|
HEPATITIS B VAC RECOMBINANT 10 MCG/0.5 ML IJ SUSY VFC [408188013]
|
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
|
|
|
HEPATITIS B VAC RECOMBINANT 10 MCG/ML IJ SUSP [27324]
|
Facility
|
OP
|
$80.04
|
|
|
Service Code
|
NDC 00006499541
|
| Hospital Charge Code |
00006499541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$64.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.02
|
| Rate for Payer: Aetna Government |
$40.02
|
| Rate for Payer: Brighton Health Commercial |
$60.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.43
|
| Rate for Payer: Group Health Inc Commercial |
$40.02
|
| Rate for Payer: Group Health Inc Medicare |
$28.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.03
|
|
|
HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP [27326]
|
Facility
|
OP
|
$83.24
|
|
|
Service Code
|
NDC 58160082111
|
| Hospital Charge Code |
58160082111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.62
|
| Rate for Payer: Aetna Government |
$41.62
|
| Rate for Payer: Brighton Health Commercial |
$62.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.60
|
| Rate for Payer: Group Health Inc Commercial |
$41.62
|
| Rate for Payer: Group Health Inc Medicare |
$29.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.10
|
|
|
HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP [27326]
|
Facility
|
OP
|
$83.24
|
|
|
Service Code
|
NDC 58160082101
|
| Hospital Charge Code |
58160082101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.62
|
| Rate for Payer: Aetna Government |
$41.62
|
| Rate for Payer: Brighton Health Commercial |
$62.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.60
|
| Rate for Payer: Group Health Inc Commercial |
$41.62
|
| Rate for Payer: Group Health Inc Medicare |
$29.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.10
|
|
|
HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY [188009]
|
Facility
|
OP
|
$83.24
|
|
|
Service Code
|
NDC 58160082143
|
| Hospital Charge Code |
58160082143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.62
|
| Rate for Payer: Aetna Government |
$41.62
|
| Rate for Payer: Brighton Health Commercial |
$62.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.60
|
| Rate for Payer: Group Health Inc Commercial |
$41.62
|
| Rate for Payer: Group Health Inc Medicare |
$29.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.10
|
|
|
HEPATITIS B VAC RECOMBINANT 40 MCG/ML IJ SUSP [108150]
|
Facility
|
OP
|
$217.49
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
00006499200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$173.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.76
|
| Rate for Payer: Aetna Government |
$140.76
|
| Rate for Payer: Brighton Health Commercial |
$163.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.89
|
| Rate for Payer: Group Health Inc Commercial |
$108.74
|
| Rate for Payer: Group Health Inc Medicare |
$76.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.37
|
|
|
HEPATITIS B VIRUS DNA
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40728016
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
HEPATITIS B VIRUS DNA
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40728016
|
|
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
|
|
|
HEPATITIS B VIRUS DNA,PCR
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40728422
|
|
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
|
|
|
HEPATITIS B VIRUS DNA,PCR
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
40728422
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
HEPATITIS C AB
|
Facility
|
IP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40728379
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$14.27
|
|
|
HEPATITIS C AB
|
Facility
|
OP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40728379
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40721335
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$14.27
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$35.68
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
40721335
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HEPATITIS C RIBA
|
Facility
|
IP
|
$38.73
|
|
|
Service Code
|
HCPCS 86804
|
| Hospital Charge Code |
40728144
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$15.49
|
|
|
HEPATITIS C RIBA
|
Facility
|
OP
|
$38.73
|
|
|
Service Code
|
HCPCS 86804
|
| Hospital Charge Code |
40728144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$29.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
HEPATITIS C VIRUS BDNA
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
40717012
|
|
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
|
|
|
HEPATITIS C VIRUS BDNA
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
40717012
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
HEPATITIS D VIRUS (HDV) TOTAL
|
Facility
|
OP
|
$42.90
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
40729898
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.16
|
| Rate for Payer: Aetna Government |
$17.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.01
|
| Rate for Payer: Brighton Health Commercial |
$32.18
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.16
|
| Rate for Payer: EmblemHealth Commercial |
$17.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.27
|
| Rate for Payer: Group Health Inc Commercial |
$17.16
|
| Rate for Payer: Group Health Inc Medicare |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.16
|
| Rate for Payer: Healthfirst QHP |
$17.16
|
| Rate for Payer: Humana Medicare |
$17.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.16
|
| Rate for Payer: United Healthcare Commercial |
$21.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.73
|
| Rate for Payer: Wellcare Medicare |
$15.44
|
|
|
HEPATITIS D VIRUS (HDV) TOTAL
|
Facility
|
IP
|
$42.90
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
40729898
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$17.16
|
|
|
HEPATITIS E ANTIBODY
|
Facility
|
IP
|
$28.93
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
40717552
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$11.57
|
|
|
HEPATITIS E ANTIBODY
|
Facility
|
OP
|
$28.93
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
40717552
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.57
|
| Rate for Payer: Aetna Government |
$11.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.10
|
| Rate for Payer: Brighton Health Commercial |
$21.70
|
| Rate for Payer: Cash Price |
$11.57
|
| Rate for Payer: Cash Price |
$11.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.57
|
| Rate for Payer: EmblemHealth Commercial |
$11.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.57
|
| Rate for Payer: Group Health Inc Medicare |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.57
|
| Rate for Payer: Healthfirst QHP |
$11.57
|
| Rate for Payer: Humana Medicare |
$11.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$14.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Wellcare Medicare |
$10.41
|
|
|
HEPATITIS E VIRUS (HEV) IGG
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HEPATITIS E VIRUS (HEV) IGG
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729386
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.88
|
|
|
HEPATITIS E VIRUS (HEV) IGM
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729897
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
