|
HAPTOGLOBIN QUANTITATION _
|
Facility
|
OP
|
$31.45
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
40607948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.58
|
| Rate for Payer: Aetna Government |
$12.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.81
|
| Rate for Payer: Brighton Health Commercial |
$23.59
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.58
|
| Rate for Payer: EmblemHealth Commercial |
$12.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.20
|
| Rate for Payer: Group Health Inc Commercial |
$12.58
|
| Rate for Payer: Group Health Inc Medicare |
$12.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.58
|
| Rate for Payer: Healthfirst QHP |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare Commercial |
$15.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.06
|
| Rate for Payer: Wellcare Medicare |
$11.32
|
|
|
HAPTOGLOBIN QUANTITATION _
|
Facility
|
IP
|
$31.45
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
40607948
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.58
|
|
|
HARMFUL HABIT CONTROL-FIXED APPLI
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D8220
|
| Hospital Charge Code |
42302210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$314.87
|
| Rate for Payer: Aetna Government |
$314.87
|
| Rate for Payer: Brighton Health Commercial |
$750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$500.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
|
HARMFUL HABIT CONTROL-REMOVABLE A
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS D8210
|
| Hospital Charge Code |
42302205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$303.28
|
| Rate for Payer: Aetna Government |
$303.28
|
| Rate for Payer: Brighton Health Commercial |
$562.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$375.00
|
| Rate for Payer: Group Health Inc Medicare |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
|
|
HARRIS DRIP TRAY
|
Facility
|
OP
|
$45.36
|
|
| Hospital Charge Code |
40202410
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Brighton Health Commercial |
$34.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
HARTMAN PROCEDURE
|
Facility
|
OP
|
$4,748.71
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
40010940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,561.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,611.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,975.70
|
| Rate for Payer: Aetna Government |
$1,975.70
|
| Rate for Payer: Brighton Health Commercial |
$3,561.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,374.36
|
| Rate for Payer: Group Health Inc Medicare |
$1,662.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,374.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,374.36
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HARVEST BONE MARROW KIT
|
Facility
|
OP
|
$5,000.00
|
|
| Hospital Charge Code |
40205461
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,750.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,500.00
|
| Rate for Payer: Aetna Government |
$2,500.00
|
| Rate for Payer: Brighton Health Commercial |
$3,750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,400.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,500.00
|
|
|
HARVEST GRAFT DELIVERY KIT
|
Facility
|
OP
|
$998.00
|
|
| Hospital Charge Code |
40205460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$798.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$548.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$499.00
|
| Rate for Payer: Aetna Government |
$499.00
|
| Rate for Payer: Brighton Health Commercial |
$748.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$798.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$678.64
|
| Rate for Payer: Group Health Inc Commercial |
$499.00
|
| Rate for Payer: Group Health Inc Medicare |
$349.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$499.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$499.00
|
|
|
Harvest of skin for tissue cultured skin autograft, 100 sq cm or less
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 15040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,476.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,476.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,476.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Humana Medicare |
$2,151.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
HBSAG CONFIRMATORY
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
40711326
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$10.33
|
|
|
HBSAG CONFIRMATORY
|
Facility
|
OP
|
$25.83
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
40711326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.33
|
| Rate for Payer: Aetna Government |
$10.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.23
|
| Rate for Payer: Brighton Health Commercial |
$19.37
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.33
|
| Rate for Payer: EmblemHealth Commercial |
$10.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.19
|
| Rate for Payer: Group Health Inc Commercial |
$10.33
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$10.33
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
|
|
HBSAG SCREEN
|
Facility
|
OP
|
$25.83
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
40729390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.33
|
| Rate for Payer: Aetna Government |
$10.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.23
|
| Rate for Payer: Brighton Health Commercial |
$19.37
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.33
|
| Rate for Payer: EmblemHealth Commercial |
$10.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.19
|
| Rate for Payer: Group Health Inc Commercial |
$10.33
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$10.33
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
|
|
HBSAG SCREEN
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
40729390
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$10.33
|
|
|
HBV GENOTYPE
|
Facility
|
OP
|
$643.63
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
40728332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$354.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.45
|
| Rate for Payer: Aetna Government |
$257.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.22
|
| Rate for Payer: Brighton Health Commercial |
$482.72
|
| Rate for Payer: Cash Price |
$257.45
|
| Rate for Payer: Cash Price |
$257.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$437.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.45
|
| Rate for Payer: EmblemHealth Commercial |
$257.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.13
|
| Rate for Payer: Group Health Inc Commercial |
$257.45
|
| Rate for Payer: Group Health Inc Medicare |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.45
|
| Rate for Payer: Healthfirst QHP |
$257.45
|
| Rate for Payer: Humana Medicare |
$262.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare Commercial |
$318.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$205.96
|
| Rate for Payer: Wellcare Medicare |
$231.70
|
|
|
HBV GENOTYPE
|
Facility
|
IP
|
$643.63
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
40728332
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$257.45
|
|
|
HBV REAL-TIME PCR, QUANT
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40729393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.32
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HBV REAL-TIME PCR, QUANT
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40729393
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
HCTZ 5MG/ML ORAL SYRINGE
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41647160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HCTZ 5MG/ML ORAL SYRINGE
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41657160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HCV
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
40717993
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
HCV
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
40717993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HCV ANTIBODY
|
Facility
|
IP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40729389
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.27
|
|
|
HCV ANTIBODY
|
Facility
|
OP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40729389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.27
|
| Rate for Payer: Aetna Government |
$14.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.99
|
| Rate for Payer: Brighton Health Commercial |
$26.76
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.27
|
| Rate for Payer: EmblemHealth Commercial |
$14.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.70
|
| Rate for Payer: Group Health Inc Commercial |
$14.27
|
| Rate for Payer: Group Health Inc Medicare |
$14.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.27
|
| Rate for Payer: Healthfirst QHP |
$14.27
|
| Rate for Payer: Humana Medicare |
$14.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$18.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.42
|
| Rate for Payer: Wellcare Medicare |
$12.84
|
|
|
HCV FIBROSURE
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40729235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$39.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$39.55
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
HCV FIBROSURE
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40729235
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$21.09
|
|
