|
HC RUBELLA - RUBELLA ANTIBODY, IGG
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGG
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Essential Plan |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Essential Plan |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC RUBELLA - RUBELLA ANTIBODY SCREENING
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC RUBELLA - RUBELLA ANTIBODY SCREENING
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3028676203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Essential Plan |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Essential Plan |
$28.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Essential Plan |
$28.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3058561301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3058561301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.58
|
| Rate for Payer: Aetna Government |
$9.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.71
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.58
|
| Rate for Payer: EmblemHealth Commercial |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.58
|
| Rate for Payer: Group Health Inc Medicare |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Healthfirst Essential Plan |
$17.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.58
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: Humana Medicare |
$9.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$12.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
|
|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT LUPUS ANTICOAGULANT REFLEX
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3058561302
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT LUPUS ANTICOAGULANT REFLEX
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3058561302
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.58
|
| Rate for Payer: Aetna Government |
$9.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.71
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.58
|
| Rate for Payer: EmblemHealth Commercial |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.58
|
| Rate for Payer: Group Health Inc Medicare |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Healthfirst Essential Plan |
$17.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.58
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: Humana Medicare |
$9.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$12.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
|
|
HC RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
6369068101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$398.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.00
|
|
|
HC RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
6369068101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.45 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$437.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.45
|
| Rate for Payer: Aetna Government |
$129.45
|
| Rate for Payer: Brighton Health Commercial |
$477.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$398.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$457.70
|
| Rate for Payer: EmblemHealth Commercial |
$398.00
|
| Rate for Payer: Group Health Inc Commercial |
$398.00
|
| Rate for Payer: Group Health Inc Medicare |
$278.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$517.40
|
|
|
HC RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
6369068001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.18 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$437.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92.18
|
| Rate for Payer: Aetna Government |
$92.18
|
| Rate for Payer: Brighton Health Commercial |
$477.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$398.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$457.70
|
| Rate for Payer: EmblemHealth Commercial |
$398.00
|
| Rate for Payer: Group Health Inc Commercial |
$398.00
|
| Rate for Payer: Group Health Inc Medicare |
$278.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$517.40
|
|
|
HC RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
6369068001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$398.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.00
|
|
|
HC RVW MEDS BY RX/DR IN RCRD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 1160F
|
| Hospital Charge Code |
9691160F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
HC RVW MEDS BY RX/DR IN RCRD
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 1160F
|
| Hospital Charge Code |
9691160F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC RX CONTACT LENS APHKIA BOTH EYES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 92316
|
| Hospital Charge Code |
5109231601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC RX CONTACT LENS APHKIA BOTH EYES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92316
|
| Hospital Charge Code |
5109231601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| 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 |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC SALIVARY GLAND IMAGING - NM SALIVARY GLAND
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78230 TC
|
| Hospital Charge Code |
3417823002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$83.96 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.96
|
| Rate for Payer: Aetna Government |
$83.96
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.05
|
| Rate for Payer: EmblemHealth Commercial |
$148.60
|
| 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 |
$148.60
|
| Rate for Payer: Healthfirst Essential Plan |
$263.14
|
| Rate for Payer: United Healthcare Commercial |
$191.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$116.95
|
|
|
HC SALIVARY GLAND IMAGING - NM SALIVARY GLAND
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78230 TC
|
| Hospital Charge Code |
3417823002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT U0003
|
| Hospital Charge Code |
306U000303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Brighton Health Commercial |
$97.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: EmblemHealth Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
