|
HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
6369074401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
|
|
HC HEP C AB TEST, CONFIRM - HEPATITIS C VIRUS, RIBA
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
3028680401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC HEP C AB TEST, CONFIRM - HEPATITIS C VIRUS, RIBA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
3028680401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Healthfirst Essential Plan |
$34.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
HC HEROIN METABOLITE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
3018035601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$69.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.24
|
| Rate for Payer: EmblemHealth Commercial |
$46.50
|
| Rate for Payer: Group Health Inc Commercial |
$46.50
|
| Rate for Payer: Group Health Inc Medicare |
$32.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$23.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC HEROIN METABOLITE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
3018035601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.50
|
|
|
HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Healthfirst Essential Plan |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Wellcare Medicare |
$17.41
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGG AB
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
3028669401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGG AB
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
3028669401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.67
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$10.76 |
| 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 |
$4.78
|
| Rate for Payer: Healthfirst Essential Plan |
$10.76
|
| 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 |
$4.78
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
HC HEXA GENE ANALYSIS COMMON VARIANTS - TAY-SACHS DISEASE PROFILE
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 81255
|
| Hospital Charge Code |
3008125501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.45
|
| Rate for Payer: Aetna Government |
$51.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$36.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$36.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$36.02
|
| Rate for Payer: Brighton Health Commercial |
$96.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.45
|
| Rate for Payer: EmblemHealth Commercial |
$51.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.79
|
| Rate for Payer: Group Health Inc Commercial |
$51.45
|
| Rate for Payer: Group Health Inc Medicare |
$51.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.45
|
| Rate for Payer: Healthfirst QHP |
$51.45
|
| Rate for Payer: Humana Medicare |
$52.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.45
|
| Rate for Payer: United Healthcare Commercial |
$46.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.88
|
| Rate for Payer: Wellcare Medicare |
$46.30
|
|
|
HC HEXA GENE ANALYSIS COMMON VARIANTS - TAY-SACHS DISEASE PROFILE
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 81255
|
| Hospital Charge Code |
3008125501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.00
|
|
|
HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
3108125601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Government |
$65.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.75
|
| Rate for Payer: Brighton Health Commercial |
$65.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.36
|
| Rate for Payer: EmblemHealth Commercial |
$65.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.17
|
| Rate for Payer: Group Health Inc Commercial |
$65.36
|
| Rate for Payer: Group Health Inc Medicare |
$65.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.36
|
| Rate for Payer: Healthfirst QHP |
$65.36
|
| Rate for Payer: Humana Medicare |
$66.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$62.09
|
| Rate for Payer: Wellcare Medicare |
$58.82
|
|
|
HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
3108125601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
6369064701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
|
|
HC HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
6369064701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$111.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.48
|
| Rate for Payer: Aetna Government |
$28.48
|
| Rate for Payer: Brighton Health Commercial |
$121.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.72
|
| Rate for Payer: EmblemHealth Commercial |
$101.50
|
| Rate for Payer: Group Health Inc Commercial |
$101.50
|
| Rate for Payer: Group Health Inc Medicare |
$71.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.95
|
|
|
HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
6369064801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.42
|
| Rate for Payer: Aetna Government |
$12.42
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.38
|
| Rate for Payer: EmblemHealth Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.25
|
|
|
HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
6369064801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
HC HISTOPLASMA - HISTOPLASMA ANTIBODIES
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
3028669801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
|
|
HC HISTOPLASMA - HISTOPLASMA ANTIBODIES
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
3028669801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.79
|
| Rate for Payer: Aetna Government |
$13.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.65
|
| Rate for Payer: Brighton Health Commercial |
$63.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.79
|
| Rate for Payer: EmblemHealth Commercial |
$13.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.27
|
| Rate for Payer: Group Health Inc Commercial |
$13.79
|
| Rate for Payer: Group Health Inc Medicare |
$13.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Healthfirst Essential Plan |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.79
|
| Rate for Payer: Healthfirst QHP |
$13.79
|
| Rate for Payer: Humana Medicare |
$14.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare Commercial |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Wellcare Medicare |
$12.41
|
|
|
HC HIV-1, DNA, DIR PROBE - HIV-1 DNA PROBE, DIRECT
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87534
|
| Hospital Charge Code |
3068753401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.92
|
| Rate for Payer: Aetna Government |
$21.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.34
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.92
|
| 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 |
$21.92
|
| Rate for Payer: EmblemHealth Commercial |
$21.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.51
|
| Rate for Payer: Group Health Inc Commercial |
$21.92
|
| Rate for Payer: Group Health Inc Medicare |
$21.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.92
|
| Rate for Payer: Healthfirst QHP |
$21.92
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.92
|
| Rate for Payer: United Healthcare Commercial |
$25.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.82
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
|
|
HC HIV-1, DNA, DIR PROBE - HIV-1 DNA PROBE, DIRECT
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87534
|
| Hospital Charge Code |
3068753401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
