|
HC DETECT AGENT, MULT ORGS, DNA, AMP - BORDETELLA PERTUSS/PARAPERTUSS
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3068780101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.20
|
| Rate for Payer: Aetna Government |
$70.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.14
|
| Rate for Payer: Brighton Health Commercial |
$57.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.20
|
| Rate for Payer: EmblemHealth Commercial |
$70.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.48
|
| Rate for Payer: Group Health Inc Commercial |
$70.20
|
| Rate for Payer: Group Health Inc Medicare |
$70.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.40
|
| Rate for Payer: Healthfirst Essential Plan |
$90.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.20
|
| Rate for Payer: Healthfirst QHP |
$70.20
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$88.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.40
|
| Rate for Payer: Wellcare Medicare |
$63.18
|
|
|
HC DETECT AGENT, MULT ORGS, DNA, AMP - BORDETELLA PERTUSS/PARAPERTUSS
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3068780101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
|
|
HC DETECT AGENT NOS, DNA, AMP - EPSTEIN-BARR VIRUS PCR
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779801
|
|
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 DETECT AGENT NOS, DNA, AMP - EPSTEIN-BARR VIRUS PCR
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC DETECT AGENT NOS, DNA, AMP - INFLUENZA A H1N1
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779802
|
|
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 DETECT AGENT NOS, DNA, AMP - INFLUENZA A H1N1
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC DETECT AGENT NOS, DNA, AMP - JC VIRUS ,PCR, CSF
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC DETECT AGENT NOS, DNA, AMP - JC VIRUS ,PCR, CSF
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779805
|
|
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 DETECT AGENT NOS, DNA, AMP - VARICELLA ZOSTER VIRUS, PCR
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC DETECT AGENT NOS, DNA, AMP - VARICELLA ZOSTER VIRUS, PCR
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779804
|
|
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 DETECT AGENT NOS, DNA, AMP - ZIKA VIRUS RT-PCR
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779803
|
|
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 DETECT AGENT NOS, DNA, AMP - ZIKA VIRUS RT-PCR
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3068779803
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - EPSTEIN-BARR VIRUS DNA, QUANTITATIVE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - EPSTEIN-BARR VIRUS DNA, QUANTITATIVE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - JC VIRUSM DNA, QUANTITATIVE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - JC VIRUSM DNA, QUANTITATIVE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - VARICELLA ZOSTER DNA, QUANTITATIVE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - VARICELLA ZOSTER DNA, QUANTITATIVE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3068779903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
HC DETERMINATION OF REFRACTIVE STATE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 92015
|
| Hospital Charge Code |
5109201501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.61
|
| Rate for Payer: Aetna Government |
$16.61
|
| 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 |
$149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC DETERMINATION OF REFRACTIVE STATE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 92015
|
| Hospital Charge Code |
5109201501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.00
|
|
|
HC DETOXIFICATION PRIVATE
|
Facility
|
IP
|
$4,209.00
|
|
| Hospital Charge Code |
1260000002
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$2,104.50 |
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$933.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,104.50
|
| Rate for Payer: Optum Commercial/Medicare |
$1,043.00
|
| Rate for Payer: Optum Medicaid |
$1,023.00
|
|
|
HC DETOXIFICATION SEMI-PRIVATE
|
Facility
|
IP
|
$4,093.00
|
|
| Hospital Charge Code |
1260000001
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$2,046.50 |
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$933.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.50
|
| Rate for Payer: Optum Commercial/Medicare |
$1,043.00
|
| Rate for Payer: Optum Medicaid |
$1,023.00
|
|
|
HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
9189611001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.00
|
|
|
HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
9189611001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
| Rate for Payer: Aetna Government |
$8.11
|
| Rate for Payer: Brighton Health Commercial |
$238.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.24
|
| Rate for Payer: EmblemHealth Commercial |
$159.00
|
| Rate for Payer: Group Health Inc Commercial |
$159.00
|
| Rate for Payer: Group Health Inc Medicare |
$111.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$159.00
|
|
|
HC DEVEL TST PHYS/QHP 1ST HR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
9189611201
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$430.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| 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 |
$314.25
|
| 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 |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| 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 |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.08
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Healthfirst Essential Plan |
$430.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$312.16
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.51
|
| 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 |
$191.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: SOMOS Essential |
$430.90
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| 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 |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
