|
TC-99M PENTETATE
|
Facility
|
OP
|
$7.35
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
41646576
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Government |
$25.94
|
| Rate for Payer: Brighton Health Commercial |
$5.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.68
|
| Rate for Payer: Group Health Inc Medicare |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.68
|
|
|
TC-99M PENTETATE AEROSOL
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
41646577
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna Government |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$4.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
TC-99M PENTETATE AEROSOL
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
41656577
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna Government |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$4.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
TCD EMBOLI DETCT W/INJ
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93893 TC
|
| Hospital Charge Code |
41301523
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
TCD EMBOLI DETCT W/INJ
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93893 TC
|
| Hospital Charge Code |
41301523
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
TCD EMBOLI DETECT W/O INJ
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93892 TC
|
| Hospital Charge Code |
41301522
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
TCD EMBOLI DETECT W/O INJ
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93892 TC
|
| Hospital Charge Code |
41301522
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
TCD VASOREACTIVITY STUDY
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93890 TC
|
| Hospital Charge Code |
41301521
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
TCD VASOREACTIVITY STUDY
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93890 TC
|
| Hospital Charge Code |
41301521
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
IP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
40629622
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$46.98
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
OP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
30305610
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.89 |
| Max. Negotiated Rate |
$88.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.98
|
| Rate for Payer: Aetna Government |
$46.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.89
|
| Rate for Payer: Brighton Health Commercial |
$88.09
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.98
|
| Rate for Payer: EmblemHealth Commercial |
$46.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.81
|
| Rate for Payer: Group Health Inc Commercial |
$46.98
|
| Rate for Payer: Group Health Inc Medicare |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.98
|
| Rate for Payer: Healthfirst QHP |
$46.98
|
| Rate for Payer: Humana Medicare |
$47.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$59.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.58
|
| Rate for Payer: Wellcare Medicare |
$42.28
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
OP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
40629622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.89 |
| Max. Negotiated Rate |
$88.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.98
|
| Rate for Payer: Aetna Government |
$46.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.89
|
| Rate for Payer: Brighton Health Commercial |
$88.09
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.98
|
| Rate for Payer: EmblemHealth Commercial |
$46.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.81
|
| Rate for Payer: Group Health Inc Commercial |
$46.98
|
| Rate for Payer: Group Health Inc Medicare |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.98
|
| Rate for Payer: Healthfirst QHP |
$46.98
|
| Rate for Payer: Humana Medicare |
$47.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$59.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.58
|
| Rate for Payer: Wellcare Medicare |
$42.28
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
IP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
30305610
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$46.98
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659570
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649572
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659572
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659571
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TDAP (VFC) 0.5ML IM VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649571
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) O.5ML IM SYR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649570
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
TDAP (VFC) O.5ML IM SYR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41649570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
