|
ALBUMIN 25% 50ML INJ
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41659576
|
|
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
|
|
|
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
|
|
|
ALBUMIN 255 50ML INJ
|
Facility
|
IP
|
$91.50
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41646498
|
|
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 255 50ML INJ
|
Facility
|
OP
|
$91.50
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
41646498
|
|
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 5% 250ML INJ
|
Facility
|
OP
|
$91.50
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
41656497
|
|
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 5% 250ML INJ
|
Facility
|
IP
|
$91.50
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
41656497
|
|
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 5% 250ML INJ
|
Facility
|
OP
|
$91.50
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
41646497
|
|
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 5% 250ML INJ
|
Facility
|
IP
|
$91.50
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
41646497
|
|
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-BF
|
Facility
|
IP
|
$19.45
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
40602683
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$7.78
|
|
|
ALBUMIN-BF
|
Facility
|
OP
|
$19.45
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
40602683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.78
|
| Rate for Payer: Aetna Government |
$7.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.45
|
| Rate for Payer: Brighton Health Commercial |
$14.59
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.78
|
| 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 |
$7.78
|
| Rate for Payer: EmblemHealth Commercial |
$7.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.78
|
| Rate for Payer: Group Health Inc Medicare |
$7.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.78
|
| Rate for Payer: Healthfirst QHP |
$7.78
|
| Rate for Payer: Humana Medicare |
$7.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.22
|
| Rate for Payer: Wellcare Medicare |
$7.00
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
68516521601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna Government |
$0.56
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.64
|
| Rate for Payer: EmblemHealth Commercial |
$0.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
68516521607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
68516521607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna Government |
$0.56
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.64
|
| Rate for Payer: EmblemHealth Commercial |
$0.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
68516521601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
00944049301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ALBUMIN HUMAN 25 % IV SOLN [8981]
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
HCPCS P9074
|
| Hospital Charge Code |
00944049301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
|
|
ALBUMIN HUMAN 5%, (25GM/500 ML)
|
Facility
|
OP
|
$27.93
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
41650394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.62
|
| Rate for Payer: Aetna Government |
$10.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.43
|
| Rate for Payer: Brighton Health Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.62
|
| Rate for Payer: EmblemHealth Commercial |
$10.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.15
|
| Rate for Payer: Group Health Inc Commercial |
$10.62
|
| Rate for Payer: Group Health Inc Medicare |
$10.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.02
|
| Rate for Payer: Healthfirst QHP |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.25
|
| Rate for Payer: SOMOS Essential |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$10.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.49
|
| Rate for Payer: Wellcare Medicare |
$10.08
|
|
|
ALBUMIN HUMAN 5%, (25GM/500 ML)
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
41640394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.96
|
|
|
ALBUMIN HUMAN 5%, (25GM/500 ML)
|
Facility
|
OP
|
$27.93
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
41640394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.62
|
| Rate for Payer: Aetna Government |
$10.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.43
|
| Rate for Payer: Brighton Health Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.62
|
| Rate for Payer: EmblemHealth Commercial |
$10.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.15
|
| Rate for Payer: Group Health Inc Commercial |
$10.62
|
| Rate for Payer: Group Health Inc Medicare |
$10.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.02
|
| Rate for Payer: Healthfirst QHP |
$10.62
|
| Rate for Payer: Humana Medicare |
$10.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.25
|
| Rate for Payer: SOMOS Essential |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$10.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.49
|
| Rate for Payer: Wellcare Medicare |
$10.08
|
|
|
ALBUMIN HUMAN 5%, (25GM/500 ML)
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
41650394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.96
|
|
|
ALBUMIN HUMAN 5 % IV SOLN [8982]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 68516521405
|
| Hospital Charge Code |
68516521405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
ALBUMIN HUMAN 5 % IV SOLN [8982]
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 00944049505
|
| Hospital Charge Code |
00944049505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ALBUMIN HUMAN 5 % IV SOLN [8982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 68516521409
|
| Hospital Charge Code |
68516521409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
ALBUMIN HUMAN 5 % IV SOLN [8982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 68516521804
|
| Hospital Charge Code |
68516521804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
ALBUMIN HUMAN 5 % IV SOLN [8982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 68516521409
|
| Hospital Charge Code |
68516521409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
