|
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 |
$57.02 |
| 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: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
40509872
|
|
Hospital Revenue Code
|
331
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
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 |
$57.02 |
| 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: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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 PERITONEAL CVTY/INCL PERITO
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
40509875
|
|
Hospital Revenue Code
|
331
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
CHEMO PERITONEAL CVTY/INCL PERITO
|
Facility
|
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
40509875
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$274.15 |
| Max. Negotiated Rate |
$703.28 |
| 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: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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 |
$274.15 |
| Max. Negotiated Rate |
$703.28 |
| 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: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 96440
|
| Hospital Charge Code |
40509882
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
CHEMO PORTACATHER. ACCESS
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
40000035
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
CHEMO PORTACATHER. ACCESS
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
40000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$6,295.15 |
| 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: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| 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 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 Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
30301132
|
|
Hospital Revenue Code
|
331
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
CHEMOTHERAPY INJECTION
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
30301132
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$274.15 |
| 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: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$417.38
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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: Brighton Health Commercial |
$32.16
|
| 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: Brighton Health Commercial |
$56.25
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
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: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$84.75
|
| 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: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare 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 TO TISSUE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS D4381
|
| Hospital Charge Code |
42303314
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$102,439.49
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$34,643.17 |
| Max. Negotiated Rate |
$102,439.49 |
| 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: Humana Medicare |
$102,439.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74,501.45
|
| Rate for Payer: United Healthcare Commercial |
$96,332.63
|
| Rate for Payer: United Healthcare 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
|
$48,243.52
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$16,315.08 |
| Max. Negotiated Rate |
$48,243.52 |
| 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: Humana Medicare |
$48,243.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,086.20
|
| Rate for Payer: United Healthcare Commercial |
$39,807.81
|
| Rate for Payer: United Healthcare 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
|
$34,922.84
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$11,174.10 |
| Max. Negotiated Rate |
$34,922.84 |
| 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: Humana Medicare |
$34,922.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,398.43
|
| Rate for Payer: United Healthcare Commercial |
$25,914.75
|
| Rate for Payer: United Healthcare 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
|
$33,197.24
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,398.00 |
| Max. Negotiated Rate |
$33,197.24 |
| 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: Humana Medicare |
$33,197.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,143.45
|
| Rate for Payer: United Healthcare Commercial |
$24,114.98
|
| Rate for Payer: United Healthcare 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
|
$56,677.12
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$19,167.17 |
| Max. Negotiated Rate |
$56,677.12 |
| 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: Humana Medicare |
$56,677.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,219.72
|
| Rate for Payer: United Healthcare Commercial |
$48,603.83
|
| Rate for Payer: United Healthcare 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
|
$26,020.17
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,512.71 |
| Max. Negotiated Rate |
$26,020.17 |
| 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: Humana Medicare |
$26,020.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,923.76
|
| Rate for Payer: United Healthcare Commercial |
$16,629.51
|
| Rate for Payer: United Healthcare 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 |
$274.15 |
| Max. Negotiated Rate |
$703.28 |
| 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: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CHEMOTX ADMN PRTL CAVITY
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
40509901
|
|
Hospital Revenue Code
|
331
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
CHEST CATHETER
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
40000100
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
CHEST CATHETER
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
40000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,705.21 |
| 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: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$3,705.21
|
| 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 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 Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare 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
|
|
