|
IFOSFAMIDE 3000 MG INJ
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
41641326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$10.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.03
|
| Rate for Payer: SOMOS Essential |
$28.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
IFOSFAMIDE 3000 MG INJ
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
41651326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$10.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.03
|
| Rate for Payer: SOMOS Essential |
$28.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
IFOSFAMIDE 3000 MG INJ
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
41641326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10019092616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$77.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.20
|
| Rate for Payer: EmblemHealth Commercial |
$64.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.50
|
| Rate for Payer: Group Health Inc Commercial |
$64.52
|
| Rate for Payer: Group Health Inc Medicare |
$45.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.88
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
IP
|
$125.56
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
00338399301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.78
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10019092616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.52
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10019092602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$77.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.20
|
| Rate for Payer: EmblemHealth Commercial |
$64.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.50
|
| Rate for Payer: Group Health Inc Commercial |
$64.52
|
| Rate for Payer: Group Health Inc Medicare |
$45.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.88
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10019092602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.52
|
|
|
IFOSFAMIDE 3 G IV SOLR [10249]
|
Facility
|
OP
|
$125.56
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
00338399301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$131.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$75.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.20
|
| Rate for Payer: EmblemHealth Commercial |
$62.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.84
|
| Rate for Payer: Group Health Inc Commercial |
$62.78
|
| Rate for Payer: Group Health Inc Medicare |
$43.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.61
|
|
|
IGE PEANUT COMPONENT PROFILE
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729871
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
IGE PEANUT COMPONENT PROFILE
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729871
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
IGE PEANUT W/COMPONENT REFLEX
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729872
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
IGE PEANUT W/COMPONENT REFLEX
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729872
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
IGF-1_
|
Facility
|
IP
|
$53.15
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
40609116
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$21.26
|
|
|
IGF-1_
|
Facility
|
OP
|
$53.15
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
40609116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$39.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.26
|
| Rate for Payer: Aetna Government |
$21.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.88
|
| Rate for Payer: Brighton Health Commercial |
$39.86
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.26
|
| Rate for Payer: EmblemHealth Commercial |
$21.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.92
|
| Rate for Payer: Group Health Inc Commercial |
$21.26
|
| Rate for Payer: Group Health Inc Medicare |
$21.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.26
|
| Rate for Payer: Healthfirst QHP |
$21.26
|
| Rate for Payer: Humana Medicare |
$21.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.01
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
|
|
IGF-2
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
40609848
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.40
|
|
|
IGF-2
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
40609848
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna Government |
$18.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.88
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$18.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.38
|
| Rate for Payer: Group Health Inc Commercial |
$18.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.40
|
| Rate for Payer: Healthfirst QHP |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$17.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.72
|
| Rate for Payer: Wellcare Medicare |
$16.56
|
|
|
IGF-BP1
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
IGF-BP1
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609091
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
IGF-BP3
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
IGF-BP3
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609090
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
IGG, SUBCLASS 4
|
Facility
|
OP
|
$20.05
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
40609752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$15.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.02
|
| Rate for Payer: Aetna Government |
$8.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.61
|
| Rate for Payer: Brighton Health Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$8.02
|
| Rate for Payer: Cash Price |
$8.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$8.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$8.02
|
| Rate for Payer: Group Health Inc Medicare |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.02
|
| Rate for Payer: Healthfirst QHP |
$8.02
|
| Rate for Payer: Humana Medicare |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.42
|
| Rate for Payer: Wellcare Medicare |
$7.22
|
|
|
IGG, SUBCLASS 4
|
Facility
|
IP
|
$20.05
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
40609752
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$8.02
|
|
|
IGG SYNTHESIS INDEX-CSF
|
Facility
|
OP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40617765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
IGG SYNTHESIS INDEX-CSF
|
Facility
|
IP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40617765
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$9.30
|
|
