|
REVISION UP EYELID W EXCESS SKIN
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
40019818
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
REVISN - AMPUTATION, FINGER
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15050
|
| Hospital Charge Code |
40062405
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
REVISN - AMPUTATION, FINGER
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15050
|
| Hospital Charge Code |
40062405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$1,129.01
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
REVISN - SPINL CORD STIMULTR
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
40000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
REVISN - SPINL CORD STIMULTR
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
40000120
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
RHEUMATOID FACTOR (RF)
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
40614216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.67
|
| Rate for Payer: Aetna Government |
$5.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.97
|
| Rate for Payer: Brighton Health Commercial |
$7.88
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.67
|
| Rate for Payer: EmblemHealth Commercial |
$5.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.05
|
| Rate for Payer: Group Health Inc Commercial |
$5.67
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.67
|
| Rate for Payer: Healthfirst QHP |
$5.67
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.67
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.54
|
| Rate for Payer: Wellcare Medicare |
$5.10
|
|
|
RHEUMATOID FACTOR (RF)
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
40614216
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.67
|
|
|
RHEUMATOID FACTOR-TITRE
|
Facility
|
OP
|
$15.35
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
40614085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.14
|
| Rate for Payer: Aetna Government |
$6.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.30
|
| Rate for Payer: Brighton Health Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.14
|
| Rate for Payer: EmblemHealth Commercial |
$6.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.46
|
| Rate for Payer: Group Health Inc Commercial |
$6.14
|
| Rate for Payer: Group Health Inc Medicare |
$6.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.14
|
| Rate for Payer: Healthfirst QHP |
$6.14
|
| Rate for Payer: Humana Medicare |
$6.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.91
|
| Rate for Payer: Wellcare Medicare |
$5.53
|
|
|
RHEUMATOID FACTOR-TITRE
|
Facility
|
IP
|
$15.35
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
40614085
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$6.14
|
|
|
RH IG FULL DOSE IM
|
Facility
|
OP
|
$470.26
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
30303205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$376.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.03
|
| Rate for Payer: Aetna Government |
$77.03
|
| Rate for Payer: Brighton Health Commercial |
$352.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$319.78
|
| Rate for Payer: Group Health Inc Commercial |
$235.13
|
| Rate for Payer: Group Health Inc Medicare |
$164.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.67
|
|
|
RHIGV HUMAN ONLY FOR IV USE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 90386
|
| Hospital Charge Code |
40509907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.91
|
| Rate for Payer: Aetna Government |
$9.91
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.50
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
40062415
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
40109030
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
40062415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
40109030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
RHO-D I.G.2500 UNITS/2.2 ML INJ
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
41647010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.96
|
| Rate for Payer: Aetna Government |
$32.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.07
|
| Rate for Payer: Brighton Health Commercial |
$9.16
|
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.96
|
| Rate for Payer: EmblemHealth Commercial |
$32.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.61
|
| Rate for Payer: Group Health Inc Commercial |
$32.96
|
| Rate for Payer: Group Health Inc Medicare |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.02
|
| Rate for Payer: Healthfirst QHP |
$32.96
|
| Rate for Payer: Humana Medicare |
$33.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.48
|
| Rate for Payer: SOMOS Essential |
$32.48
|
| Rate for Payer: United Healthcare Commercial |
$32.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Wellcare Medicare |
$31.32
|
|
|
RHO-D I.G.2500 UNITS/2.2 ML INJ
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
41647010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
|
|
RHO D IMMUNE GLOBULIN 1500 IU
|
Facility
|
OP
|
$8.78
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
41656499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.70
|
| Rate for Payer: Aetna Government |
$4.70
|
| Rate for Payer: Brighton Health Commercial |
$5.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.05
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.08
|
| Rate for Payer: SOMOS Essential |
$5.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
RHO D IMMUNE GLOBULIN 1500 IU
|
Facility
|
IP
|
$8.78
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
41646499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
|
|
RHO D IMMUNE GLOBULIN 1500 IU
|
Facility
|
OP
|
$8.78
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
41646499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.70
|
| Rate for Payer: Aetna Government |
$4.70
|
| Rate for Payer: Brighton Health Commercial |
$5.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.05
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.08
|
| Rate for Payer: SOMOS Essential |
$5.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
RHO D IMMUNE GLOBULIN 1500 IU
|
Facility
|
IP
|
$8.78
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
41656499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
|
|
RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY [127771]
|
Facility
|
OP
|
$90.62
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
13533063110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$84.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.54
|
| Rate for Payer: Aetna Government |
$75.54
|
| Rate for Payer: Brighton Health Commercial |
$67.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.62
|
| Rate for Payer: Group Health Inc Commercial |
$45.31
|
| Rate for Payer: Group Health Inc Medicare |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.91
|
|
|
RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY [127771]
|
Facility
|
OP
|
$126.14
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
00562780501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.15 |
| Max. Negotiated Rate |
$100.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.54
|
| Rate for Payer: Aetna Government |
$75.54
|
| Rate for Payer: Brighton Health Commercial |
$94.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$100.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.78
|
| Rate for Payer: Group Health Inc Commercial |
$63.07
|
| Rate for Payer: Group Health Inc Medicare |
$44.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.99
|
|
|
RHO D IMMUNE GLOBULIN 2500 UNIT/2.2ML IJ SOLN [70573]
|
Facility
|
OP
|
$493.81
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70257035002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$395.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$271.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.96
|
| Rate for Payer: Aetna Government |
$32.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.07
|
| Rate for Payer: Brighton Health Commercial |
$370.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$395.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$335.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.96
|
| Rate for Payer: EmblemHealth Commercial |
$32.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.34
|
| Rate for Payer: Group Health Inc Commercial |
$32.96
|
| Rate for Payer: Group Health Inc Medicare |
$32.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.02
|
| Rate for Payer: Healthfirst QHP |
$32.96
|
| Rate for Payer: Humana Medicare |
$33.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Wellcare Medicare |
$31.32
|
|
|
RHOGAM BLOOD TYPING
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
40701095
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$46.38
|
|
