|
HC HIV-1 - HIV 1 ANTIBODY EIA
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$22.73
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$10.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.00
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$22.73
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
HC HIV-1 - HIV 1 ANTIBODY EIA
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
|
|
HC HIV-1 - HIV 1 ANTIBODY EIA MATERNAL
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$22.73
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$10.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.00
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$22.73
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
HC HIV-1 - HIV 1 ANTIBODY EIA MATERNAL
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
|
|
HC HIV-1 - HIV 1 ANTIBODY EIA ORASURE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
|
|
HC HIV-1 - HIV 1 ANTIBODY EIA ORASURE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3028670103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$22.73
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$10.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.00
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$22.73
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
HC HIV-1/HIV-2, ORAQUICK - RAPID HIV 1 AND 2 SCREEN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
3028670302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC HIV-1/HIV-2, ORAQUICK - RAPID HIV 1 AND 2 SCREEN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
3028670302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.71
|
| Rate for Payer: Aetna Government |
$13.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.59
|
| Rate for Payer: Amida Care Medicaid |
$15.59
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.71
|
| Rate for Payer: EmblemHealth Commercial |
$13.71
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$35.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$15.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$13.71
|
| Rate for Payer: Group Health Inc Medicare |
$13.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,559.00
|
| Rate for Payer: Healthfirst Essential Plan |
$35.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.71
|
| Rate for Payer: Healthfirst QHP |
$25.41
|
| Rate for Payer: Humana Medicare |
$13.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: SOMOS Essential |
$35.08
|
| Rate for Payer: United Healthcare Commercial |
$17.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.15
|
| Rate for Payer: United Healthcare Medicaid |
$15.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.59
|
| Rate for Payer: Wellcare Medicare |
$12.34
|
|
|
HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
3028670301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
3028670301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.71
|
| Rate for Payer: Aetna Government |
$13.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.59
|
| Rate for Payer: Amida Care Medicaid |
$15.59
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.71
|
| Rate for Payer: EmblemHealth Commercial |
$13.71
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$35.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$15.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$13.71
|
| Rate for Payer: Group Health Inc Medicare |
$13.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,559.00
|
| Rate for Payer: Healthfirst Essential Plan |
$35.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.71
|
| Rate for Payer: Healthfirst QHP |
$25.41
|
| Rate for Payer: Humana Medicare |
$13.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: SOMOS Essential |
$35.08
|
| Rate for Payer: United Healthcare Commercial |
$17.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.15
|
| Rate for Payer: United Healthcare Medicaid |
$15.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.59
|
| Rate for Payer: Wellcare Medicare |
$12.34
|
|
|
HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
3068753501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| 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 |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| 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 |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
3068753501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3068753601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$191.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.10
|
| Rate for Payer: Healthfirst Essential Plan |
$191.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$85.10
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3068753601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.00
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3068753602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.00
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3068753602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$191.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.10
|
| Rate for Payer: Healthfirst Essential Plan |
$191.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$85.10
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
HC HIV-2 - HIV-2 ANTIBODIES
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
3028670201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$1,538.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.52
|
| Rate for Payer: Aetna Government |
$13.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$34.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$34.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.38
|
| Rate for Payer: Amida Care Medicaid |
$15.38
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.52
|
| Rate for Payer: EmblemHealth Commercial |
$13.52
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$34.60
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$15.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.15
|
| Rate for Payer: Group Health Inc Commercial |
$13.52
|
| Rate for Payer: Group Health Inc Medicare |
$13.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,538.00
|
| Rate for Payer: Healthfirst Essential Plan |
$34.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.52
|
| Rate for Payer: Healthfirst QHP |
$25.07
|
| Rate for Payer: Humana Medicare |
$13.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.38
|
| Rate for Payer: SOMOS Essential |
$34.60
|
| Rate for Payer: United Healthcare Commercial |
$17.13
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$34.60
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$16.92
|
| Rate for Payer: United Healthcare Medicaid |
$15.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.38
|
| Rate for Payer: Wellcare Medicare |
$12.17
|
|
|
HC HIV-2 - HIV-2 ANTIBODIES
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
3028670201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC HIV-2 PROBE&REVRSE TRNSCRIPJ - HIV-2 DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
3068753801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.60
|
| 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 |
$159.00
|
| 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 HIV-2 PROBE&REVRSE TRNSCRIPJ - HIV-2 DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
3068753801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.00
|
|
|
HC HLA CLASS II TYPING, LOW RESOLUTION ONE ANTIGEN EQUIVALT, EACH
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 81377
|
| Hospital Charge Code |
3108137701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.74
|
| Rate for Payer: Aetna Government |
$94.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$66.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$66.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$66.32
|
| Rate for Payer: Brighton Health Commercial |
$94.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$273.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$94.74
|
| Rate for Payer: EmblemHealth Commercial |
$94.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.32
|
| Rate for Payer: Group Health Inc Commercial |
$94.74
|
| Rate for Payer: Group Health Inc Medicare |
$94.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.74
|
| Rate for Payer: Healthfirst QHP |
$94.74
|
| Rate for Payer: Humana Medicare |
$96.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$90.00
|
| Rate for Payer: Wellcare Medicare |
$85.27
|
|
|
HC HLA CLASS II TYPING, LOW RESOLUTION ONE ANTIGEN EQUIVALT, EACH
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 81377
|
| Hospital Charge Code |
3108137701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.00
|
|
|
HC HLA CLASS II TYPING, LOW RES, ONE ANTIGEN
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
3108137401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.03 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.33
|
| Rate for Payer: Aetna Government |
$74.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$52.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.03
|
| Rate for Payer: Brighton Health Commercial |
$74.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$148.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.33
|
| Rate for Payer: EmblemHealth Commercial |
$74.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.15
|
| Rate for Payer: Group Health Inc Commercial |
$74.33
|
| Rate for Payer: Group Health Inc Medicare |
$74.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.33
|
| Rate for Payer: Healthfirst QHP |
$74.33
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$70.61
|
| Rate for Payer: Wellcare Medicare |
$66.90
|
|
|
HC HLA CLASS II TYPING, LOW RES, ONE ANTIGEN
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
3108137401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$92.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.50
|
|
|
HC HLA CLASS II TYPING, LOW RES,ONE FOCUS, DRB1,DRB345
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
3108137601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.55 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.22
|
| Rate for Payer: Aetna Government |
$122.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$85.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$85.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$85.55
|
| Rate for Payer: Brighton Health Commercial |
$122.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$207.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$122.22
|
| Rate for Payer: EmblemHealth Commercial |
$122.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.78
|
| Rate for Payer: Group Health Inc Commercial |
$122.22
|
| Rate for Payer: Group Health Inc Medicare |
$122.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.22
|
| Rate for Payer: Healthfirst QHP |
$122.22
|
| Rate for Payer: Humana Medicare |
$124.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$116.11
|
| Rate for Payer: Wellcare Medicare |
$110.00
|
|
