|
HSC MOD PLUS GEL BREAST IMP
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40004201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.00 |
| Max. Negotiated Rate |
$895.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.00
|
|
|
HSV 1/2 PCR
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
40729395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HSV 1/2 PCR
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
40729395
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
HSV 1 AND 2-SPECIFIC AB, IGG
|
Facility
|
OP
|
$32.98
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
40619170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$24.74
|
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.55
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HSV 1 AND 2-SPECIFIC AB, IGG
|
Facility
|
IP
|
$32.98
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
40619170
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.19
|
|
|
HSV 2 IGG HERPESSELECT AB
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
40618417
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
HSV 2 IGG HERPESSELECT AB
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
40618417
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HSV CULTURE AND TYPING
|
Facility
|
IP
|
$84.65
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
40619193
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$33.86
|
|
|
HSV CULTURE AND TYPING
|
Facility
|
OP
|
$84.65
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
40619193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.86
|
| Rate for Payer: Aetna Government |
$33.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.70
|
| Rate for Payer: Brighton Health Commercial |
$63.49
|
| Rate for Payer: Cash Price |
$33.86
|
| Rate for Payer: Cash Price |
$33.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.86
|
| Rate for Payer: EmblemHealth Commercial |
$33.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.14
|
| Rate for Payer: Group Health Inc Commercial |
$33.86
|
| Rate for Payer: Group Health Inc Medicare |
$33.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.86
|
| Rate for Payer: Healthfirst QHP |
$33.86
|
| Rate for Payer: Humana Medicare |
$34.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.86
|
| Rate for Payer: United Healthcare Commercial |
$42.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.09
|
| Rate for Payer: Wellcare Medicare |
$30.47
|
|
|
HSV, IGM I/II COMBINATION
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
40619169
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.39
|
|
|
HSV, IGM I/II COMBINATION
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
40619169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$26.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.98
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HSV TYPE 1
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
30303378
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.90
|
| Rate for Payer: Brighton Health Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.57
|
| Rate for Payer: EmblemHealth Commercial |
$5.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.96
|
| Rate for Payer: Group Health Inc Commercial |
$5.57
|
| Rate for Payer: Group Health Inc Medicare |
$5.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.57
|
| Rate for Payer: Healthfirst QHP |
$5.57
|
| Rate for Payer: Humana Medicare |
$5.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.57
|
| Rate for Payer: United Healthcare Commercial |
$7.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.46
|
| Rate for Payer: Wellcare Medicare |
$5.01
|
|
|
HSV TYPE 1
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
30303378
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$5.57
|
|
|
HSV TYPE 2-SPECIFIC AB, IGG
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
40619171
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HSV TYPE 2-SPECIFIC AB, IGG
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
40619171
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
HTA PROCEDURE SET
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
40200886
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$654.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$595.00
|
| Rate for Payer: Aetna Government |
$595.00
|
| Rate for Payer: Brighton Health Commercial |
$892.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$952.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$809.20
|
| Rate for Payer: Group Health Inc Commercial |
$595.00
|
| Rate for Payer: Group Health Inc Medicare |
$416.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$595.00
|
|
|
HTLV-I/II ANTIBODIES, QUAL
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729385
|
|
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
|
|
|
HTLV-I/II ANTIBODIES, QUAL
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729385
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.88
|
|
|
HUBER NEEDLE
|
Facility
|
OP
|
$4.25
|
|
| Hospital Charge Code |
40200085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$3.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: Group Health Inc Commercial |
$2.12
|
| Rate for Payer: Group Health Inc Medicare |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.12
|
|
|
HUMAN CANCELLOUS CRUSHED 0.5 CC
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.25
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.50
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.50
|
|
|
HUMAN CANCELLOUS CRUSHED 0.5 CC
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
HUMAN CANCELLOUS CRUSHED 10CC
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.50
|
|
|
HUMAN CANCELLOUS CRUSHED 10CC
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$266.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$291.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$242.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.88
|
| Rate for Payer: EmblemHealth Commercial |
$242.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$509.25
|
| Rate for Payer: Group Health Inc Commercial |
$242.50
|
| Rate for Payer: Group Health Inc Medicare |
$169.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.25
|
|
|
HUMAN CANCELLOUS CRUSHED 5CC
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
HUMAN CANCELLOUS CRUSHED 5CC
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40001237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$180.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$172.50
|
| Rate for Payer: EmblemHealth Commercial |
$150.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
|
