|
DIPH/TET/PERT (VFC) 0.5ML SYR
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41646909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML SYR
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41656909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41656907
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.70
|
| Rate for Payer: Aetna Government |
$27.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41656907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41647001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41657001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41657001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.70
|
| Rate for Payer: Aetna Government |
$27.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41647001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.70
|
| Rate for Payer: Aetna Government |
$27.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41646907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPH/TET/PERT (VFC) 0.5ML VIAL
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
41646907
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.70
|
| Rate for Payer: Aetna Government |
$27.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPHTHERIA ANTIBODIES
|
Facility
OP
|
$38.03
|
|
|
Service Code
|
HCPCS 86648
|
| Hospital Charge Code |
40728009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.21
|
| Rate for Payer: Aetna Government |
$15.21
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.21
|
| Rate for Payer: EmblemHealth Commercial |
$15.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.54
|
| Rate for Payer: Group Health Inc Commercial |
$15.21
|
| Rate for Payer: Group Health Inc Medicare |
$15.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.21
|
| Rate for Payer: Healthfirst QHP |
$15.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.17
|
| Rate for Payer: Wellcare Medicare |
$13.69
|
|
|
DIPHTHERIA ANTITOXOID AB
|
Facility
OP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40729340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.99
|
| Rate for Payer: Aetna Government |
$14.99
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$14.99
|
| 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 |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.17
|
| 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 |
$18.74
|
| 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: Senior Whole Health 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 |
$11.99
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS + HAEMO
|
Facility
IP
|
$86.00
|
|
| Hospital Charge Code |
41643440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.00
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS + HAEMO
|
Facility
IP
|
$86.00
|
|
| Hospital Charge Code |
41653440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.00
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS + HAEMO
|
Facility
OP
|
$86.00
|
|
| Hospital Charge Code |
41643440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Government |
$43.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.45
|
| Rate for Payer: Group Health Inc Commercial |
$43.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.90
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS + HAEMO
|
Facility
OP
|
$86.00
|
|
| Hospital Charge Code |
41653440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Government |
$43.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.45
|
| Rate for Payer: Group Health Inc Commercial |
$43.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.90
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS (INFANR
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
41645204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS (INFANR
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
41655204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (AD
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41644223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.87
|
| Rate for Payer: Group Health Inc Commercial |
$32.50
|
| Rate for Payer: Group Health Inc Medicare |
$22.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.25
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (AD
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41654223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (AD
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41654223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.87
|
| Rate for Payer: Group Health Inc Commercial |
$32.50
|
| Rate for Payer: Group Health Inc Medicare |
$22.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.25
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (AD
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41644223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (BO
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41654662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.87
|
| Rate for Payer: Group Health Inc Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.10
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (BO
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41654662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
|
|
DIPHTHERIA + TETANUS + PERTUSSIS INJ (BO
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41644662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
|
