|
HIP/STEM
|
Facility
|
OP
|
$9,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,507.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,979.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$5,432.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,527.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,206.28
|
| Rate for Payer: EmblemHealth Commercial |
$4,527.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,507.12
|
| Rate for Payer: Group Health Inc Commercial |
$4,527.20
|
| Rate for Payer: Group Health Inc Medicare |
$3,169.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,527.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,527.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,885.36
|
|
|
HIP/STEM
|
Facility
|
IP
|
$9,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,527.20 |
| Max. Negotiated Rate |
$4,527.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,527.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,527.20
|
|
|
HIP SYSTEM
|
Facility
|
OP
|
$24,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$25,347.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,277.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$14,484.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,070.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,880.50
|
| Rate for Payer: EmblemHealth Commercial |
$12,070.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,347.00
|
| Rate for Payer: Group Health Inc Commercial |
$12,070.00
|
| Rate for Payer: Group Health Inc Medicare |
$8,449.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,070.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,691.00
|
|
|
HIP SYSTEM
|
Facility
|
IP
|
$24,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,070.00 |
| Max. Negotiated Rate |
$12,070.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,070.00
|
|
|
HIP ZMR FEM 12/14 43MM C
|
Facility
|
IP
|
$8,175.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.85 |
| Max. Negotiated Rate |
$4,087.85 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,087.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,087.85
|
|
|
HIP ZMR FEM 12/14 43MM C
|
Facility
|
OP
|
$8,175.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$8,584.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,496.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$4,905.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,087.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,701.03
|
| Rate for Payer: EmblemHealth Commercial |
$4,087.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,584.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,087.85
|
| Rate for Payer: Group Health Inc Medicare |
$2,861.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,087.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,087.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,314.20
|
|
|
HISTOPLASMA ANTIGEN, URINE
|
Facility
|
IP
|
$33.13
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
40729392
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.25
|
|
|
HISTOPLASMA ANTIGEN, URINE
|
Facility
|
OP
|
$33.13
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
40729392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.85
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.60
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
HIV 1/2 EIA, SCR W/RFL
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
40728338
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.71
|
|
|
HIV 1/2 EIA, SCR W/RFL
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
40728338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.71
|
| Rate for Payer: Aetna Government |
$13.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.59
|
| Rate for Payer: Amida Care Medicaid |
$15.59
|
| Rate for Payer: Brighton Health Commercial |
$25.71
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.71
|
| Rate for Payer: EmblemHealth Commercial |
$13.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,559.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$13.71
|
| Rate for Payer: Group Health Inc Medicare |
$13.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.59
|
| Rate for Payer: Healthfirst Essential Plan |
$35.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.71
|
| Rate for Payer: Healthfirst QHP |
$15.59
|
| Rate for Payer: Humana Medicare |
$13.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: SOMOS Essential |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$17.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.15
|
| Rate for Payer: United Healthcare Medicaid |
$15.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.97
|
| Rate for Payer: Wellcare Medicare |
$12.34
|
|
|
HIV-1 AB CONF, WB
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
40728381
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
HIV-1 AB CONF, WB
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
40728381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
|
|
HIV-1 AB, EIA
|
Facility
|
IP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40728193
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$8.89
|
|
|
HIV-1 AB, EIA
|
Facility
|
OP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40728193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.67
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,010.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$10.10
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
HIV1 ANTIGEN W HIV1&2 ANTIBODIES
|
Facility
|
OP
|
$60.20
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
40609153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Government |
$24.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.86
|
| Rate for Payer: Brighton Health Commercial |
$45.15
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.08
|
| Rate for Payer: EmblemHealth Commercial |
$24.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.43
|
| Rate for Payer: Group Health Inc Commercial |
$24.08
|
| Rate for Payer: Group Health Inc Medicare |
$24.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.08
|
| Rate for Payer: Healthfirst QHP |
$24.08
|
| Rate for Payer: Humana Medicare |
$24.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare Commercial |
$30.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.26
|
| Rate for Payer: Wellcare Medicare |
$21.67
|
|
|
HIV1 ANTIGEN W HIV1&2 ANTIBODIES
|
Facility
|
IP
|
$60.20
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
40609153
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$24.08
|
|
|
HIV1 GENOTYPE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
40609632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$204.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.73
|
| Rate for Payer: Aetna Government |
$128.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.11
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$128.73
|
| Rate for Payer: EmblemHealth Commercial |
$128.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.57
|
| Rate for Payer: Group Health Inc Commercial |
$128.73
|
| Rate for Payer: Group Health Inc Medicare |
$128.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.73
|
| Rate for Payer: Healthfirst QHP |
$128.73
|
| Rate for Payer: Humana Medicare |
$131.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.73
|
| Rate for Payer: United Healthcare Commercial |
$163.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$102.98
|
| Rate for Payer: Wellcare Medicare |
$115.86
|
|
|
HIV1 GENOTYPE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
40609632
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$128.73
|
|
|
HIV-1 RNA, QUANT REAL-TIME PCR
|
Facility
|
OP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40608378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.08
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
HIV-1 RNA, QUANT REAL-TIME PCR
|
Facility
|
IP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40608378
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$85.10
|
|
|
HIV-2 AB IMMUNOBLOT
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
40728382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
|
|
HIV-2 AB IMMUNOBLOT
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
40728382
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
HIV AG/AB COMBO
|
Facility
|
IP
|
$60.20
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
40602690
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$24.08
|
|
|
HIV AG/AB COMBO
|
Facility
|
OP
|
$60.20
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
40602690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Government |
$24.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.86
|
| Rate for Payer: Brighton Health Commercial |
$45.15
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.08
|
| Rate for Payer: EmblemHealth Commercial |
$24.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.43
|
| Rate for Payer: Group Health Inc Commercial |
$24.08
|
| Rate for Payer: Group Health Inc Medicare |
$24.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.08
|
| Rate for Payer: Healthfirst QHP |
$24.08
|
| Rate for Payer: Humana Medicare |
$24.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare Commercial |
$30.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.26
|
| Rate for Payer: Wellcare Medicare |
$21.67
|
|
|
HIV PEP STARTER PACK [401285]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 09999123476
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| 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
|
|
