|
AIRWAY ORAL PEDS SIZE 00 L/F
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
64901724
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.25
|
| Rate for Payer: Aetna Government |
$21.25
|
| Rate for Payer: Brighton Health Commercial |
$31.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.90
|
| Rate for Payer: Group Health Inc Commercial |
$21.25
|
| Rate for Payer: Group Health Inc Medicare |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.25
|
|
|
AIRWAY ORAL PEDS SIZE 2 NON-ST
|
Facility
|
OP
|
$25.23
|
|
| Hospital Charge Code |
64904203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Brighton Health Commercial |
$18.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.16
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.62
|
|
|
AIRWAY OVASSAPIAN
|
Facility
|
OP
|
$14.22
|
|
| Hospital Charge Code |
64904307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.11
|
| Rate for Payer: Aetna Government |
$7.11
|
| Rate for Payer: Brighton Health Commercial |
$10.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.67
|
| Rate for Payer: Group Health Inc Commercial |
$7.11
|
| Rate for Payer: Group Health Inc Medicare |
$4.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
|
|
AIRWAY PEDIATRIC SIZE 1
|
Facility
|
OP
|
$46.25
|
|
| Hospital Charge Code |
64904225
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.12
|
| Rate for Payer: Aetna Government |
$23.12
|
| Rate for Payer: Brighton Health Commercial |
$34.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.45
|
| Rate for Payer: Group Health Inc Commercial |
$23.12
|
| Rate for Payer: Group Health Inc Medicare |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.12
|
|
|
AIRWAY PEDS ORAL SIZE 3 NON-ST
|
Facility
|
OP
|
$1.84
|
|
| Hospital Charge Code |
64904205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$1.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.92
|
| Rate for Payer: Group Health Inc Medicare |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
|
|
AIRWAY WILLIAMS 100MM INTUBATR
|
Facility
|
OP
|
$95.00
|
|
| Hospital Charge Code |
64904828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.50
|
| Rate for Payer: Aetna Government |
$47.50
|
| Rate for Payer: Brighton Health Commercial |
$71.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$47.50
|
| Rate for Payer: Group Health Inc Medicare |
$33.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.50
|
|
|
AIRWAY WILLIAMS 90MM INTUBATR
|
Facility
|
OP
|
$95.00
|
|
| Hospital Charge Code |
64904826
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.50
|
| Rate for Payer: Aetna Government |
$47.50
|
| Rate for Payer: Brighton Health Commercial |
$71.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$47.50
|
| Rate for Payer: Group Health Inc Medicare |
$33.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.50
|
|
|
AKLAINE PHOSPHATASE
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
40602120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
AKLAINE PHOSPHATASE
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
40602120
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
AL 1 100CM 6.0 FR
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
66528357
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna Government |
$110.00
|
| Rate for Payer: Brighton Health Commercial |
$165.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.60
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
ALBENDAZOLE 200 MG PO TABS [8979]
|
Facility
|
OP
|
$228.91
|
|
|
Service Code
|
NDC 42799011002
|
| Hospital Charge Code |
42799011002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$183.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.45
|
| Rate for Payer: Aetna Government |
$114.45
|
| Rate for Payer: Brighton Health Commercial |
$171.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.66
|
| Rate for Payer: Group Health Inc Commercial |
$114.45
|
| Rate for Payer: Group Health Inc Medicare |
$80.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.79
|
|
|
ALBENDAZOLE 200 MG PO TABS [8979]
|
Facility
|
OP
|
$228.91
|
|
|
Service Code
|
NDC 72205005108
|
| Hospital Charge Code |
72205005108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$183.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.45
|
| Rate for Payer: Aetna Government |
$114.45
|
| Rate for Payer: Brighton Health Commercial |
$171.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.66
|
| Rate for Payer: Group Health Inc Commercial |
$114.45
|
| Rate for Payer: Group Health Inc Medicare |
$80.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.79
|
|
|
ALBENDAZOLE 200 MG PO TABS [8979]
|
Facility
|
OP
|
$261.80
|
|
|
Service Code
|
NDC 31722093502
|
| Hospital Charge Code |
31722093502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$209.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.90
|
| Rate for Payer: Aetna Government |
$130.90
|
| Rate for Payer: Brighton Health Commercial |
$196.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.02
|
| Rate for Payer: Group Health Inc Commercial |
$130.90
|
| Rate for Payer: Group Health Inc Medicare |
$91.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.17
|
|
|
ALBENDAZOLE 200 MG TAB
|
Facility
|
OP
|
$49.55
|
|
| Hospital Charge Code |
41652638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.78
|
| Rate for Payer: Aetna Government |
$24.78
|
| Rate for Payer: Brighton Health Commercial |
$37.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.69
|
| Rate for Payer: Group Health Inc Commercial |
$24.78
|
| Rate for Payer: Group Health Inc Medicare |
$17.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.21
|
|
|
ALBENDAZOLE 200 MG TAB
|
Facility
|
OP
|
$49.55
|
|
| Hospital Charge Code |
41642638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.78
|
| Rate for Payer: Aetna Government |
$24.78
|
| Rate for Payer: Brighton Health Commercial |
$37.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.69
|
| Rate for Payer: Group Health Inc Commercial |
$24.78
|
| Rate for Payer: Group Health Inc Medicare |
$17.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.21
|
|
|
ALB+PROT
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40609823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
ALB+PROT
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40609823
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
ALBUMIN
|
Facility
|
IP
|
$12.38
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
40602095
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$4.95
|
|
|
ALBUMIN
|
Facility
|
OP
|
$12.38
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
40602095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna Government |
$4.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.46
|
| Rate for Payer: Brighton Health Commercial |
$9.28
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.95
|
| Rate for Payer: EmblemHealth Commercial |
$4.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.41
|
| Rate for Payer: Group Health Inc Commercial |
$4.95
|
| Rate for Payer: Group Health Inc Medicare |
$4.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.95
|
| Rate for Payer: Healthfirst QHP |
$4.95
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.96
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
|
|
ALBUMIN 25%
|
Facility
|
IP
|
$131.13
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
40701091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.56 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.56
|
|
|
ALBUMIN 25%
|
Facility
|
OP
|
$131.13
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
40701091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$85.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.08
|
| Rate for Payer: Aetna Government |
$53.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$37.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37.15
|
| Rate for Payer: Brighton Health Commercial |
$78.68
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$53.08
|
| Rate for Payer: EmblemHealth Commercial |
$53.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$53.08
|
| Rate for Payer: Group Health Inc Medicare |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.12
|
| Rate for Payer: Healthfirst QHP |
$53.08
|
| Rate for Payer: Humana Medicare |
$54.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.26
|
| Rate for Payer: SOMOS Essential |
$56.26
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42.46
|
| Rate for Payer: Wellcare Medicare |
$50.42
|
|
|
ALBUMIN 25% 50 ML INJ
|
Facility
|
OP
|
$91.50
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41656498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$59.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.08
|
| Rate for Payer: Aetna Government |
$53.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$37.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37.15
|
| Rate for Payer: Brighton Health Commercial |
$54.90
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$53.08
|
| Rate for Payer: EmblemHealth Commercial |
$53.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$53.08
|
| Rate for Payer: Group Health Inc Medicare |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.12
|
| Rate for Payer: Healthfirst QHP |
$53.08
|
| Rate for Payer: Humana Medicare |
$54.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.26
|
| Rate for Payer: SOMOS Essential |
$56.26
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42.46
|
| Rate for Payer: Wellcare Medicare |
$50.42
|
|
|
ALBUMIN 25% 50 ML INJ
|
Facility
|
IP
|
$91.50
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41656498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.75
|
|
|
ALBUMIN 25% 50ML INJ
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41659576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.08
|
| Rate for Payer: Aetna Government |
$53.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$37.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37.15
|
| Rate for Payer: Brighton Health Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$53.08
|
| Rate for Payer: EmblemHealth Commercial |
$53.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$53.08
|
| Rate for Payer: Group Health Inc Medicare |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.12
|
| Rate for Payer: Healthfirst QHP |
$53.08
|
| Rate for Payer: Humana Medicare |
$54.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.26
|
| Rate for Payer: SOMOS Essential |
$56.26
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42.46
|
| Rate for Payer: Wellcare Medicare |
$50.42
|
|
|
ALBUMIN 25% 50ML INJ
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41649576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.50
|
|
