|
HC ALCOHOL &/OR DRUG INTERVENTION-PLANNED
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT H0022
|
| Hospital Charge Code |
900H002201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$23.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.03
|
| Rate for Payer: Aetna Government |
$23.03
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
|
|
HC ALCOHOL/SBS INTERVENTION 15-30 MIN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT G0396
|
| Hospital Charge Code |
940G039601
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ALCOHOL/SBS INTERVENTION 15-30 MIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT G0396
|
| Hospital Charge Code |
940G039601
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$323.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.40
|
| Rate for Payer: Aetna Government |
$36.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$323.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$323.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$143.63
|
| Rate for Payer: Amida Care Medicaid |
$143.63
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$143.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.40
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$323.16
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$143.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.81
|
| Rate for Payer: Group Health Inc Commercial |
$36.40
|
| Rate for Payer: Group Health Inc Medicare |
$36.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.63
|
| Rate for Payer: Healthfirst Essential Plan |
$323.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.94
|
| Rate for Payer: Healthfirst QHP |
$234.11
|
| Rate for Payer: Humana Medicare |
$37.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.16
|
| Rate for Payer: Optum Medicaid |
$0.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.63
|
| Rate for Payer: SOMOS Essential |
$323.16
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$323.16
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$157.99
|
| Rate for Payer: United Healthcare Medicaid |
$143.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$143.63
|
| Rate for Payer: Wellcare Medicare |
$34.58
|
|
|
HC ALCOHOL/SUBS ABUSE SVCS, FAMILY/COUPLE COUNSELING
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT T1006
|
| Hospital Charge Code |
945T100601
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
|
|
HC ALCOHOL/SUBS ABUSE SVCS, FAMILY/COUPLE COUNSELING
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT T1006
|
| Hospital Charge Code |
945T100601
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.08
|
| Rate for Payer: Aetna Government |
$28.08
|
| Rate for Payer: Brighton Health Commercial |
$210.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$224.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.08
|
| Rate for Payer: EmblemHealth Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Medicare |
$98.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.50
|
| Rate for Payer: Optum Commercial/Medicare |
$239.00
|
|
|
HC ALCOHOL/SUBS ABUSE SVCS, SKILLS DEVELOPMENT
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT T1012
|
| Hospital Charge Code |
945T101201
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.22
|
| Rate for Payer: Aetna Government |
$11.22
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: EmblemHealth Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: Optum Commercial/Medicare |
$239.00
|
|
|
HC ALCOHOL/SUBS ABUSE SVCS, SKILLS DEVELOPMENT
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT T1012
|
| Hospital Charge Code |
945T101201
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
|
|
HC ALCOHOL/SUBS ASSESS > 30 MIN
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT G0397
|
| Hospital Charge Code |
940G039701
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$430.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.31
|
| Rate for Payer: Aetna Government |
$196.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$430.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$430.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$191.51
|
| Rate for Payer: Amida Care Medicaid |
$191.51
|
| Rate for Payer: Brighton Health Commercial |
$177.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$191.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$196.31
|
| Rate for Payer: EmblemHealth Commercial |
$196.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$430.90
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$191.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.08
|
| Rate for Payer: Group Health Inc Commercial |
$196.31
|
| Rate for Payer: Group Health Inc Medicare |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Healthfirst Essential Plan |
$430.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.86
|
| Rate for Payer: Healthfirst QHP |
$312.16
|
| Rate for Payer: Humana Medicare |
$200.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$430.90
|
| Rate for Payer: Optum Medicaid |
$0.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: SOMOS Essential |
$430.90
|
| Rate for Payer: United Healthcare Commercial |
$118.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$430.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$210.66
|
| Rate for Payer: United Healthcare Medicaid |
$191.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Wellcare Medicare |
$186.49
|
|
|
HC ALCOHOL/SUBS ASSESS > 30 MIN
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT G0397
|
| Hospital Charge Code |
940G039701
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC ALC/SUBSTANCE ABUSE SCREENING OVER 30 MIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 99409
|
| Hospital Charge Code |
5109940901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
|
|
HC ALC/SUBSTANCE ABUSE SCREENING OVER 30 MIN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 99409
|
| Hospital Charge Code |
5109940901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.53 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.53
|
| Rate for Payer: Aetna Government |
$49.53
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC ALKALOIDS NOT OTHERWISE SPECIFIED - NICOTINE SCREEN URINE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
3018032301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC ALKALOIDS NOT OTHERWISE SPECIFIED - NICOTINE SCREEN URINE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
3018032301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: EmblemHealth Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Medicare |
$37.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMI, RECOMBINANT/PURIFIED COMPONENT, EACH
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
3018600801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$19.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
HC ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMI, RECOMBINANT/PURIFIED COMPONENT, EACH
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
3018600801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALDER, SMOOTH IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860037R
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALDER, SMOOTH IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860037R
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALFALFA IGE
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALFALFA IGE
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALLSPICE IGE
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALLSPICE IGE
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALMONDS IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ALMONDS IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN AMPICILLIN IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860037T
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Healthfirst Essential Plan |
$8.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.69
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN AMPICILLIN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860037T
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
