|
HC CHEMODERNERV TRUNK 6/> MUSCLES
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
5106464701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$888.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| 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 |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$888.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC CHEMODERNERV TRUNK 6/> MUSCLES
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
5106464701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.57 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| 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 |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC CHEMO IA PUMP INFUSION EA ADD HR
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
3359642501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
|
HC CHEMO IA PUMP INFUSION EA ADD HR
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
3359642501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| 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 |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHERAPY INJECTION, SI NG/MULT AGENTS
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
3319654201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| 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 |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHERAPY INJECTION, SI NG/MULT AGENTS
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
3319654201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
3319644601
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| 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 |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
3319644601
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
|
HC CHEMOTHERAPY, UNSPECIFIED PROCEDURE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
3319654901
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.50
|
|
|
HC CHEMOTHERAPY, UNSPECIFIED PROCEDURE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
3319654901
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$95.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| 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 |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC CHEMOTHER,IA INFUSN TECH,<1 HR
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96422 TC
|
| Hospital Charge Code |
3359642201
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC CHEMOTHER,IA INFUSN TECH,<1 HR
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96422 TC
|
| Hospital Charge Code |
3359642201
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$169.72 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: EmblemHealth Commercial |
$278.00
|
| 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 |
$278.00
|
| Rate for Payer: Group Health Inc Medicare |
$194.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC CHEMOTHER,IA INFUSN TECH,EA HR,1-8HR
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96423
|
| Hospital Charge Code |
3359642301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC CHEMOTHER,IA INFUSN TECH,EA HR,1-8HR
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96423
|
| Hospital Charge Code |
3359642301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC CHEMOTHER,IA PUSH TECHNIQUE
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96420 TC
|
| Hospital Charge Code |
3319642001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$105.37 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.37
|
| Rate for Payer: Aetna Government |
$105.37
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: EmblemHealth Commercial |
$468.50
|
| 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 |
$468.50
|
| Rate for Payer: Group Health Inc Medicare |
$327.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC CHEMOTHER,IA PUSH TECHNIQUE
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96420 TC
|
| Hospital Charge Code |
3319642001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
|
HC CHEMOTHER,INTRACAVITARY,PLEURAL
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
3319644001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
|
HC CHEMOTHER,INTRACAVITARY,PLEURAL
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
3319644001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| 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 |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| 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 |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
