|
INFECTIOUS DISEASE SS
|
Professional
|
Both
|
$396.66
|
|
|
Service Code
|
HCPCS G4010
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.50
|
| Rate for Payer: SOMOS Essential |
$297.50
|
|
|
INFECTIOUS MONO-SLIDE SCREEN
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
40614070
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
INFECTIOUS MONO-SLIDE SCREEN
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
40614070
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
INFINI 16 70CM LEAD KIT
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
64903771
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,031.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$937.50
|
| Rate for Payer: Aetna Government |
$937.50
|
| Rate for Payer: Brighton Health Commercial |
$1,406.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,275.00
|
| Rate for Payer: Group Health Inc Commercial |
$937.50
|
| Rate for Payer: Group Health Inc Medicare |
$656.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$937.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$937.50
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$40,984.45
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$13,860.19 |
| Max. Negotiated Rate |
$40,984.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,901.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,806.87
|
| Rate for Payer: Aetna Government |
$29,806.87
|
| Rate for Payer: Brighton Health Commercial |
$23,504.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,403.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,993.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,101.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,316.53
|
| Rate for Payer: EmblemHealth Commercial |
$13,900.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,806.87
|
| Rate for Payer: Group Health Inc Commercial |
$29,806.87
|
| Rate for Payer: Group Health Inc Medicare |
$29,806.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,806.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,860.19
|
| Rate for Payer: Humana Medicare |
$40,984.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,806.87
|
| Rate for Payer: United Healthcare Commercial |
$32,236.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,806.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,806.87
|
| Rate for Payer: Wellcare Medicare |
$28,316.53
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$25,331.83
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,860.86 |
| Max. Negotiated Rate |
$25,331.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,797.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,423.15
|
| Rate for Payer: Aetna Government |
$18,423.15
|
| Rate for Payer: Brighton Health Commercial |
$11,601.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,791.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,816.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,402.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,501.99
|
| Rate for Payer: EmblemHealth Commercial |
$6,860.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,423.15
|
| Rate for Payer: Group Health Inc Commercial |
$18,423.15
|
| Rate for Payer: Group Health Inc Medicare |
$18,423.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,423.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,566.76
|
| Rate for Payer: Humana Medicare |
$25,331.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,423.15
|
| Rate for Payer: United Healthcare Commercial |
$15,911.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,423.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,423.15
|
| Rate for Payer: Wellcare Medicare |
$17,501.99
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$28,601.91
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$8,331.47 |
| Max. Negotiated Rate |
$28,601.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,326.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,801.39
|
| Rate for Payer: Aetna Government |
$20,801.39
|
| Rate for Payer: Brighton Health Commercial |
$14,088.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,217.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,778.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,846.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,761.32
|
| Rate for Payer: EmblemHealth Commercial |
$8,331.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,801.39
|
| Rate for Payer: Group Health Inc Commercial |
$20,801.39
|
| Rate for Payer: Group Health Inc Medicare |
$20,801.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,801.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,672.65
|
| Rate for Payer: Humana Medicare |
$28,601.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,801.39
|
| Rate for Payer: United Healthcare Commercial |
$19,322.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,801.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,801.39
|
| Rate for Payer: Wellcare Medicare |
$19,761.32
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$39,952.91
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$13,436.20 |
| Max. Negotiated Rate |
$39,952.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,103.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,056.66
|
| Rate for Payer: Aetna Government |
$29,056.66
|
| Rate for Payer: Brighton Health Commercial |
$22,720.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,637.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,058.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,330.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,603.83
|
| Rate for Payer: EmblemHealth Commercial |
$13,436.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,056.66
|
| Rate for Payer: Group Health Inc Commercial |
$29,056.66
|
| Rate for Payer: Group Health Inc Medicare |
$29,056.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,056.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,511.35
|
| Rate for Payer: Humana Medicare |
$39,952.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,056.66
|
| Rate for Payer: United Healthcare Commercial |
$31,160.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,056.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,056.66
|
| Rate for Payer: Wellcare Medicare |
$27,603.83
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$23,119.94
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$5,866.16 |
| Max. Negotiated Rate |
$23,119.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,087.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,814.50
|
| Rate for Payer: Aetna Government |
$16,814.50
|
| Rate for Payer: Brighton Health Commercial |
$9,919.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,150.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,813.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,749.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,973.78
|
| Rate for Payer: EmblemHealth Commercial |
$5,866.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,814.50
|
| Rate for Payer: Group Health Inc Commercial |
$16,814.50
|
| Rate for Payer: Group Health Inc Medicare |
$16,814.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,814.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,818.74
|
| Rate for Payer: Humana Medicare |
$23,119.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,814.50
|
| Rate for Payer: United Healthcare Commercial |
$13,604.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,814.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,814.50
|
| Rate for Payer: Wellcare Medicare |
$15,973.78
|
|
|
INFLATOR LEVEEN 10ML UROL BALL
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
64904862
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.00
|
| Rate for Payer: Aetna Government |
$45.00
|
| Rate for Payer: Brighton Health Commercial |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.20
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
INFLIXIMAB 100 MG INJ
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
41651967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
|
|
INFLIXIMAB 100 MG INJ
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
41651967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$7,766.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.16
|
| Rate for Payer: Aetna Government |
$32.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$174.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$174.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$77.66
|
| Rate for Payer: Amida Care Medicaid |
$77.66
|
| Rate for Payer: Brighton Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.16
|
| Rate for Payer: EmblemHealth Commercial |
$32.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,766.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.54
|
| Rate for Payer: Group Health Inc Commercial |
$32.16
|
| Rate for Payer: Group Health Inc Medicare |
$32.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.66
|
| Rate for Payer: Healthfirst Essential Plan |
$174.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.34
|
| Rate for Payer: Healthfirst QHP |
$77.66
|
| Rate for Payer: Humana Medicare |
$32.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.66
|
| Rate for Payer: SOMOS Essential |
$77.66
|
| Rate for Payer: United Healthcare Commercial |
$34.86
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$174.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$85.43
|
| Rate for Payer: United Healthcare Medicaid |
$77.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.73
|
| Rate for Payer: Wellcare Medicare |
$30.55
|
|
|
INFLIXIMAB 100 MG INJ
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
41641967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$7,766.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.16
|
| Rate for Payer: Aetna Government |
$32.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$174.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$174.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$77.66
|
| Rate for Payer: Amida Care Medicaid |
$77.66
|
| Rate for Payer: Brighton Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.16
|
| Rate for Payer: EmblemHealth Commercial |
$32.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,766.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.54
|
| Rate for Payer: Group Health Inc Commercial |
$32.16
|
| Rate for Payer: Group Health Inc Medicare |
$32.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.66
|
| Rate for Payer: Healthfirst Essential Plan |
$174.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.34
|
| Rate for Payer: Healthfirst QHP |
$77.66
|
| Rate for Payer: Humana Medicare |
$32.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.66
|
| Rate for Payer: SOMOS Essential |
$77.66
|
| Rate for Payer: United Healthcare Commercial |
$34.86
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$174.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$85.43
|
| Rate for Payer: United Healthcare Medicaid |
$77.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.73
|
| Rate for Payer: Wellcare Medicare |
$30.55
|
|
|
INFLIXIMAB 100 MG INJ
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
41641967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
|
|
INFLIXIMAB 100 MG IV SOLR [23796]
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
57894016001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$7,766.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.16
|
| Rate for Payer: Aetna Government |
$32.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$174.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$174.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$77.66
|
| Rate for Payer: Amida Care Medicaid |
$77.66
|
| Rate for Payer: Brighton Health Commercial |
$342.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$327.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$32.16
|
| Rate for Payer: EmblemHealth Commercial |
$285.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,766.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.54
|
| Rate for Payer: Group Health Inc Commercial |
$32.16
|
| Rate for Payer: Group Health Inc Medicare |
$32.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.66
|
| Rate for Payer: Healthfirst Essential Plan |
$174.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.34
|
| Rate for Payer: Healthfirst QHP |
$77.66
|
| Rate for Payer: Humana Medicare |
$32.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.66
|
| Rate for Payer: SOMOS Essential |
$77.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$174.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$85.43
|
| Rate for Payer: United Healthcare Medicaid |
$77.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.73
|
|
|
INFLIXIMAB 100 MG IV SOLR [23796]
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
57894016001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.00
|
|
|
INFLIXIMAB-ABDA 100 MG IV SOLR [139293]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
78206016201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.04 |
| Max. Negotiated Rate |
$452.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.04
|
|
|
INFLIXIMAB-ABDA 100 MG IV SOLR [139293]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
78206016201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$587.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$497.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.50
|
| Rate for Payer: Aetna Government |
$31.50
|
| Rate for Payer: Brighton Health Commercial |
$542.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$452.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$519.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.50
|
| Rate for Payer: EmblemHealth Commercial |
$452.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.50
|
| Rate for Payer: Group Health Inc Commercial |
$31.50
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.77
|
| Rate for Payer: Healthfirst QHP |
$31.50
|
| Rate for Payer: Humana Medicare |
$32.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$587.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.20
|
|
|
INFLIXIMAB-AXXQ 100 MG IV SOLR [173130]
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
55513067001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.56
|
| Rate for Payer: Aetna Government |
$25.56
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$345.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.56
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.56
|
| Rate for Payer: Group Health Inc Commercial |
$25.56
|
| Rate for Payer: Group Health Inc Medicare |
$25.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.72
|
| Rate for Payer: Healthfirst QHP |
$25.56
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.44
|
|
|
INFLIXIMAB-AXXQ 100 MG IV SOLR [173130]
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
55513067001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
INFLIXIMAB-DYYB 100 MG IV SOLR [134057]
|
Facility
|
IP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
00069080901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.77 |
| Max. Negotiated Rate |
$567.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.77
|
|
|
INFLIXIMAB-DYYB 100 MG IV SOLR [134057]
|
Facility
|
OP
|
$1,135.54
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
00069080901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$738.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$624.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.29
|
| Rate for Payer: Aetna Government |
$14.29
|
| Rate for Payer: Brighton Health Commercial |
$681.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$567.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$652.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.29
|
| Rate for Payer: EmblemHealth Commercial |
$567.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.29
|
| Rate for Payer: Group Health Inc Commercial |
$14.29
|
| Rate for Payer: Group Health Inc Medicare |
$14.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.15
|
| Rate for Payer: Healthfirst QHP |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$738.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.44
|
|
|
INFL QUAD VACCINE 0.5ML (4YRS & +
|
Facility
|
OP
|
$34.35
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
41657850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.94
|
| Rate for Payer: Aetna Government |
$29.94
|
| Rate for Payer: Brighton Health Commercial |
$20.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.18
|
| Rate for Payer: Group Health Inc Medicare |
$12.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.22
|
| Rate for Payer: SOMOS Essential |
$36.22
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
|
INFL QUAD VACCINE 0.5ML (4YRS & +
|
Facility
|
IP
|
$34.35
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
41657850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.18
|
|
|
INFL QUAD VACCINE 0.5ML (4YRS & >
|
Facility
|
OP
|
$34.35
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
41647850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.94
|
| Rate for Payer: Aetna Government |
$29.94
|
| Rate for Payer: Brighton Health Commercial |
$20.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.18
|
| Rate for Payer: Group Health Inc Medicare |
$12.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.22
|
| Rate for Payer: SOMOS Essential |
$36.22
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
