|
HC ANTIBODY - DENGUE VIRUS IGG AND IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| 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 |
$24.00
|
| 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 |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| 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 |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC ANTIBODY - HEPATITIS E VIRUS (HEV) IGG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ANTIBODY - HEPATITIS E VIRUS (HEV) IGG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| 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 |
$24.00
|
| 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 |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| 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 |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC ANTIBODY - HEPATITIS E VIRUS (HEV) IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| 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 |
$24.00
|
| 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 |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| 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 |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC ANTIBODY - HEPATITIS E VIRUS (HEV) IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ANTIBODY - HTLV-I/II
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| 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 |
$24.00
|
| 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 |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| 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 |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC ANTIBODY - HTLV-I/II
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ANTIBODY IDENTIFICATION - SEROTININ RELEASE ASSAY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
3018602201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.37
|
| Rate for Payer: Aetna Government |
$18.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.86
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.37
|
| Rate for Payer: EmblemHealth Commercial |
$18.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.35
|
| Rate for Payer: Group Health Inc Commercial |
$18.37
|
| Rate for Payer: Group Health Inc Medicare |
$18.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.37
|
| Rate for Payer: Healthfirst QHP |
$18.37
|
| Rate for Payer: Humana Medicare |
$18.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare Commercial |
$23.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.45
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
|
|
HC ANTIBODY IDENTIFICATION - SEROTININ RELEASE ASSAY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
3018602201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3028678002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.76
|
| Rate for Payer: Healthfirst Essential Plan |
$28.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.76
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3028678002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3028678001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.76
|
| Rate for Payer: Healthfirst Essential Plan |
$28.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.76
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3028678001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC ANTIBODY - ZIKA VIRUS MAC-ELISA (EUA)
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
3028679401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ANTIBODY - ZIKA VIRUS MAC-ELISA (EUA)
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
3028679401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$36.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.79
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Healthfirst Essential Plan |
$36.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Humana Medicare |
$17.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
HC ANTICOAGULATION MGMT EACH SUBS 90 DAYS
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 99364
|
| Hospital Charge Code |
5109936401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.00
|
| Rate for Payer: Aetna Government |
$165.00
|
| 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 |
$165.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC ANTICOAGULATION MGMT EACH SUBS 90 DAYS
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 99364
|
| Hospital Charge Code |
5109936401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED -TRAZODONE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3018033801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED -TRAZODONE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3018033801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$35.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$22.00
|
| Rate for Payer: Group Health Inc Commercial |
$22.00
|
| Rate for Payer: Group Health Inc Medicare |
$15.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$11.34
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - AMITRIPTYLINE LVL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - AMITRIPTYLINE LVL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: EmblemHealth Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$21.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - NORTRIPTYLINE LVL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: EmblemHealth Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$21.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - NORTRIPTYLINE LVL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC ANTIDEP TRICYCLIC/CYCLICALS 1-2 AMITRIPTYLINE LVL - BUNDLED CHARGE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.48
|
| Rate for Payer: EmblemHealth Commercial |
$18.00
|
| Rate for Payer: Group Health Inc Commercial |
$18.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$21.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC ANTIDEP TRICYCLIC/CYCLICALS 1-2 AMITRIPTYLINE LVL - BUNDLED CHARGE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
3018033508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
