|
HC FUNDAL PHOTOGRAPHY - FUNDUS PHOTOS - OS - LEFT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC FUNDAL PHOTOGRAPHY - FUNDUS PHOTOS - OS - LEFT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC FUNDAL PHOTOGRAPHY - FUNDUS PHOTOS - OU - BOTH EYES
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC FUNDAL PHOTOGRAPHY - FUNDUS PHOTOS - OU - BOTH EYES
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC FUNDAL PHOTOGRAPHY - MONOCHROMATIC FUNDUS PHOTOGRAPHY OS LEFT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC FUNDAL PHOTOGRAPHY - MONOCHROMATIC FUNDUS PHOTOGRAPHY OS LEFT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
9209225001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
3068710701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
3068710701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.22
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Healthfirst Essential Plan |
$22.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, ALTERNARIA TENUIS IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, ALTERNARIA TENUIS IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, AUREOBASIDIUM PUL IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, AUREOBASIDIUM PUL IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CANDIDA ALBICANS IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CANDIDA ALBICANS IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CLADOSPORIUM IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CLADOSPORIUM IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, FUSARIUM PRO/MON IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, FUSARIUM PRO/MON IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
3028667105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78264 TC
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$204.46
|
| Rate for Payer: Aetna Government |
$204.46
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.05
|
| Rate for Payer: EmblemHealth Commercial |
$272.83
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.83
|
| Rate for Payer: Healthfirst Essential Plan |
$465.48
|
| Rate for Payer: United Healthcare Commercial |
$191.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$206.88
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78264 TC
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY - SMALL BOWL
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78266 TC
|
| Hospital Charge Code |
3417826601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.18 |
| Max. Negotiated Rate |
$1,143.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$288.18
|
| Rate for Payer: Aetna Government |
$288.18
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,143.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$971.72
|
| Rate for Payer: EmblemHealth Commercial |
$366.65
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.65
|
| Rate for Payer: Healthfirst Essential Plan |
$900.95
|
| Rate for Payer: United Healthcare Commercial |
$353.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$400.42
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY - SMALL BOWL
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78266 TC
|
| Hospital Charge Code |
3417826601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY - SMALL BOWL & COLON
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78265 TC
|
| Hospital Charge Code |
3417826501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$891.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.69
|
| Rate for Payer: Aetna Government |
$217.69
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$891.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$757.52
|
| Rate for Payer: EmblemHealth Commercial |
$323.48
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.48
|
| Rate for Payer: Healthfirst Essential Plan |
$759.44
|
| Rate for Payer: United Healthcare Commercial |
$266.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$337.53
|
|
