|
HC I&D PILONIDAL CYST, SIMPLE
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
3611008001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.09 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,385.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC I&D PILONIDAL CYST, SIMPLE
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
3611008001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC I&D SUBMUCOSAL ABSCESS, RECTUM
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
5104500501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
|
HC I&D SUBMUCOSAL ABSCESS, RECTUM
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
5104500501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| 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 |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| 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 |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,512.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 1
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.02
|
| Rate for Payer: Aetna Government |
$8.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.61
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$8.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$8.02
|
| Rate for Payer: Group Health Inc Medicare |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Healthfirst Essential Plan |
$13.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.02
|
| Rate for Payer: Healthfirst QHP |
$8.02
|
| Rate for Payer: Humana Medicare |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Wellcare Medicare |
$7.22
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 1
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 2
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.02
|
| Rate for Payer: Aetna Government |
$8.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.61
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$8.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$8.02
|
| Rate for Payer: Group Health Inc Medicare |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Healthfirst Essential Plan |
$13.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.02
|
| Rate for Payer: Healthfirst QHP |
$8.02
|
| Rate for Payer: Humana Medicare |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Wellcare Medicare |
$7.22
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 2
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 3
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 3
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.02
|
| Rate for Payer: Aetna Government |
$8.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.61
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$8.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$8.02
|
| Rate for Payer: Group Health Inc Medicare |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Healthfirst Essential Plan |
$13.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.02
|
| Rate for Payer: Healthfirst QHP |
$8.02
|
| Rate for Payer: Humana Medicare |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Wellcare Medicare |
$7.22
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 4
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 4
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3018278704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.02
|
| Rate for Payer: Aetna Government |
$8.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.61
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$8.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$8.02
|
| Rate for Payer: Group Health Inc Medicare |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Healthfirst Essential Plan |
$13.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.02
|
| Rate for Payer: Healthfirst QHP |
$8.02
|
| Rate for Payer: Humana Medicare |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.96
|
| Rate for Payer: Wellcare Medicare |
$7.22
|
|
|
HC IIV3 VACCINE 3 YRS & OLDER FOR IM USE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
6369065801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
|
|
HC IIV3 VACCINE 3 YRS & OLDER FOR IM USE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
6369065801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.32
|
| Rate for Payer: Aetna Government |
$16.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.83
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.83
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.48
|
| Rate for Payer: Amida Care Medicaid |
$11.48
|
| Rate for Payer: Brighton Health Commercial |
$14.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$25.83
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$11.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,148.00
|
| Rate for Payer: Healthfirst Essential Plan |
$25.83
|
| Rate for Payer: Healthfirst QHP |
$18.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.48
|
| Rate for Payer: SOMOS Essential |
$25.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$25.83
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$12.63
|
| Rate for Payer: United Healthcare Medicaid |
$11.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.48
|
|
|
HC IIV3 VACCINE TO CHILD 6-35 MONTHS FOR IM USE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
6369065701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
HC IIV3 VACCINE TO CHILD 6-35 MONTHS FOR IM USE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
6369065701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.50
|
| Rate for Payer: Aetna Government |
$9.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.74
|
| Rate for Payer: Amida Care Medicaid |
$5.74
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$7.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$12.91
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$5.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.03
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.00
|
| Rate for Payer: Healthfirst Essential Plan |
$12.91
|
| Rate for Payer: Healthfirst QHP |
$9.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.74
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$13.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$12.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$6.31
|
| Rate for Payer: United Healthcare Medicaid |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.74
|
|
|
HC IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
|
|
HC IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$1,267.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.69
|
| Rate for Payer: Aetna Government |
$17.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.67
|
| Rate for Payer: Amida Care Medicaid |
$12.67
|
| Rate for Payer: Brighton Health Commercial |
$14.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$28.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$12.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.30
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,267.00
|
| Rate for Payer: Healthfirst Essential Plan |
$28.51
|
| Rate for Payer: Healthfirst QHP |
$20.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.67
|
| Rate for Payer: SOMOS Essential |
$28.51
|
| Rate for Payer: United Healthcare Commercial |
$12.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$28.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.94
|
| Rate for Payer: United Healthcare Medicaid |
$12.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.67
|
|
|
HC IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Brighton Health Commercial |
$45.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.70
|
| Rate for Payer: EmblemHealth Commercial |
$38.00
|
| Rate for Payer: Group Health Inc Commercial |
$38.00
|
| Rate for Payer: Group Health Inc Medicare |
$26.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.00
|
| Rate for Payer: United Healthcare Commercial |
$21.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.40
|
|
|
HC IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.00
|
|
|
HC IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
6369068501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
HC IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
6369068501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.64
|
| Rate for Payer: Aetna Government |
$21.64
|
| Rate for Payer: Brighton Health Commercial |
$480.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
| Rate for Payer: EmblemHealth Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
|
HC IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
6369068701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
HC IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
6369068701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.95
|
| Rate for Payer: Aetna Government |
$9.95
|
| Rate for Payer: Brighton Health Commercial |
$240.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
| Rate for Payer: EmblemHealth Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
|
HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
6369068801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.91
|
| Rate for Payer: Aetna Government |
$19.91
|
| Rate for Payer: Brighton Health Commercial |
$283.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$236.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.98
|
| Rate for Payer: EmblemHealth Commercial |
$236.50
|
| Rate for Payer: Group Health Inc Commercial |
$236.50
|
| Rate for Payer: Group Health Inc Medicare |
$165.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.50
|
| Rate for Payer: United Healthcare Commercial |
$20.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.45
|
|
