|
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
|
|
|
ANTI-MYELIN ASSOC GLYCOP IGG
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40729883
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
ANTI-MYELIN ASSOC GLYCOP IGG
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40729883
|
|
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-MYELIN ASSOC. GLY. IGM
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
40729891
|
|
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-MYELIN ASSOC. GLY. IGM
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
40729891
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
ANTIMYELOPEROXIDASE (MPO) ABS
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609754
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
ANTIMYELOPEROXIDASE (MPO) ABS
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609754
|
|
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
|
|
|
ANTINUCLEAR ANTIBODIES - NEG
|
Facility
|
IP
|
$30.23
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
40614105
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.09
|
|
|
ANTINUCLEAR ANTIBODIES - NEG
|
Facility
|
OP
|
$30.23
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
40614105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$22.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.09
|
| Rate for Payer: Aetna Government |
$12.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.46
|
| Rate for Payer: Brighton Health Commercial |
$22.67
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.09
|
| Rate for Payer: EmblemHealth Commercial |
$12.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.09
|
| Rate for Payer: Group Health Inc Medicare |
$12.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.09
|
| Rate for Payer: Healthfirst QHP |
$12.09
|
| Rate for Payer: Humana Medicare |
$12.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare Commercial |
$15.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.67
|
| Rate for Payer: Wellcare Medicare |
$10.88
|
|
|
ANTIOXIDANT INFUSED 28 X 42MM
|
Facility
|
OP
|
$6,130.00
|
|
| Hospital Charge Code |
64905978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,145.50 |
| Max. Negotiated Rate |
$4,904.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,371.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,065.00
|
| Rate for Payer: Aetna Government |
$3,065.00
|
| Rate for Payer: Brighton Health Commercial |
$4,597.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,904.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,168.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,065.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,145.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,065.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,065.00
|
|
|
ANTIPANCREATIC ISLET CELLS
|
Facility
|
OP
|
$58.93
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
40609148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.57
|
| Rate for Payer: Aetna Government |
$23.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$44.20
|
| Rate for Payer: Cash Price |
$23.57
|
| Rate for Payer: Cash Price |
$23.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$23.57
|
| Rate for Payer: EmblemHealth Commercial |
$23.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.98
|
| Rate for Payer: Group Health Inc Commercial |
$23.57
|
| Rate for Payer: Group Health Inc Medicare |
$23.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.57
|
| Rate for Payer: Healthfirst QHP |
$23.57
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.57
|
| Rate for Payer: United Healthcare Commercial |
$25.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.86
|
| Rate for Payer: Wellcare Medicare |
$21.21
|
|
|
ANTIPANCREATIC ISLET CELLS
|
Facility
|
IP
|
$58.93
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
40609148
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$23.57
|
|
|
ANTIPARIETAL CELL ANTIBODY
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729237
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
ANTIPARIETAL CELL ANTIBODY
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729237
|
|
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
|
|
|
ANTIPHOSPHATIDYLSERINE IGG/M/A
|
Facility
|
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.25
|
| Rate for Payer: Brighton Health Commercial |
$30.14
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Humana Medicare |
$16.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$20.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
ANTIPHOSPHATIDYLSERINE IGG/M/A
|
Facility
|
IP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729847
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$16.07
|
|
|
ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.25
|
| Rate for Payer: Brighton Health Commercial |
$30.14
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Humana Medicare |
$16.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$20.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
IP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729451
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.07
|
|
|
ANTI-PR3 ANTIBODIES
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729914
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
ANTI-PR3 ANTIBODIES
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729914
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
ANTI-PR3 ANTOBODIES
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729920
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
ANTI-PR3 ANTOBODIES
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729920
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
ANTIPROTEINASE 3 (PR-3) ABS
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609755
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
ANTIPROTEINASE 3 (PR-3) ABS
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609755
|
|
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
|
|
|
ANTIPYRINE-OXYQUINOLINE-BENZO OTIC SOLN
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
41645308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
