|
HEPATITIS B CORE ANTIGEN
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
40721330
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
HEPATITIS B CORE ANTIGEN
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
40721330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
HEPATITIS B CORE IGM
|
Facility
|
OP
|
$29.43
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
40717558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$22.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.77
|
| Rate for Payer: Aetna Government |
$11.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.24
|
| Rate for Payer: Brighton Health Commercial |
$22.07
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.77
|
| Rate for Payer: EmblemHealth Commercial |
$11.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.48
|
| Rate for Payer: Group Health Inc Commercial |
$11.77
|
| Rate for Payer: Group Health Inc Medicare |
$11.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.77
|
| Rate for Payer: Healthfirst QHP |
$11.77
|
| Rate for Payer: Humana Medicare |
$12.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$14.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.42
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
|
|
HEPATITIS B CORE IGM
|
Facility
|
IP
|
$29.43
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
40717558
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$11.77
|
|
|
HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
40717555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
40717555
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
HEPATITIS B + HAEMOPHILUS B CONJUGATE (C
|
Facility
|
OP
|
$86.12
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
41643101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.90
|
| Rate for Payer: Aetna Government |
$42.90
|
| Rate for Payer: Brighton Health Commercial |
$64.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.56
|
| Rate for Payer: Group Health Inc Commercial |
$43.06
|
| Rate for Payer: Group Health Inc Medicare |
$30.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.98
|
|
|
HEPATITIS B + HAEMOPHILUS B CONJUGATE (C
|
Facility
|
OP
|
$86.12
|
|
| Hospital Charge Code |
41653101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.06
|
| Rate for Payer: Aetna Government |
$43.06
|
| Rate for Payer: Brighton Health Commercial |
$64.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.56
|
| Rate for Payer: Group Health Inc Commercial |
$43.06
|
| Rate for Payer: Group Health Inc Medicare |
$30.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.98
|
|
|
HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY [180688]
|
Facility
|
OP
|
$212.28
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
13533063603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$169.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.89
|
| Rate for Payer: Aetna Government |
$137.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$96.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$96.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.52
|
| Rate for Payer: Brighton Health Commercial |
$159.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.89
|
| Rate for Payer: EmblemHealth Commercial |
$137.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.72
|
| Rate for Payer: Group Health Inc Commercial |
$137.89
|
| Rate for Payer: Group Health Inc Medicare |
$137.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.21
|
| Rate for Payer: Healthfirst QHP |
$137.89
|
| Rate for Payer: Humana Medicare |
$140.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.31
|
| Rate for Payer: Wellcare Medicare |
$131.00
|
|
|
HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SOSY [180689]
|
Facility
|
OP
|
$200.15
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
13533063602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$160.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.89
|
| Rate for Payer: Aetna Government |
$137.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$96.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$96.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.52
|
| Rate for Payer: Brighton Health Commercial |
$150.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.89
|
| Rate for Payer: EmblemHealth Commercial |
$137.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.72
|
| Rate for Payer: Group Health Inc Commercial |
$137.89
|
| Rate for Payer: Group Health Inc Medicare |
$137.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.21
|
| Rate for Payer: Healthfirst QHP |
$137.89
|
| Rate for Payer: Humana Medicare |
$140.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.31
|
| Rate for Payer: Wellcare Medicare |
$131.00
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ 5 ML (HE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS J1571
|
| Hospital Charge Code |
41641907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.62
|
| Rate for Payer: Aetna Government |
$59.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$41.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$41.73
|
| Rate for Payer: Brighton Health Commercial |
$106.20
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$59.62
|
| Rate for Payer: EmblemHealth Commercial |
$59.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.60
|
| Rate for Payer: Group Health Inc Commercial |
$59.62
|
| Rate for Payer: Group Health Inc Medicare |
$59.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.68
|
| Rate for Payer: Healthfirst QHP |
$59.62
|
| Rate for Payer: Humana Medicare |
$60.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.41
|
| Rate for Payer: SOMOS Essential |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$69.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.70
|
| Rate for Payer: Wellcare Medicare |
$56.64
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ 5 ML (HE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS J1571
|
| Hospital Charge Code |
41641907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.50
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ 5 ML (HE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS J1571
|
| Hospital Charge Code |
41651907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.50
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ 5 ML (HE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS J1571
|
| Hospital Charge Code |
41651907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.62
|
| Rate for Payer: Aetna Government |
$59.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$41.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$41.73
|
| Rate for Payer: Brighton Health Commercial |
$106.20
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$59.62
|
| Rate for Payer: EmblemHealth Commercial |
$59.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.60
|
| Rate for Payer: Group Health Inc Commercial |
$59.62
|
| Rate for Payer: Group Health Inc Medicare |
$59.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.68
|
| Rate for Payer: Healthfirst QHP |
$59.62
|
| Rate for Payer: Humana Medicare |
$60.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.41
|
| Rate for Payer: SOMOS Essential |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$69.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.70
|
| Rate for Payer: Wellcare Medicare |
$56.64
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
OP
|
$168.46
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41654523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.23
|
| Rate for Payer: Aetna Government |
$84.23
|
| Rate for Payer: Brighton Health Commercial |
$101.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.86
|
| Rate for Payer: Group Health Inc Commercial |
$84.23
|
| Rate for Payer: Group Health Inc Medicare |
$58.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.50
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
IP
|
$168.46
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41654523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$84.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.23
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41644857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.50
|
| Rate for Payer: Aetna Government |
$144.50
|
| Rate for Payer: Brighton Health Commercial |
$173.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.18
|
| Rate for Payer: Group Health Inc Commercial |
$144.50
|
| Rate for Payer: Group Health Inc Medicare |
$101.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41644857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
OP
|
$168.46
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41644523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.23
|
| Rate for Payer: Aetna Government |
$84.23
|
| Rate for Payer: Brighton Health Commercial |
$101.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.86
|
| Rate for Payer: Group Health Inc Commercial |
$84.23
|
| Rate for Payer: Group Health Inc Medicare |
$58.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.50
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
IP
|
$168.46
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41644523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$84.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.23
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41654857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.50
|
| Rate for Payer: Aetna Government |
$144.50
|
| Rate for Payer: Brighton Health Commercial |
$173.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.18
|
| Rate for Payer: Group Health Inc Commercial |
$144.50
|
| Rate for Payer: Group Health Inc Medicare |
$101.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
|
|
HEPATITIS B IMMUNE GLOBULIN INJ NEONATAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
41654857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
|
|
HEPATITIS B SCREENING NON-PREGNAN
|
Facility
|
IP
|
$26.85
|
|
|
Service Code
|
HCPCS G0499
|
| Hospital Charge Code |
30301469
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$28.27
|
|
|
HEPATITIS B SCREENING NON-PREGNAN
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
HCPCS G0499
|
| Hospital Charge Code |
30301469
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$31.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.27
|
| Rate for Payer: Aetna Government |
$28.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.79
|
| Rate for Payer: Brighton Health Commercial |
$20.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$28.27
|
| Rate for Payer: EmblemHealth Commercial |
$28.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.16
|
| Rate for Payer: Group Health Inc Commercial |
$28.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.03
|
| Rate for Payer: Healthfirst QHP |
$28.27
|
| Rate for Payer: Humana Medicare |
$28.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.27
|
| Rate for Payer: United Healthcare Commercial |
$31.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.62
|
| Rate for Payer: Wellcare Medicare |
$25.44
|
|
|
HEPATITIS B SURF AB QUANT
|
Facility
|
IP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40729338
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.99
|
|
