|
HEPATITIS B SURF AB QUANT
|
Facility
|
OP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40729338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$28.11 |
| 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: Affinity Essential Plan 1&2 |
$10.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.49
|
| Rate for Payer: Brighton Health Commercial |
$28.11
|
| 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 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 Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$18.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
HEPATITIS B SURFACE AB, QN
|
Facility
|
OP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40728380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$28.11 |
| 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: Affinity Essential Plan 1&2 |
$10.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.49
|
| Rate for Payer: Brighton Health Commercial |
$28.11
|
| 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 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 Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$18.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
HEPATITIS B SURFACE AB, QN
|
Facility
|
IP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40728380
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$14.99
|
|
|
HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
40721305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.74
|
| Rate for Payer: Aetna Government |
$10.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.52
|
| Rate for Payer: Brighton Health Commercial |
$20.14
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.74
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.56
|
| Rate for Payer: Group Health Inc Commercial |
$10.74
|
| Rate for Payer: Group Health Inc Medicare |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.74
|
| Rate for Payer: Healthfirst QHP |
$10.74
|
| Rate for Payer: Humana Medicare |
$10.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$13.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.59
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
|
|
HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$26.85
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
40721305
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$10.74
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$25.83
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
40721325
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
40721325
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$10.33
|
|
|
HEPATITIS B VACCINE
|
Facility
|
IP
|
$244.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.06 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.06
|
|
|
HEPATITIS B VACCINE
|
Facility
|
OP
|
$244.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$158.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.06
|
| Rate for Payer: Aetna Government |
$122.06
|
| Rate for Payer: Brighton Health Commercial |
$146.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.37
|
| Rate for Payer: Group Health Inc Commercial |
$122.06
|
| Rate for Payer: Group Health Inc Medicare |
$85.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.68
|
|
|
HEPATITIS B VACCINE
|
Facility
|
IP
|
$244.12
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
41640338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.06 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.06
|
|
|
HEPATITIS B VACCINE
|
Facility
|
OP
|
$244.12
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
41640338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$169.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.21
|
| Rate for Payer: Aetna Government |
$144.21
|
| Rate for Payer: Brighton Health Commercial |
$146.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.37
|
| Rate for Payer: Group Health Inc Commercial |
$122.06
|
| Rate for Payer: Group Health Inc Medicare |
$85.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.90
|
| Rate for Payer: SOMOS Essential |
$169.90
|
| Rate for Payer: United Healthcare Commercial |
$152.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.68
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41644287
|
|
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
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41654287
|
|
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
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41644287
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| 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: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41655345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41655345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$16.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.19
|
| Rate for Payer: Group Health Inc Commercial |
$14.08
|
| Rate for Payer: Group Health Inc Medicare |
$9.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.30
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41654287
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| 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: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41645345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
|
|
HEPATITIS B VACCINE 0.5 ML INJ (BIRTH DO
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41645345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$16.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.19
|
| Rate for Payer: Group Health Inc Commercial |
$14.08
|
| Rate for Payer: Group Health Inc Medicare |
$9.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.30
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
41645100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
41655100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41655371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
41645100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Government |
$21.50
|
| Rate for Payer: Brighton Health Commercial |
$25.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.72
|
| Rate for Payer: Group Health Inc Commercial |
$21.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.95
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41645371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$16.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.19
|
| Rate for Payer: Group Health Inc Commercial |
$14.08
|
| Rate for Payer: Group Health Inc Medicare |
$9.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$29.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.30
|
|
|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41645371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
|
