|
ANTI-DNASE B STREP ANTIBODIES
|
Facility
|
OP
|
$33.13
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
40729329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.85
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.60
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
ANTI-DSDNA ANTIBODIES
|
Facility
|
IP
|
$34.35
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
40729330
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.74
|
|
|
ANTI-DSDNA ANTIBODIES
|
Facility
|
OP
|
$34.35
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
40729330
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.74
|
| Rate for Payer: Aetna Government |
$13.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.62
|
| Rate for Payer: Brighton Health Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.74
|
| Rate for Payer: EmblemHealth Commercial |
$13.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.23
|
| Rate for Payer: Group Health Inc Commercial |
$13.74
|
| Rate for Payer: Group Health Inc Medicare |
$13.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.74
|
| Rate for Payer: Healthfirst QHP |
$13.74
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.99
|
| Rate for Payer: Wellcare Medicare |
$12.37
|
|
|
ANTI E CADHERIN
|
Facility
|
OP
|
$543.70
|
|
| Hospital Charge Code |
64903634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.30 |
| Max. Negotiated Rate |
$434.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$299.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.85
|
| Rate for Payer: Aetna Government |
$271.85
|
| Rate for Payer: Brighton Health Commercial |
$407.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$434.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$369.72
|
| Rate for Payer: Group Health Inc Commercial |
$271.85
|
| Rate for Payer: Group Health Inc Medicare |
$190.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.85
|
|
|
ANTI EMETIC EACH ADDITIONAL
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
30103253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$54.93
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ANTI EMETIC EACH ADDITIONAL
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
30103253
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ANTIEXTRACTABLE NUCLEAR AG
|
Facility
|
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
ANTIEXTRACTABLE NUCLEAR AG
|
Facility
|
IP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729336
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.93
|
|
|
ANTIFUNGAL SUSCEP 3 DRUGS
|
Facility
|
IP
|
$21.63
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
40619852
|
|
Hospital Revenue Code
|
309
|
| Rate for Payer: Cash Price |
$8.65
|
|
|
ANTIFUNGAL SUSCEP 3 DRUGS
|
Facility
|
OP
|
$21.63
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
40619852
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.65
|
| Rate for Payer: Aetna Government |
$8.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.06
|
| Rate for Payer: Brighton Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.65
|
| Rate for Payer: EmblemHealth Commercial |
$8.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.70
|
| Rate for Payer: Group Health Inc Commercial |
$8.65
|
| Rate for Payer: Group Health Inc Medicare |
$8.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.65
|
| Rate for Payer: Healthfirst QHP |
$8.65
|
| Rate for Payer: Humana Medicare |
$8.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$10.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.92
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
|
|
ANTIFUNGAL SUSCEP 8 DRUGS
|
Facility
|
OP
|
$21.63
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
40619854
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.65
|
| Rate for Payer: Aetna Government |
$8.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.06
|
| Rate for Payer: Brighton Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.65
|
| Rate for Payer: EmblemHealth Commercial |
$8.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.70
|
| Rate for Payer: Group Health Inc Commercial |
$8.65
|
| Rate for Payer: Group Health Inc Medicare |
$8.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.65
|
| Rate for Payer: Healthfirst QHP |
$8.65
|
| Rate for Payer: Humana Medicare |
$8.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$10.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.92
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
|
|
ANTIFUNGAL SUSCEP 8 DRUGS
|
Facility
|
IP
|
$21.63
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
40619854
|
|
Hospital Revenue Code
|
309
|
| Rate for Payer: Cash Price |
$8.65
|
|
|
ANTIGEN THERAPY SERVICES
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 95145
|
| Hospital Charge Code |
30301419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$38.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$38.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$38.45
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.89
|
| 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 |
$57.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$54.93
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ANTIGEN THERAPY SERVICES
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 95145
|
| Hospital Charge Code |
30301419
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ANTIGLOMERULAR BM AB
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ANTIGLOMERULAR BM AB
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729242
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
ANTIHISTONE ANTIBODIES
|
Facility
|
IP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729332
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.93
|
|
|
ANTIHISTONE ANTIBODIES
|
Facility
|
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
ANTI-HISTONE ANTIBODY
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40617609
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
ANTI-HISTONE ANTIBODY
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40617609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
ANTI-HU ANTIBODIES
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
40729892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
ANTI-HU ANTIBODIES
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
40729892
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
ANTI-JO-1
|
Facility
|
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
ANTI-JO-1
|
Facility
|
IP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729333
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.93
|
|
|
ANTI-MPO ANTIBODIES
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729913
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$11.53
|
|
