|
HC CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
3068711601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.80
|
| Rate for Payer: Aetna Government |
$10.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.56
|
| Rate for Payer: Brighton Health Commercial |
$59.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.80
|
| Rate for Payer: EmblemHealth Commercial |
$10.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.61
|
| Rate for Payer: Group Health Inc Commercial |
$10.80
|
| Rate for Payer: Group Health Inc Medicare |
$10.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.80
|
| Rate for Payer: Healthfirst Essential Plan |
$24.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.80
|
| Rate for Payer: Healthfirst QHP |
$10.80
|
| Rate for Payer: Humana Medicare |
$11.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.80
|
| Rate for Payer: Wellcare Medicare |
$9.72
|
|
|
HC CULTURE, TYPING BLOOD PATHOGEN ID & RESISTANCE TYPING, 6 OR MORE TARGETS
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
3018715401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$218.06
|
| Rate for Payer: Aetna Government |
$218.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$152.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$152.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$152.64
|
| Rate for Payer: Brighton Health Commercial |
$321.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$342.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$291.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$218.06
|
| Rate for Payer: EmblemHealth Commercial |
$218.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.07
|
| Rate for Payer: Group Health Inc Commercial |
$218.06
|
| Rate for Payer: Group Health Inc Medicare |
$218.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.06
|
| Rate for Payer: Healthfirst QHP |
$218.06
|
| Rate for Payer: Humana Medicare |
$222.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.06
|
| Rate for Payer: United Healthcare Commercial |
$196.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$207.16
|
| Rate for Payer: Wellcare Medicare |
$196.25
|
|
|
HC CULTURE, TYPING BLOOD PATHOGEN ID & RESISTANCE TYPING, 6 OR MORE TARGETS
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
3018715401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.00
|
|
|
HC CULTURE, TYPING, DNA/RNA AMPLIFIED PROBE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
3068715001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CULTURE, TYPING, DNA/RNA AMPLIFIED PROBE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
3068715001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| 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 |
$65.25
|
| 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 |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| 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 |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$33.34
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
3068714001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
3068714001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| 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 |
$9.75
|
| 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 |
$9.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.57
|
| Rate for Payer: EmblemHealth Commercial |
$5.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.01
|
| 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 |
$5.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$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 |
$5.29
|
| Rate for Payer: Wellcare Medicare |
$5.01
|
|
|
HC CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID PER CULTURE OR ISOLATE, EACH ORGANISM PROBED
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
3068714901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.05
|
| Rate for Payer: Aetna Government |
$20.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.04
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.05
|
| Rate for Payer: EmblemHealth Commercial |
$20.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.84
|
| Rate for Payer: Group Health Inc Commercial |
$20.05
|
| Rate for Payer: Group Health Inc Medicare |
$20.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.05
|
| Rate for Payer: Healthfirst QHP |
$20.05
|
| Rate for Payer: Humana Medicare |
$20.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.05
|
| Rate for Payer: United Healthcare Commercial |
$25.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.05
|
| Rate for Payer: Wellcare Medicare |
$18.05
|
|
|
HC CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID PER CULTURE OR ISOLATE, EACH ORGANISM PROBED
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
3068714901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
3068715301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$196.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$115.36
|
| Rate for Payer: Aetna Government |
$115.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$80.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$80.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$80.75
|
| Rate for Payer: Brighton Health Commercial |
$78.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$115.36
|
| Rate for Payer: EmblemHealth Commercial |
$115.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.67
|
| Rate for Payer: Group Health Inc Commercial |
$115.36
|
| Rate for Payer: Group Health Inc Medicare |
$115.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.36
|
| Rate for Payer: Healthfirst QHP |
$115.36
|
| Rate for Payer: Humana Medicare |
$117.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.36
|
| Rate for Payer: United Healthcare Commercial |
$146.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$109.59
|
| Rate for Payer: Wellcare Medicare |
$103.82
|
|
|
HC CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
3068715301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
|
|
HC CULTURE, TYPING, IMMUNOLOGIC METHOD
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
3068714701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.92
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
HC CULTURE, TYPING, IMMUNOLOGIC METHOD
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
3068714701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC CULTURE, TYPING; OTHER METHODS
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87158
|
| Hospital Charge Code |
3068715801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Government |
$7.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.42
|
| Rate for Payer: Brighton Health Commercial |
$76.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.74
|
| Rate for Payer: EmblemHealth Commercial |
$7.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.89
|
| Rate for Payer: Group Health Inc Commercial |
$7.74
|
| Rate for Payer: Group Health Inc Medicare |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.74
|
| Rate for Payer: Healthfirst QHP |
$7.74
|
| Rate for Payer: Humana Medicare |
$7.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.74
|
| Rate for Payer: United Healthcare Commercial |
$6.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
|
|
HC CULTURE, TYPING; OTHER METHODS
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87158
|
| Hospital Charge Code |
3068715801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
|
|
HC CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
3615916001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC CURETTAGE, POSTPARTUM
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
3615916001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC CURETTE/TREAT CORNEA
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
5106543501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,222.00 |
| Max. Negotiated Rate |
$1,222.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,222.00
|
|
|
HC CURETTE/TREAT CORNEA
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
5106543501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$1,242.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| 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 |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
|
HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
3028620001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
3028620001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.95
|
| Rate for Payer: Aetna Government |
$12.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.06
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.95
|
| Rate for Payer: EmblemHealth Commercial |
$12.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.53
|
| Rate for Payer: Group Health Inc Commercial |
$12.95
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.95
|
| Rate for Payer: Healthfirst QHP |
$12.95
|
| Rate for Payer: Humana Medicare |
$13.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.30
|
| Rate for Payer: Wellcare Medicare |
$11.65
|
|
|
HC CYMETRA INJECTABLE 1 CC
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT Q4112
|
| Hospital Charge Code |
636Q411201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$301.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.00
|
|
|
HC CYMETRA INJECTABLE 1 CC
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT Q4112
|
| Hospital Charge Code |
636Q411201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$872.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$331.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$872.08
|
| Rate for Payer: Aetna Government |
$872.08
|
| Rate for Payer: Brighton Health Commercial |
$361.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$301.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$346.15
|
| Rate for Payer: EmblemHealth Commercial |
$301.00
|
| Rate for Payer: Group Health Inc Commercial |
$301.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.30
|
|
|
HC CYSTOGRPHY / VOIDING URETHROCYSTOGRAPHY
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
3615160001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.50
|
|
|
HC CYSTOGRPHY / VOIDING URETHROCYSTOGRAPHY
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
3615160001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.87
|
| Rate for Payer: Aetna Government |
$53.87
|
| Rate for Payer: Brighton Health Commercial |
$453.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$302.50
|
| Rate for Payer: Group Health Inc Commercial |
$302.50
|
| Rate for Payer: Group Health Inc Medicare |
$211.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.68
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
