|
QUINIDINE SULFATE 200 MG TAB
|
Facility
|
OP
|
$0.23
|
|
| Hospital Charge Code |
41642960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
QUINIDINE SULFATE 200 MG TAB
|
Facility
|
OP
|
$0.23
|
|
| Hospital Charge Code |
41652960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
QUINIDINE SULFATE 300 MG PO TABS [6778]
|
Facility
|
OP
|
$15.90
|
|
|
Service Code
|
NDC 42806051230
|
| Hospital Charge Code |
42806051230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Brighton Health Commercial |
$11.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.81
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.34
|
|
|
QUINIDINE SULFATE 300 MG TAB
|
Facility
|
OP
|
$0.38
|
|
| Hospital Charge Code |
41642961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
QUINIDINE SULFATE 300 MG TAB
|
Facility
|
OP
|
$0.38
|
|
| Hospital Charge Code |
41652961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
QUININE SULFATE 324 MG CAP
|
Facility
|
OP
|
$10.91
|
|
| Hospital Charge Code |
41654685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.46
|
| Rate for Payer: Aetna Government |
$5.46
|
| Rate for Payer: Brighton Health Commercial |
$8.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.42
|
| Rate for Payer: Group Health Inc Commercial |
$5.46
|
| Rate for Payer: Group Health Inc Medicare |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.09
|
|
|
QUININE SULFATE 324 MG CAP
|
Facility
|
OP
|
$10.91
|
|
| Hospital Charge Code |
41644685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.46
|
| Rate for Payer: Aetna Government |
$5.46
|
| Rate for Payer: Brighton Health Commercial |
$8.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.42
|
| Rate for Payer: Group Health Inc Commercial |
$5.46
|
| Rate for Payer: Group Health Inc Medicare |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.09
|
|
|
QUININE SULFATE 324 MG PO CAPS [6781]
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
NDC 68180056006
|
| Hospital Charge Code |
68180056006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna Government |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$5.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.81
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.60
|
|
|
R3 3HOLE ACETABULAR SHELL 54MM
|
Facility
|
IP
|
$3,754.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,877.06 |
| Max. Negotiated Rate |
$1,877.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.06
|
|
|
R3 3HOLE ACETABULAR SHELL 54MM
|
Facility
|
OP
|
$3,754.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,941.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,064.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,252.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,877.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,158.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,877.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,941.84
|
| Rate for Payer: Group Health Inc Commercial |
$1,877.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,313.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,440.18
|
|
|
R3 56MM CUP 3-HOLE
|
Facility
|
OP
|
$3,754.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,941.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,064.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,252.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,877.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,158.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,877.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,941.84
|
| Rate for Payer: Group Health Inc Commercial |
$1,877.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,313.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,440.18
|
|
|
R3 56MM CUP 3-HOLE
|
Facility
|
IP
|
$3,754.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,877.06 |
| Max. Negotiated Rate |
$1,877.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.06
|
|
|
R3 XLPE 20DEG LINER 36MMX54MM
|
Facility
|
OP
|
$2,966.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,115.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,631.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,780.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,483.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,705.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,483.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,115.22
|
| Rate for Payer: Group Health Inc Commercial |
$1,483.44
|
| Rate for Payer: Group Health Inc Medicare |
$1,038.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,928.47
|
|
|
R3 XLPE 20DEG LINER 36MMX54MM
|
Facility
|
IP
|
$2,966.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,483.44 |
| Max. Negotiated Rate |
$1,483.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.44
|
|
|
RABIES IG,IM/SC
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
30101192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
RABIES IG,IM/SC
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
30101192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
RABIES IG MINIDOES IM
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90385
|
| Hospital Charge Code |
30101221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$7,824.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.53
|
| Rate for Payer: Aetna Government |
$29.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$176.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$176.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.24
|
| Rate for Payer: Amida Care Medicaid |
$78.24
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,824.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.15
|
| Rate for Payer: Group Health Inc Commercial |
$432.32
|
| Rate for Payer: Group Health Inc Medicare |
$302.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.24
|
| Rate for Payer: Healthfirst Essential Plan |
$176.04
|
| Rate for Payer: Healthfirst QHP |
$78.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.24
|
| Rate for Payer: SOMOS Essential |
$176.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$176.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$86.06
|
| Rate for Payer: United Healthcare Medicaid |
$78.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.24
|
|
|
RABIES IG MINIDOES IM
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90385
|
| Hospital Charge Code |
30101221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
RABIES IMMUNE GLOBULIN 1500 UNIT/10ML IJ SOLN [160137]
|
Facility
|
OP
|
$408.39
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
76125015010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.41 |
| Max. Negotiated Rate |
$326.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$256.30
|
| Rate for Payer: Aetna Government |
$256.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$179.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$179.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$179.41
|
| Rate for Payer: Brighton Health Commercial |
$306.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$256.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$326.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$277.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$256.30
|
| Rate for Payer: EmblemHealth Commercial |
$256.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.11
|
| Rate for Payer: Group Health Inc Commercial |
$256.30
|
| Rate for Payer: Group Health Inc Medicare |
$256.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.86
|
| Rate for Payer: Healthfirst QHP |
$256.30
|
| Rate for Payer: Humana Medicare |
$261.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$250.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$266.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$256.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$205.04
|
| Rate for Payer: Wellcare Medicare |
$243.49
|
|
|
RABIES IMMUNE GLOBULIN 300 UNIT/2ML IJ SOLN [160131]
|
Facility
|
OP
|
$266.04
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
76125015002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.41 |
| Max. Negotiated Rate |
$266.04 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$256.30
|
| Rate for Payer: Aetna Government |
$256.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$179.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$179.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$179.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$256.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$256.30
|
| Rate for Payer: EmblemHealth Commercial |
$256.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.11
|
| Rate for Payer: Group Health Inc Commercial |
$256.30
|
| Rate for Payer: Group Health Inc Medicare |
$256.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.86
|
| Rate for Payer: Healthfirst QHP |
$256.30
|
| Rate for Payer: Humana Medicare |
$261.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$250.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$266.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$256.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$256.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$205.04
|
| Rate for Payer: Wellcare Medicare |
$243.49
|
|
|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41641839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41641839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41651839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
OP
|
$927.00
|
|
| Hospital Charge Code |
41641834
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$324.45 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$509.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$463.50
|
| Rate for Payer: Aetna Government |
$463.50
|
| Rate for Payer: Brighton Health Commercial |
$695.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$741.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$630.36
|
| Rate for Payer: Group Health Inc Commercial |
$463.50
|
| Rate for Payer: Group Health Inc Medicare |
$324.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$602.55
|
|
|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
OP
|
$927.00
|
|
| Hospital Charge Code |
41651834
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$324.45 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$509.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$463.50
|
| Rate for Payer: Aetna Government |
$463.50
|
| Rate for Payer: Brighton Health Commercial |
$695.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$741.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$630.36
|
| Rate for Payer: Group Health Inc Commercial |
$463.50
|
| Rate for Payer: Group Health Inc Medicare |
$324.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$602.55
|
|
