|
HC HEPATITIS C AB TEST - ADDITIONAL CHARGE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3028680302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC HEPATITIS C AB TEST - ADDITIONAL CHARGE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3028680302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.27
|
| Rate for Payer: Aetna Government |
$14.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.99
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.27
|
| Rate for Payer: EmblemHealth Commercial |
$14.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.70
|
| Rate for Payer: Group Health Inc Commercial |
$14.27
|
| Rate for Payer: Group Health Inc Medicare |
$14.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.27
|
| Rate for Payer: Healthfirst QHP |
$14.27
|
| Rate for Payer: Humana Medicare |
$14.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$18.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$12.84
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.27
|
| Rate for Payer: Aetna Government |
$14.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.99
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.27
|
| Rate for Payer: EmblemHealth Commercial |
$14.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.70
|
| Rate for Payer: Group Health Inc Commercial |
$14.27
|
| Rate for Payer: Group Health Inc Medicare |
$14.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.27
|
| Rate for Payer: Healthfirst QHP |
$14.27
|
| Rate for Payer: Humana Medicare |
$14.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$18.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$12.84
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
3028669201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.16
|
| Rate for Payer: Aetna Government |
$17.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.01
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.16
|
| Rate for Payer: EmblemHealth Commercial |
$17.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.27
|
| Rate for Payer: Group Health Inc Commercial |
$17.16
|
| Rate for Payer: Group Health Inc Medicare |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.16
|
| Rate for Payer: Healthfirst Essential Plan |
$38.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.16
|
| Rate for Payer: Healthfirst QHP |
$17.16
|
| Rate for Payer: Humana Medicare |
$17.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.16
|
| Rate for Payer: United Healthcare Commercial |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$15.44
|
|
|
HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
3028669201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.50
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.34 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.63
|
| Rate for Payer: Aetna Government |
$47.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.34
|
| Rate for Payer: Brighton Health Commercial |
$89.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.63
|
| Rate for Payer: EmblemHealth Commercial |
$47.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.39
|
| Rate for Payer: Group Health Inc Commercial |
$47.63
|
| Rate for Payer: Group Health Inc Medicare |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.63
|
| Rate for Payer: Healthfirst QHP |
$47.63
|
| Rate for Payer: Humana Medicare |
$48.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.63
|
| Rate for Payer: United Healthcare Commercial |
$60.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.25
|
| Rate for Payer: Wellcare Medicare |
$42.87
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78226 TC
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.33 |
| Max. Negotiated Rate |
$891.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$202.58
|
| Rate for Payer: Aetna Government |
$202.58
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$891.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$757.52
|
| Rate for Payer: EmblemHealth Commercial |
$268.78
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.78
|
| Rate for Payer: Healthfirst Essential Plan |
$430.49
|
| Rate for Payer: United Healthcare Commercial |
$234.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.33
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78226 TC
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
6369063301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.50
|
|
|
HC HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
6369063301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.42
|
| Rate for Payer: Aetna Government |
$35.42
|
| Rate for Payer: Brighton Health Commercial |
$40.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.52
|
| Rate for Payer: EmblemHealth Commercial |
$33.50
|
| Rate for Payer: Group Health Inc Commercial |
$33.50
|
| Rate for Payer: Group Health Inc Medicare |
$23.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.55
|
|
|
HC HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$7,039.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.08
|
| Rate for Payer: Aetna Government |
$64.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$158.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$158.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$70.39
|
| Rate for Payer: Amida Care Medicaid |
$70.39
|
| Rate for Payer: Brighton Health Commercial |
$28.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.02
|
| Rate for Payer: EmblemHealth Commercial |
$23.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$158.38
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$70.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.91
|
| Rate for Payer: Group Health Inc Commercial |
$23.50
|
| Rate for Payer: Group Health Inc Medicare |
$16.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7,039.00
|
| Rate for Payer: Healthfirst Essential Plan |
$158.38
|
| Rate for Payer: Healthfirst QHP |
$114.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.39
|
| Rate for Payer: SOMOS Essential |
$158.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$158.38
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77.43
|
| Rate for Payer: United Healthcare Medicaid |
$70.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$70.39
|
|
|
HC HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.50
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.77
|
| Rate for Payer: Aetna Government |
$11.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.24
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.77
|
| Rate for Payer: EmblemHealth Commercial |
$11.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.48
|
| Rate for Payer: Group Health Inc Commercial |
$11.77
|
| Rate for Payer: Group Health Inc Medicare |
$11.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Healthfirst Essential Plan |
$22.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.77
|
| Rate for Payer: Healthfirst QHP |
$11.77
|
| Rate for Payer: Humana Medicare |
$12.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$14.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
3028670401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Healthfirst Essential Plan |
$22.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Wellcare Medicare |
$10.85
|
|
|
HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
3028670401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC HEP B IMMUNE GLOBULIN 5ML DOSE
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
6369037101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$218.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.19
|
| Rate for Payer: Aetna Government |
$134.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$93.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$93.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$93.93
|
| Rate for Payer: Brighton Health Commercial |
$173.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$134.19
|
| Rate for Payer: EmblemHealth Commercial |
$134.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.90
|
| Rate for Payer: Group Health Inc Commercial |
$134.19
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.19
|
| Rate for Payer: Healthfirst Commercial |
$218.73
|
| Rate for Payer: Healthfirst Essential Plan |
$134.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.06
|
| Rate for Payer: Healthfirst QHP |
$134.19
|
| Rate for Payer: Humana Medicare |
$136.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.19
|
| Rate for Payer: United Healthcare Commercial |
$128.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$127.48
|
| Rate for Payer: Wellcare Medicare |
$127.48
|
|
|
HC HEP B IMMUNE GLOBULIN 5ML DOSE
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
6369037101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
|
|
HC HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 90743
|
| Hospital Charge Code |
6369074301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
|
|
HC HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 90743
|
| Hospital Charge Code |
6369074301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.17
|
| Rate for Payer: Aetna Government |
$64.17
|
| Rate for Payer: Brighton Health Commercial |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.10
|
| Rate for Payer: EmblemHealth Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$73.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
HC HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
6369074601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
|
|
HC HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
6369074601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$7,038.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.65
|
| Rate for Payer: Aetna Government |
$69.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$158.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$158.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$70.38
|
| Rate for Payer: Amida Care Medicaid |
$70.38
|
| Rate for Payer: Brighton Health Commercial |
$56.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.05
|
| Rate for Payer: EmblemHealth Commercial |
$47.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$158.35
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$70.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.90
|
| Rate for Payer: Group Health Inc Commercial |
$47.00
|
| Rate for Payer: Group Health Inc Medicare |
$32.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7,038.00
|
| Rate for Payer: Healthfirst Essential Plan |
$158.35
|
| Rate for Payer: Healthfirst QHP |
$114.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.38
|
| Rate for Payer: SOMOS Essential |
$158.35
|
| Rate for Payer: United Healthcare Commercial |
$70.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$158.35
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77.42
|
| Rate for Payer: United Healthcare Medicaid |
$70.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$70.38
|
|
|
HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
6369074401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.10
|
| Rate for Payer: EmblemHealth Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.67
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
