|
IMMUNE GLOBULIN (WINRHO SDF) 5,000 INTL
|
Facility
|
OP
|
$34.91
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
41654558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.20
|
| 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 |
$20.95
|
| 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 |
$17.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.07
|
| 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 |
$17.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.46
|
| 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 |
$22.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Wellcare Medicare |
$31.32
|
|
|
IMMUNE GLOBULIN (WINRHO SDF) 5,000 INTL
|
Facility
|
OP
|
$34.91
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
41644558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.20
|
| 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 |
$20.95
|
| 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 |
$17.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.07
|
| 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 |
$17.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.46
|
| 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 |
$22.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Wellcare Medicare |
$31.32
|
|
|
IMMUNIZATION ADMIN
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
30101179
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
IMMUNIZATION ADMIN
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
30101179
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
IMMUNIZATION ADMIN EACH ADD
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
30101180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IMMUNIZATION ADMIN EACH ADD
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
30301180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IMMUNIZATION ADMINISTRATION
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
40501004
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
IMMUNIZATION ADMINISTRATION
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
40501004
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$91.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
IMMUNOFIXATION (IGG,A M) SERUM
|
Facility
|
IP
|
$55.85
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
40608219
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$22.34
|
|
|
IMMUNOFIXATION (IGG,A M) SERUM
|
Facility
|
OP
|
$55.85
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
40608219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$41.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.34
|
| Rate for Payer: Aetna Government |
$22.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.64
|
| Rate for Payer: Brighton Health Commercial |
$41.89
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.34
|
| Rate for Payer: EmblemHealth Commercial |
$22.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.88
|
| Rate for Payer: Group Health Inc Commercial |
$22.34
|
| Rate for Payer: Group Health Inc Medicare |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.34
|
| Rate for Payer: Healthfirst QHP |
$22.34
|
| Rate for Payer: Humana Medicare |
$22.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.87
|
| Rate for Payer: Wellcare Medicare |
$20.11
|
|
|
IMMUNOFIXATION, SERUM
|
Facility
|
OP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609075
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
IMMUNOFIXATION, SERUM
|
Facility
|
IP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609075
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$9.30
|
|
|
IMMUNOFIXATION, URINE
|
Facility
|
IP
|
$73.38
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
40609145
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$29.35
|
|
|
IMMUNOFIXATION, URINE
|
Facility
|
OP
|
$73.38
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
40609145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.35
|
| Rate for Payer: Aetna Government |
$29.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.54
|
| Rate for Payer: Brighton Health Commercial |
$55.04
|
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.35
|
| Rate for Payer: EmblemHealth Commercial |
$29.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.12
|
| Rate for Payer: Group Health Inc Commercial |
$29.35
|
| Rate for Payer: Group Health Inc Medicare |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.35
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: Humana Medicare |
$29.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare Commercial |
$37.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.48
|
| Rate for Payer: Wellcare Medicare |
$26.42
|
|
|
IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$279.03
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
40639624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$223.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.89
|
| Rate for Payer: Aetna Government |
$44.89
|
| Rate for Payer: Brighton Health Commercial |
$209.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$223.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.74
|
| Rate for Payer: Group Health Inc Commercial |
$139.52
|
| Rate for Payer: Group Health Inc Medicare |
$97.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.52
|
| Rate for Payer: United Healthcare Commercial |
$39.34
|
|
|
IMMUNOGLOBULIN A, QN, SERUM
|
Facility
|
IP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609074
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$9.30
|
|
|
IMMUNOGLOBULIN A, QN, SERUM
|
Facility
|
OP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609074
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
IMMUNOGLOBULIN E, TOTAL
|
Facility
|
OP
|
$41.15
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
40609076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$30.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.46
|
| Rate for Payer: Aetna Government |
$16.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.46
|
| Rate for Payer: EmblemHealth Commercial |
$16.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.65
|
| Rate for Payer: Group Health Inc Commercial |
$16.46
|
| Rate for Payer: Group Health Inc Medicare |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.46
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$16.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$20.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.17
|
| Rate for Payer: Wellcare Medicare |
$14.81
|
|
|
IMMUNOGLOBULIN E, TOTAL
|
Facility
|
IP
|
$41.15
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
40609076
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.46
|
|
|
IMMUNOGLOBULIN M, QN, SERUM
|
Facility
|
OP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609073
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
IMMUNOGLOBULIN M, QN, SERUM
|
Facility
|
IP
|
$23.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
40609073
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$9.30
|
|
|
IMMUNOPEROXIDATE,EACH ANTIBODY
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
40635456
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$197.52
|
|
|
IMMUNOPEROXIDATE,EACH ANTIBODY
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
40635455
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
IMMUNOPEROXIDATE,EACH ANTIBODY
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
40635456
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
IMMUNOPEROXIDATE,EACH ANTIBODY
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
40635455
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$197.52
|
|
