|
HC HEMRRHOIDECTOMY, INTERNAL
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
5104622101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,169.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| 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 |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,169.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC HEPA/HEPB VACCINE ADULT IM
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
6369063601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.55 |
| Max. Negotiated Rate |
$13,452.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.35
|
| Rate for Payer: Aetna Government |
$114.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$302.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$302.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.52
|
| Rate for Payer: Amida Care Medicaid |
$134.52
|
| Rate for Payer: Brighton Health Commercial |
$103.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$99.47
|
| Rate for Payer: EmblemHealth Commercial |
$86.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$302.67
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$134.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.25
|
| Rate for Payer: Group Health Inc Commercial |
$86.50
|
| Rate for Payer: Group Health Inc Medicare |
$60.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13,452.00
|
| Rate for Payer: Healthfirst Essential Plan |
$302.67
|
| Rate for Payer: Healthfirst QHP |
$219.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.52
|
| Rate for Payer: SOMOS Essential |
$302.67
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$302.67
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$147.97
|
| Rate for Payer: United Healthcare Medicaid |
$134.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$134.52
|
|
|
HC HEPA/HEPB VACCINE ADULT IM
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
6369063601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$86.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.50
|
|
|
HC HEPARIN ASSAY - HEPARIN LEVEL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
3058552002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.09
|
| Rate for Payer: Aetna Government |
$13.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.16
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.09
|
| Rate for Payer: EmblemHealth Commercial |
$13.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.65
|
| Rate for Payer: Group Health Inc Commercial |
$13.09
|
| Rate for Payer: Group Health Inc Medicare |
$13.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.09
|
| Rate for Payer: Healthfirst Essential Plan |
$29.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.09
|
| Rate for Payer: Healthfirst QHP |
$13.09
|
| Rate for Payer: Humana Medicare |
$13.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.09
|
| Rate for Payer: United Healthcare Commercial |
$16.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.09
|
| Rate for Payer: Wellcare Medicare |
$11.78
|
|
|
HC HEPARIN ASSAY - HEPARIN LEVEL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
3058552002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$8.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.27
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.32
|
| Rate for Payer: Healthfirst Essential Plan |
$16.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.17
|
| Rate for Payer: Healthfirst QHP |
$8.17
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$10.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.32
|
| Rate for Payer: Wellcare Medicare |
$7.35
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.39
|
| Rate for Payer: Aetna Government |
$12.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.67
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.39
|
| Rate for Payer: EmblemHealth Commercial |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.03
|
| Rate for Payer: Group Health Inc Commercial |
$12.39
|
| Rate for Payer: Group Health Inc Medicare |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.39
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$15.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC HEPATITIS A ANTIBODY HAAB - REFLEX TO IGM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC HEPATITIS A ANTIBODY HAAB - REFLEX TO IGM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.39
|
| Rate for Payer: Aetna Government |
$12.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.67
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.39
|
| Rate for Payer: EmblemHealth Commercial |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.03
|
| Rate for Payer: Group Health Inc Commercial |
$12.39
|
| Rate for Payer: Group Health Inc Medicare |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.39
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$15.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
|
|
HC HEPATITIS A ANTIBODY HAAB - W/REFLEX
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC HEPATITIS A ANTIBODY HAAB - W/REFLEX
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3028670803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.39
|
| Rate for Payer: Aetna Government |
$12.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.67
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.39
|
| Rate for Payer: EmblemHealth Commercial |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.03
|
| Rate for Payer: Group Health Inc Commercial |
$12.39
|
| Rate for Payer: Group Health Inc Medicare |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.39
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$15.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.26
|
| Rate for Payer: Aetna Government |
$11.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.88
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$11.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.02
|
| Rate for Payer: Group Health Inc Commercial |
$11.26
|
| Rate for Payer: Group Health Inc Medicare |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.26
|
| Rate for Payer: Healthfirst QHP |
$11.26
|
| Rate for Payer: Humana Medicare |
$11.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$14.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$10.13
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA PROBE, DIRECT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3068751702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA PROBE, DIRECT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3068751702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.57
|
| Rate for Payer: Aetna Government |
$11.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.10
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.57
|
| Rate for Payer: EmblemHealth Commercial |
$11.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.57
|
| Rate for Payer: Group Health Inc Medicare |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Healthfirst Essential Plan |
$22.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.57
|
| Rate for Payer: Healthfirst QHP |
$11.57
|
| Rate for Payer: Humana Medicare |
$11.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$14.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Wellcare Medicare |
$10.41
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.74
|
| Rate for Payer: Aetna Government |
$10.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.52
|
| Rate for Payer: Brighton Health Commercial |
$19.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.74
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.56
|
| Rate for Payer: Group Health Inc Commercial |
$10.74
|
| Rate for Payer: Group Health Inc Medicare |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Healthfirst Essential Plan |
$22.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.74
|
| Rate for Payer: Healthfirst QHP |
$10.74
|
| Rate for Payer: Humana Medicare |
$10.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$13.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
|
|
HC HEPATITIS B VACCINE (HEPB), CPG-ADJUVANTED, ADULT DOSAGE, 2 DOSE OR 4 DOSE
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
6369073901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.50
|
|
|
HC HEPATITIS B VACCINE (HEPB), CPG-ADJUVANTED, ADULT DOSAGE, 2 DOSE OR 4 DOSE
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
6369073901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$252.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.21
|
| Rate for Payer: Aetna Government |
$144.21
|
| Rate for Payer: Brighton Health Commercial |
$275.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$229.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$263.93
|
| Rate for Payer: EmblemHealth Commercial |
$229.50
|
| Rate for Payer: Group Health Inc Commercial |
$229.50
|
| Rate for Payer: Group Health Inc Medicare |
$160.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.56
|
| Rate for Payer: United Healthcare Commercial |
$152.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.35
|
|
