|
HEPATITIS B VACCINE 10 MCG/0.5 ML INJ PE
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41655371
|
|
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
|
OP
|
$43.00
|
|
| Hospital Charge Code |
41655100
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41642241
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41652423
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41642423
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41652241
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41652241
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41642241
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41652423
|
|
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 5 MCG/0.5 ML INJ PED
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41642423
|
|
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 (ADULT) 10 MCG/ML IN
|
Facility
|
IP
|
$28.51
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41642851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.26
|
|
|
HEPATITIS B VACCINE (ADULT) 10 MCG/ML IN
|
Facility
|
OP
|
$28.51
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41652851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.65
|
| Rate for Payer: Aetna Government |
$69.65
|
| Rate for Payer: Brighton Health Commercial |
$17.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.39
|
| Rate for Payer: Group Health Inc Commercial |
$14.26
|
| Rate for Payer: Group Health Inc Medicare |
$9.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.60
|
| Rate for Payer: SOMOS Essential |
$74.60
|
| Rate for Payer: United Healthcare Commercial |
$70.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.53
|
|
|
HEPATITIS B VACCINE (ADULT) 10 MCG/ML IN
|
Facility
|
OP
|
$28.51
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41642851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.65
|
| Rate for Payer: Aetna Government |
$69.65
|
| Rate for Payer: Brighton Health Commercial |
$17.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.39
|
| Rate for Payer: Group Health Inc Commercial |
$14.26
|
| Rate for Payer: Group Health Inc Medicare |
$9.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.60
|
| Rate for Payer: SOMOS Essential |
$74.60
|
| Rate for Payer: United Healthcare Commercial |
$70.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.53
|
|
|
HEPATITIS B VACCINE (ADULT) 10 MCG/ML IN
|
Facility
|
IP
|
$28.51
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41652851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.26
|
|
|
HEPATITIS B VACCINE (ADULT) 20 MCG/ML IN
|
Facility
|
IP
|
$94.85
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41655155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
|
|
HEPATITIS B VACCINE (ADULT) 20 MCG/ML IN
|
Facility
|
OP
|
$94.85
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41645155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.65
|
| Rate for Payer: Aetna Government |
$69.65
|
| Rate for Payer: Brighton Health Commercial |
$56.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.54
|
| Rate for Payer: Group Health Inc Commercial |
$47.42
|
| Rate for Payer: Group Health Inc Medicare |
$33.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.60
|
| Rate for Payer: SOMOS Essential |
$74.60
|
| Rate for Payer: United Healthcare Commercial |
$70.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.65
|
|
|
HEPATITIS B VACCINE (ADULT) 20 MCG/ML IN
|
Facility
|
OP
|
$94.85
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41655155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.65
|
| Rate for Payer: Aetna Government |
$69.65
|
| Rate for Payer: Brighton Health Commercial |
$56.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.54
|
| Rate for Payer: Group Health Inc Commercial |
$47.42
|
| Rate for Payer: Group Health Inc Medicare |
$33.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.60
|
| Rate for Payer: SOMOS Essential |
$74.60
|
| Rate for Payer: United Healthcare Commercial |
$70.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.65
|
|
|
HEPATITIS B VACCINE (ADULT) 20 MCG/ML IN
|
Facility
|
IP
|
$94.85
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
41645155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
|
|
HEPATITIS B VACCINE (DIALYSIS) 40 MCG/ML
|
Facility
|
OP
|
$208.13
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
41652850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$167.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.76
|
| Rate for Payer: Aetna Government |
$140.76
|
| Rate for Payer: Brighton Health Commercial |
$124.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.67
|
| Rate for Payer: Group Health Inc Commercial |
$104.06
|
| Rate for Payer: Group Health Inc Medicare |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.64
|
| Rate for Payer: SOMOS Essential |
$167.64
|
| Rate for Payer: United Healthcare Commercial |
$146.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.28
|
|
|
HEPATITIS B VACCINE (DIALYSIS) 40 MCG/ML
|
Facility
|
IP
|
$208.13
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
41642850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
|
|
HEPATITIS B VACCINE (DIALYSIS) 40 MCG/ML
|
Facility
|
IP
|
$208.13
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
41652850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
|
|
HEPATITIS B VACCINE (DIALYSIS) 40 MCG/ML
|
Facility
|
OP
|
$208.13
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
41642850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$167.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.76
|
| Rate for Payer: Aetna Government |
$140.76
|
| Rate for Payer: Brighton Health Commercial |
$124.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.67
|
| Rate for Payer: Group Health Inc Commercial |
$104.06
|
| Rate for Payer: Group Health Inc Medicare |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.64
|
| Rate for Payer: SOMOS Essential |
$167.64
|
| Rate for Payer: United Healthcare Commercial |
$146.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.28
|
|
|
HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY [162765]
|
Facility
|
OP
|
$354.31
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
43528000305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$283.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.21
|
| Rate for Payer: Aetna Government |
$144.21
|
| Rate for Payer: Brighton Health Commercial |
$265.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$283.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.93
|
| Rate for Payer: Group Health Inc Commercial |
$177.16
|
| Rate for Payer: Group Health Inc Medicare |
$124.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.30
|
|
|
HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY [188013]
|
Facility
|
OP
|
$67.91
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
58160082052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$54.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$50.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.18
|
| Rate for Payer: Group Health Inc Commercial |
$33.96
|
| Rate for Payer: Group Health Inc Medicare |
$23.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.14
|
|
|
HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY [188013]
|
Facility
|
OP
|
$67.91
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
58160082043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$54.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.22
|
| Rate for Payer: Aetna Government |
$28.22
|
| Rate for Payer: Brighton Health Commercial |
$50.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.18
|
| Rate for Payer: Group Health Inc Commercial |
$33.96
|
| Rate for Payer: Group Health Inc Medicare |
$23.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.14
|
|
