|
HEPATITIS E VIRUS (HEV) IGM
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729897
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.88
|
|
|
HEPATITIS PROFILE
|
Facility
|
IP
|
$119.08
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
40721345
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$47.63
|
|
|
HEPATITIS PROFILE
|
Facility
|
OP
|
$119.08
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
40721345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.34 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.63
|
| Rate for Payer: Aetna Government |
$47.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.34
|
| Rate for Payer: Brighton Health Commercial |
$89.31
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.63
|
| Rate for Payer: EmblemHealth Commercial |
$47.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.39
|
| Rate for Payer: Group Health Inc Commercial |
$47.63
|
| Rate for Payer: Group Health Inc Medicare |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.63
|
| Rate for Payer: Healthfirst QHP |
$47.63
|
| Rate for Payer: Humana Medicare |
$48.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.63
|
| Rate for Payer: United Healthcare Commercial |
$60.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$38.10
|
| Rate for Payer: Wellcare Medicare |
$42.87
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$42,673.84
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$14,431.52 |
| Max. Negotiated Rate |
$42,673.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,208.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,035.52
|
| Rate for Payer: Aetna Government |
$31,035.52
|
| Rate for Payer: Brighton Health Commercial |
$24,789.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,656.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,523.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,363.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,483.74
|
| Rate for Payer: EmblemHealth Commercial |
$14,659.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,035.52
|
| Rate for Payer: Group Health Inc Commercial |
$31,035.52
|
| Rate for Payer: Group Health Inc Medicare |
$31,035.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,035.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,431.52
|
| Rate for Payer: Humana Medicare |
$42,673.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,035.52
|
| Rate for Payer: United Healthcare Commercial |
$33,998.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,035.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,035.52
|
| Rate for Payer: Wellcare Medicare |
$29,483.74
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$71,107.52
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$24,047.27 |
| Max. Negotiated Rate |
$71,107.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47,195.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51,714.56
|
| Rate for Payer: Aetna Government |
$51,714.56
|
| Rate for Payer: Brighton Health Commercial |
$46,411.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52,748.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55,274.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45,614.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$49,128.83
|
| Rate for Payer: EmblemHealth Commercial |
$27,446.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$51,714.56
|
| Rate for Payer: Group Health Inc Commercial |
$51,714.56
|
| Rate for Payer: Group Health Inc Medicare |
$51,714.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51,714.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24,047.27
|
| Rate for Payer: Humana Medicare |
$71,107.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51,714.56
|
| Rate for Payer: United Healthcare Commercial |
$63,654.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51,714.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51,714.56
|
| Rate for Payer: Wellcare Medicare |
$49,128.83
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,980.24
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$12,099.30 |
| Max. Negotiated Rate |
$36,980.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,805.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,894.72
|
| Rate for Payer: Aetna Government |
$26,894.72
|
| Rate for Payer: Brighton Health Commercial |
$20,459.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,432.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,366.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,108.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,549.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,099.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,894.72
|
| Rate for Payer: Group Health Inc Commercial |
$26,894.72
|
| Rate for Payer: Group Health Inc Medicare |
$26,894.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,894.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,506.04
|
| Rate for Payer: Humana Medicare |
$36,980.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,894.72
|
| Rate for Payer: United Healthcare Commercial |
$28,060.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,894.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,894.72
|
| Rate for Payer: Wellcare Medicare |
$25,549.98
|
|
|
HEP A VACCINE- ADULT IM
|
Facility
|
OP
|
$47.18
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
30301161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.08
|
| Rate for Payer: Aetna Government |
$64.08
|
| Rate for Payer: Brighton Health Commercial |
$28.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.13
|
| Rate for Payer: Group Health Inc Commercial |
$23.59
|
| Rate for Payer: Group Health Inc Medicare |
$16.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.77
|
| Rate for Payer: SOMOS Essential |
$74.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.67
|
|
|
HEP A VACCINE- ADULT IM
|
Facility
|
IP
|
$47.18
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
30301161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.59
|
|
|
HEP B CORE AB,IGM
|
Facility
|
IP
|
$29.43
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
40729369
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.77
|
|
|
HEP B CORE AB,IGM
|
Facility
|
OP
|
$29.43
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
40729369
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HEP B CORE AB TOT
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
40729708
|
|
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
|
|
|
HEP B CORE AB TOT
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
40729708
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
HEP BE AB
|
Facility
|
IP
|
$28.93
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
40729370
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.57
|
|
|
HEP BE AB
|
Facility
|
OP
|
$28.93
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
40729370
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HEP BE AG
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
40729391
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
HEP BE AG
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
40729391
|
|
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
|
|
|
HEP B HIB (VFC) 0.5ML VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
41659558
|
|
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
|
|
|
HEP B HIB (VFC) 0.5ML VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
41649558
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.90
|
| Rate for Payer: Aetna Government |
$42.90
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
HEP B HIB (VFC) 0.5ML VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
41649558
|
|
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
|
|
|
HEP B HIB (VFC) 0.5ML VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
41659558
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.90
|
| Rate for Payer: Aetna Government |
$42.90
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
HEP B IMMUNE GLOBULIN 5ML DOSE
|
Facility
|
OP
|
$289.73
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
30105153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$188.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.35
|
| 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 |
$173.84
|
| Rate for Payer: Cash Price |
$137.89
|
| Rate for Payer: Cash Price |
$137.89
|
| 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 |
$144.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.89
|
| Rate for Payer: EmblemHealth Commercial |
$137.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.79
|
| 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 |
$144.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.86
|
| 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: Senior Whole Health Medicare Advantage |
$137.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.58
|
| Rate for Payer: SOMOS Essential |
$149.58
|
| Rate for Payer: United Healthcare Commercial |
$128.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.31
|
| Rate for Payer: Wellcare Medicare |
$131.00
|
|
|
HEP B IMMUNE GLOBULIN 5ML DOSE
|
Facility
|
IP
|
$289.73
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
30105153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.86 |
| Max. Negotiated Rate |
$144.86 |
| Rate for Payer: Cash Price |
$137.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.86
|
|
|
HEP B PED 10MCG/0.5ML SYR
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41649579
|
|
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
|
|
|
HEP B PED 10MCG/0.5ML SYR
|
Facility
|
IP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41659579
|
|
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
|
|
|
HEP B PED 10MCG/0.5ML SYR
|
Facility
|
OP
|
$28.15
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
41659579
|
|
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
|
|
