|
HC ALLERGEN SPEC IGE - ALLERGEN CODFISH IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600364
|
|
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 CODFISH IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600364
|
|
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 CORN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600366
|
|
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 CORN IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600366
|
|
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 CRAB IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600371
|
|
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 CRAB IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600371
|
|
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 CRANBERRY IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600372
|
|
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 CRANBERRY IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600372
|
|
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 D FARINAE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038U
|
|
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 D FARINAE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038U
|
|
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 DOG DANDER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038Z
|
|
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 DOG DANDER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038Z
|
|
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 D PTERONYSSINUS
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038V
|
|
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 D PTERONYSSINUS
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860038V
|
|
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 DRUG: AMOXICILLOYL IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30286003C7
|
|
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 DRUG: AMOXICILLOYL IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30286003C7
|
|
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 DUCK FEATHERS IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600382
|
|
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 DUCK FEATHERS IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600382
|
|
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 EGG WHITE IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860039B
|
|
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 EGG WHITE IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
302860039B
|
|
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 EGG, WHOLE IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600384
|
|
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 EGG, WHOLE IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600384
|
|
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 EGG YOLK IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600383
|
|
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 EGG YOLK IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600383
|
|
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 EPICOCCUM PURPURASCEN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3028600388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
