OP
|
$223.91
|
|
|
Service Code
|
HCPCS Q0083
|
| Hospital Charge Code |
40011325
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.20
|
| Rate for Payer: Aetna Government |
$74.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$111.96
|
| Rate for Payer: Group Health Inc Medicare |
$78.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.96
|
|
|
CHEMODENERV TRUNK 1-5 MUSCLES
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
30305437
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
CHEMODERNERV TRUNK 6/> MUSCLES
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
30305438
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
CHEMODERVATE FACIAL/TRIGEM USC MI
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
30305367
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
CHEMO HORMONAL SQ OR INTRAMUSCULA
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
40509873
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
CHEMO, IA INFUSION, PUSH
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
40509856
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.50
|
| Rate for Payer: Aetna Government |
$22.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
CHEMO, IA INFUSION, UPTO 1 HR.
|
Facility
OP
|
$556.18
|
|
|
Service Code
|
HCPCS 96422
|
| Hospital Charge Code |
40509857
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$196.67 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO IA PUMP INFUSION EA ADD HR
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96425
|
| Hospital Charge Code |
40509859
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO IA PUSH TECHNIQUE
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96420
|
| Hospital Charge Code |
40500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$127.42 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO, INITIAL CHEMORX INFUSION
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
40509868
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO, INTRALESIONAL, MORE THAN 7
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
40509851
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
CHEMO IV INFUSION EA ADD'1 HR
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
40509854
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
CHEMO, IV INFUSION, EACH ADD'L HR
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
40509869
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
CHEMO IV INFUSION INITIAL
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
40509853
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO, IV PUMP INFUSION, >8 HRS.
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
40509855
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$158.79 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO IV PUSH EA ADD'1 SUBSTANCE
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
40509871
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
CHEMO IV PUSH INITIAL
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
40509879
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
CHEMO IV SECOND DRUG UP TO 1 HR
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
40509870
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
CHEMO NON HORMONAL SQ OR INTRAMUS
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
40509872
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
