|
CHEMO PERITONEAL CVTY/INCL PERITO
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
40509875
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$35.16
|
| 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 PLEURAL CVTY/INCL THORACTIS
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96440
|
| Hospital Charge Code |
40509882
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$155.81 |
| 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 |
$155.81
|
| 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 PORTACATHER. ACCESS
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
40000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.84 |
| Max. Negotiated Rate |
$4,196.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
CHEMOTHERAPY INJECTION
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
30301132
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$49.19 |
| 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 |
$49.19
|
| 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
|
|
|
CHEMOTHERAPY KIT
|
Facility
OP
|
$42.88
|
|
| Hospital Charge Code |
40201060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$34.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.44
|
| Rate for Payer: Aetna Government |
$21.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.16
|
| Rate for Payer: Group Health Inc Commercial |
$21.44
|
| Rate for Payer: Group Health Inc Medicare |
$15.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.44
|
|
|
CHEMOTHERAPY SUB-Q INJECTION
|
Facility
OP
|
$75.00
|
|
| Hospital Charge Code |
40509865
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| 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 |
$37.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
|
CHEMOTHERAPY TO TISSUE
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
HCPCS D4381
|
| Hospital Charge Code |
42303314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
IP
|
$83,651.04
|
|
|
Service Code
|
MS-DRG 837
|
| Min. Negotiated Rate |
$34,643.17 |
| Max. Negotiated Rate |
$83,651.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70,136.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74,501.45
|
| Rate for Payer: Aetna Government |
$74,501.45
|
| Rate for Payer: Brighton Health Commercial |
$68,970.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75,991.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83,651.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69,032.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$70,776.38
|
| Rate for Payer: EmblemHealth Commercial |
$40,787.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$74,501.45
|
| Rate for Payer: Group Health Inc Commercial |
$74,501.45
|
| Rate for Payer: Group Health Inc Medicare |
$74,501.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74,501.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34,643.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74,501.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74,501.45
|
| Rate for Payer: Wellcare Medicare |
$70,776.38
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
IP
|
$35,787.92
|
|
|
Service Code
|
MS-DRG 838
|
| Min. Negotiated Rate |
$16,315.08 |
| Max. Negotiated Rate |
$35,787.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,788.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,086.20
|
| Rate for Payer: Aetna Government |
$35,086.20
|
| Rate for Payer: Brighton Health Commercial |
$28,309.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,787.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,567.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,526.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,331.89
|
| Rate for Payer: EmblemHealth Commercial |
$16,741.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,086.20
|
| Rate for Payer: Group Health Inc Commercial |
$35,086.20
|
| Rate for Payer: Group Health Inc Medicare |
$35,086.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,086.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,315.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,086.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,086.20
|
| Rate for Payer: Wellcare Medicare |
$33,331.89
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$25,906.40
|
|
|
Service Code
|
MS-DRG 839
|
| Min. Negotiated Rate |
$11,174.10 |
| Max. Negotiated Rate |
$25,906.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,214.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,398.43
|
| Rate for Payer: Aetna Government |
$25,398.43
|
| Rate for Payer: Brighton Health Commercial |
$18,894.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,906.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,503.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,570.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,128.51
|
| Rate for Payer: EmblemHealth Commercial |
$11,174.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,398.43
|
| Rate for Payer: Group Health Inc Commercial |
$25,398.43
|
| Rate for Payer: Group Health Inc Medicare |
$25,398.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,398.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,810.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,398.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,398.43
|
| Rate for Payer: Wellcare Medicare |
$24,128.51
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
IP
|
$24,626.32
|
|
|
Service Code
|
MS-DRG 847
|
| Min. Negotiated Rate |
$10,398.00 |
| Max. Negotiated Rate |
$24,626.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,879.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,143.45
|
| Rate for Payer: Aetna Government |
$24,143.45
|
| Rate for Payer: Brighton Health Commercial |
$17,582.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,626.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,940.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,280.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,936.28
|
| Rate for Payer: EmblemHealth Commercial |
$10,398.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,143.45
|
| Rate for Payer: Group Health Inc Commercial |
$24,143.45
|
| Rate for Payer: Group Health Inc Medicare |
$24,143.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,143.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,226.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,143.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,143.45
|
| Rate for Payer: Wellcare Medicare |
$22,936.28
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
IP
|
$42,205.44
|
|
|
Service Code
|
MS-DRG 846
|
| Min. Negotiated Rate |
$19,167.17 |
| Max. Negotiated Rate |
$42,205.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,036.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,219.72
|
| Rate for Payer: Aetna Government |
$41,219.72
|
| Rate for Payer: Brighton Health Commercial |
$35,438.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,044.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42,205.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34,829.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,158.73
|
| Rate for Payer: EmblemHealth Commercial |
$20,957.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,219.72
|
| Rate for Payer: Group Health Inc Commercial |
$41,219.72
|
| Rate for Payer: Group Health Inc Medicare |
$41,219.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,219.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,167.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,219.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,219.72
|
| Rate for Payer: Wellcare Medicare |
$39,158.73
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$19,302.24
|
|
|
Service Code
|
MS-DRG 848
|
| Min. Negotiated Rate |
$6,512.71 |
| Max. Negotiated Rate |
$19,302.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,198.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,923.76
|
| Rate for Payer: Aetna Government |
$18,923.76
|
| Rate for Payer: Brighton Health Commercial |
$11,012.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,302.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,440.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,916.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,977.57
|
| Rate for Payer: EmblemHealth Commercial |
$6,512.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,923.76
|
| Rate for Payer: Group Health Inc Commercial |
$18,923.76
|
| Rate for Payer: Group Health Inc Medicare |
$18,923.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,923.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,799.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,923.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,923.76
|
| Rate for Payer: Wellcare Medicare |
$17,977.57
|
|
|
CHEMOTX ADMN PRTL CAVITY
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
40509901
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$35.16
|
| 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
|
|
|
CHEST CATHETER
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
40000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| 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 |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
CHEST CATHETER
|
Facility
OP
|
$88.24
|
|
| Hospital Charge Code |
40201050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$70.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.12
|
| Rate for Payer: Aetna Government |
$44.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.00
|
| Rate for Payer: Group Health Inc Commercial |
$44.12
|
| Rate for Payer: Group Health Inc Medicare |
$30.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.12
|
|
|
CHEST DRAINAGE PLEURVAC INFANT
|
Facility
OP
|
$104.21
|
|
| Hospital Charge Code |
64902380
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$83.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.10
|
| Rate for Payer: Aetna Government |
$52.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.86
|
| Rate for Payer: Group Health Inc Commercial |
$52.10
|
| Rate for Payer: Group Health Inc Medicare |
$36.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.10
|
|
|
CHEST DRAINAGE PLEURVAC PEDS 8000
|
Facility
OP
|
$93.75
|
|
| Hospital Charge Code |
64902382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.88
|
| Rate for Payer: Aetna Government |
$46.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.75
|
| Rate for Payer: Group Health Inc Commercial |
$46.88
|
| Rate for Payer: Group Health Inc Medicare |
$32.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.88
|
|
|
CHEST DRAIN VALVE
|
Facility
OP
|
$21.26
|
|
| Hospital Charge Code |
40200868
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.63
|
| Rate for Payer: Aetna Government |
$10.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.46
|
| Rate for Payer: Group Health Inc Commercial |
$10.63
|
| Rate for Payer: Group Health Inc Medicare |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.63
|
|
|
CHEST PAIN
|
Facility
IP
|
$17,709.52
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$6,204.87 |
| Max. Negotiated Rate |
$17,709.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,669.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,362.27
|
| Rate for Payer: Aetna Government |
$17,362.27
|
| Rate for Payer: Brighton Health Commercial |
$10,492.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,709.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,495.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,312.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,494.16
|
| Rate for Payer: EmblemHealth Commercial |
$6,204.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,362.27
|
| Rate for Payer: Group Health Inc Commercial |
$17,362.27
|
| Rate for Payer: Group Health Inc Medicare |
$17,362.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,362.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,073.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,362.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,362.27
|
| Rate for Payer: Wellcare Medicare |
$16,494.16
|
|
|
CHEST PHYSIOTHERAPY
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
40302150
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$181.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CHEVRON BUNIONECTOMY
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
40082805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$549.50 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
$907.13
|
|
|
Service Code
|
HCPCS 77295 26
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,505.47 |
| Rate for Payer: Cash Price |
$248.49
|
| Rate for Payer: Cash Price |
$248.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.22
|
| Rate for Payer: Healthfirst QHP |
$259.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$680.35
|
| Rate for Payer: SOMOS Essential |
$680.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.18
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
$1,100.16
|
|
|
Service Code
|
HCPCS 77295 TC
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,505.47 |
| Rate for Payer: Cash Price |
$304.97
|
| Rate for Payer: Cash Price |
$304.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.61
|
| Rate for Payer: Healthfirst QHP |
$314.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$825.12
|
| Rate for Payer: SOMOS Essential |
$825.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.33
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
$2,007.29
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,505.47 |
| Rate for Payer: Cash Price |
$553.46
|
| Rate for Payer: Cash Price |
$553.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$516.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$516.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$544.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$573.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$544.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$430.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$544.83
|
| Rate for Payer: Healthfirst QHP |
$573.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$401.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$573.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$487.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$401.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$573.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,505.47
|
| Rate for Payer: SOMOS Essential |
$1,505.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$573.51
|
|
