|
HC IMMM ADMIN SARSCOV2 BOOSTER DOSE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 0034A
|
| Hospital Charge Code |
7710034A01
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.36
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC IMMUNFIX E-PHORSIS - SERUM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$50.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.34
|
| Rate for Payer: Aetna Government |
$22.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.64
|
| Rate for Payer: Brighton Health Commercial |
$41.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.34
|
| Rate for Payer: EmblemHealth Commercial |
$22.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.88
|
| Rate for Payer: Group Health Inc Commercial |
$22.34
|
| Rate for Payer: Group Health Inc Medicare |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.34
|
| Rate for Payer: Healthfirst Essential Plan |
$50.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.34
|
| Rate for Payer: Healthfirst QHP |
$22.34
|
| Rate for Payer: Humana Medicare |
$22.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.34
|
| Rate for Payer: Wellcare Medicare |
$20.11
|
|
|
HC IMMUNFIX E-PHORSIS - SERUM
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
|
|
HC IMMUNFIX E-PHORSIS - URINE/CSF
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3028633501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$36.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.50
|
|
|
HC IMMUNFIX E-PHORSIS - URINE/CSF
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3028633501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$66.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.35
|
| Rate for Payer: Aetna Government |
$29.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.55
|
| Rate for Payer: Brighton Health Commercial |
$54.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.35
|
| Rate for Payer: EmblemHealth Commercial |
$29.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.12
|
| Rate for Payer: Group Health Inc Commercial |
$29.35
|
| Rate for Payer: Group Health Inc Medicare |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.35
|
| Rate for Payer: Healthfirst Essential Plan |
$66.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.35
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: Humana Medicare |
$29.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare Commercial |
$37.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.35
|
| Rate for Payer: Wellcare Medicare |
$26.41
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3028633502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$66.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.35
|
| Rate for Payer: Aetna Government |
$29.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.55
|
| Rate for Payer: Brighton Health Commercial |
$54.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.35
|
| Rate for Payer: EmblemHealth Commercial |
$29.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.12
|
| Rate for Payer: Group Health Inc Commercial |
$29.35
|
| Rate for Payer: Group Health Inc Medicare |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.35
|
| Rate for Payer: Healthfirst Essential Plan |
$66.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.35
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: Humana Medicare |
$29.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare Commercial |
$37.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.35
|
| Rate for Payer: Wellcare Medicare |
$26.41
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3028633502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$36.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.50
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.39
|
| 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 |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7719047301
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$866.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.66
|
| Rate for Payer: Amida Care Medicaid |
$8.66
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$19.48
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$8.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.09
|
| 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 |
$8.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$866.00
|
| Rate for Payer: Healthfirst Essential Plan |
$19.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.66
|
| Rate for Payer: SOMOS Essential |
$19.48
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$19.48
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.53
|
| Rate for Payer: United Healthcare Medicaid |
$8.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7719047301
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
7719047401
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
7719047401
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.80
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.19
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$12.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.56
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - DIPHTHERIA AB
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.99
|
| Rate for Payer: Aetna Government |
$14.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.49
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.99
|
| Rate for Payer: EmblemHealth Commercial |
$14.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.34
|
| Rate for Payer: Group Health Inc Commercial |
$14.99
|
| Rate for Payer: Group Health Inc Medicare |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$18.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.24
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - DIPHTHERIA AB
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - HEPATITIS B SURF AB
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - HEPATITIS B SURF AB
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.99
|
| Rate for Payer: Aetna Government |
$14.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.49
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.99
|
| Rate for Payer: EmblemHealth Commercial |
$14.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.34
|
| Rate for Payer: Group Health Inc Commercial |
$14.99
|
| Rate for Payer: Group Health Inc Medicare |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$18.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.24
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - STREP PNEUMONIAE ANTIBODY SEROTYPES
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC IMMUNOASSAY,INFECT AGENT,QUANT - STREP PNEUMONIAE ANTIBODY SEROTYPES
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3028631704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.99
|
| Rate for Payer: Aetna Government |
$14.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.49
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.99
|
| Rate for Payer: EmblemHealth Commercial |
$14.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.34
|
| Rate for Payer: Group Health Inc Commercial |
$14.99
|
| Rate for Payer: Group Health Inc Medicare |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$18.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.24
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
