|
RABIES IMMUNE GLOBULIN (IMOGAM) INJ 150
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41651839
|
|
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 VACCINE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
30101158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
|
|
RABIES VACCINE
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
30101158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$513.00
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.98
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.13
|
| Rate for Payer: SOMOS Essential |
$342.13
|
| Rate for Payer: United Healthcare Commercial |
$355.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE 2.5 INTL UNITS INJ
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41645073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$513.00
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.98
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.13
|
| Rate for Payer: SOMOS Essential |
$342.13
|
| Rate for Payer: United Healthcare Commercial |
$355.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE 2.5 INTL UNITS INJ
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41655073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
|
|
RABIES VACCINE 2.5 INTL UNITS INJ
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41655073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$513.00
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.98
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.13
|
| Rate for Payer: SOMOS Essential |
$342.13
|
| Rate for Payer: United Healthcare Commercial |
$355.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE 2.5 INTL UNITS INJ
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41645073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
|
|
RABIES VACCINE IMOVAX INJ 2.5U
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41657087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
|
|
RABIES VACCINE IMOVAX INJ 2.5U
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41657087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$513.00
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.98
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.13
|
| Rate for Payer: SOMOS Essential |
$342.13
|
| Rate for Payer: United Healthcare Commercial |
$355.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE IMOVAX INJ 2.5U
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41647087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$513.00
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.98
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.13
|
| Rate for Payer: SOMOS Essential |
$342.13
|
| Rate for Payer: United Healthcare Commercial |
$355.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE IMOVAX INJ 2.5U
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
41647087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
|
|
RABIES VACCINE, PCEC IM SUSR [22120]
|
Facility
|
OP
|
$496.69
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
50632001001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$397.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$273.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$372.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$397.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$337.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.02
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$322.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE, PCEC IM SUSR [22120]
|
Facility
|
OP
|
$392.76
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
50090182000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.38 |
| Max. Negotiated Rate |
$342.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$294.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$314.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.02
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RABIES VACCINE, PCEC IM SUSR [22120]
|
Facility
|
OP
|
$496.69
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
50632001301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$227.32 |
| Max. Negotiated Rate |
$397.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$273.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.74
|
| Rate for Payer: Aetna Government |
$324.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.32
|
| Rate for Payer: Brighton Health Commercial |
$372.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$397.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$337.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.74
|
| Rate for Payer: EmblemHealth Commercial |
$324.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.02
|
| Rate for Payer: Group Health Inc Commercial |
$324.74
|
| Rate for Payer: Group Health Inc Medicare |
$324.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.03
|
| Rate for Payer: Healthfirst QHP |
$324.74
|
| Rate for Payer: Humana Medicare |
$331.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$322.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$259.80
|
| Rate for Payer: Wellcare Medicare |
$308.51
|
|
|
RACEPINEPHRINE HCL 2.25 % IN NEBU [113082]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
00487278401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
RACEPINEPHRINE HCL 2.25 % IN NEBU [113082]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
00487590199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna Government |
$0.90
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
RACK ACRYLIC SEDIPLAST
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
64903024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.50
|
| Rate for Payer: Aetna Government |
$42.50
|
| Rate for Payer: Brighton Health Commercial |
$63.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.80
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
|
RAD EXAM, ABDOMEN, 2 VIEWS
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74019 TC
|
| Hospital Charge Code |
41103178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
RAD EXAM, ABDOMEN, 2 VIEWS
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 74019 TC
|
| Hospital Charge Code |
41103178
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
RAD EXAM, ABDOMEN, 3 OR MORE VIEW
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Hospital Charge Code |
41103179
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
RAD EXAM, ABDOMEN, 3 OR MORE VIEW
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Hospital Charge Code |
41103179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
RAD EXAM, CHEST, 2 VIEWS
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
41103175
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
RAD EXAM, CHEST, 2 VIEWS
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
41103175
|
|
Hospital Revenue Code
|
324
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
RAD EXAM, CHEST, 3 VIEWS
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 71047 TC
|
| Hospital Charge Code |
41103176
|
|
Hospital Revenue Code
|
324
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
RAD EXAM, CHEST, 3 VIEWS
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71047 TC
|
| Hospital Charge Code |
41103176
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
