|
HC HLA CLASS II TYPING, LOW RES,ONE FOCUS, DRB1,DRB345
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
3108137601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$152.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.50
|
|
|
HC HLA CLASS I TYPING, HIGH RES-B5701
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
3108138101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$118.93 |
| Max. Negotiated Rate |
$339.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.90
|
| Rate for Payer: Aetna Government |
$169.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$118.93
|
| Rate for Payer: Brighton Health Commercial |
$169.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$339.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$169.90
|
| Rate for Payer: EmblemHealth Commercial |
$169.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.21
|
| Rate for Payer: Group Health Inc Commercial |
$169.90
|
| Rate for Payer: Group Health Inc Medicare |
$169.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.90
|
| Rate for Payer: Healthfirst QHP |
$169.90
|
| Rate for Payer: Humana Medicare |
$173.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$161.41
|
| Rate for Payer: Wellcare Medicare |
$152.91
|
|
|
HC HLA CLASS I TYPING, HIGH RES-B5701
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
3108138101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$212.00 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.00
|
|
|
HC HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
3108137301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.43
|
| Rate for Payer: Aetna Government |
$127.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.20
|
| Rate for Payer: Brighton Health Commercial |
$127.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.43
|
| 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 |
$127.43
|
| Rate for Payer: EmblemHealth Commercial |
$127.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.41
|
| Rate for Payer: Group Health Inc Commercial |
$127.43
|
| Rate for Payer: Group Health Inc Medicare |
$127.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.43
|
| Rate for Payer: Healthfirst QHP |
$127.43
|
| Rate for Payer: Humana Medicare |
$129.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$121.06
|
| Rate for Payer: Wellcare Medicare |
$114.69
|
|
|
HC HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
3108137301
|
|
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 TYPING, DR/DQ,SINGLE ANTIGEN - HLA TYPING, DR/DQ, SINGLE ANTIGEN
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86816
|
| Hospital Charge Code |
3028681601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.17
|
| Rate for Payer: Aetna Government |
$30.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.12
|
| Rate for Payer: Brighton Health Commercial |
$56.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.17
|
| Rate for Payer: EmblemHealth Commercial |
$30.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.85
|
| Rate for Payer: Group Health Inc Commercial |
$30.17
|
| Rate for Payer: Group Health Inc Medicare |
$30.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.17
|
| Rate for Payer: Healthfirst QHP |
$30.17
|
| Rate for Payer: Humana Medicare |
$30.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.17
|
| Rate for Payer: United Healthcare Commercial |
$35.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.66
|
| Rate for Payer: Wellcare Medicare |
$27.15
|
|
|
HC HLA TYPING, DR/DQ,SINGLE ANTIGEN - HLA TYPING, DR/DQ, SINGLE ANTIGEN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86816
|
| Hospital Charge Code |
3028681601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
|
|
HC HOME HEALTH CERTIFICATION
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
969G018001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$87.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.56
|
| Rate for Payer: Aetna Government |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: EmblemHealth Commercial |
$54.50
|
| Rate for Payer: Group Health Inc Commercial |
$54.50
|
| Rate for Payer: Group Health Inc Medicare |
$38.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.49
|
|
|
HC HOME HEALTH CERTIFICATION
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
969G018001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC HOME SLEEP TEST/TYPE 2 PORTABLE MONITOR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT G0398 TC
|
| Hospital Charge Code |
510G039801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC HOME SLEEP TEST/TYPE 2 PORTABLE MONITOR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT G0398 TC
|
| Hospital Charge Code |
510G039801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.00
|
| Rate for Payer: Aetna Government |
$156.00
|
| 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 |
$209.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC HOMOGENIZATION, TISSUE, FOR CULTURE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
3068717601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.88
|
| Rate for Payer: Aetna Government |
$5.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.12
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.88
|
| Rate for Payer: EmblemHealth Commercial |
$5.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.23
|
| Rate for Payer: Group Health Inc Commercial |
$5.88
|
| Rate for Payer: Group Health Inc Medicare |
$5.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.88
|
| Rate for Payer: Healthfirst QHP |
$5.88
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.88
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.59
|
| Rate for Payer: Wellcare Medicare |
$5.29
|
|
|
HC HOMOGENIZATION, TISSUE, FOR CULTURE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
3068717601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC HOSPICE PRIVATE ROOM DAILY
|
Facility
|
IP
|
$4,093.00
|
|
| Hospital Charge Code |
1150000001
|
|
Hospital Revenue Code
|
115
|
| Min. Negotiated Rate |
$2,046.50 |
| Max. Negotiated Rate |
$2,046.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.50
|
|
|
HC HOSPICE SEMI-PRIVATE ROOM DAILY
|
Facility
|
IP
|
$4,093.00
|
|
| Hospital Charge Code |
1250000001
|
|
Hospital Revenue Code
|
125
|
| Min. Negotiated Rate |
$2,046.50 |
| Max. Negotiated Rate |
$2,046.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.50
|
|
|
HC HOSPITAL DISCHARGE DAY,<30 MIN
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
6579923801
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.01
|
| Rate for Payer: Aetna Government |
$54.01
|
| Rate for Payer: Brighton Health Commercial |
$268.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.44
|
| Rate for Payer: EmblemHealth Commercial |
$179.00
|
| Rate for Payer: Group Health Inc Commercial |
$179.00
|
| Rate for Payer: Group Health Inc Medicare |
$125.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.14
|
|
|
HC HOSPITAL DISCHARGE DAY,<30 MIN
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
6579923801
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC HOSPITAL OBSERVATION PER HOUR
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
762G037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$835.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$1,927.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,104.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,788.43
|
| Rate for Payer: EmblemHealth Commercial |
$63.00
|
| Rate for Payer: Group Health Inc Commercial |
$63.00
|
| Rate for Payer: Group Health Inc Medicare |
$44.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,500.00
|
| Rate for Payer: Healthfirst QHP |
$2,500.00
|
| Rate for Payer: United Healthcare Commercial |
$2,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$350.00
|
|
|
HC HOSPITAL OBSERVATION PER HOUR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
762G037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
|
|
HC HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
510G046301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.50
|
|
|
HC HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
510G046301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.22 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.46
|
| Rate for Payer: Aetna Government |
$157.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.14
|
| 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 |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.84
|
| Rate for Payer: Healthfirst QHP |
$157.46
|
| Rate for Payer: Humana Medicare |
$160.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Wellcare Medicare |
$149.59
|
|
|
HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
3018301301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$151.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.36
|
| Rate for Payer: Aetna Government |
$67.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$47.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.15
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.36
|
| Rate for Payer: EmblemHealth Commercial |
$67.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.95
|
| Rate for Payer: Group Health Inc Commercial |
$67.36
|
| Rate for Payer: Group Health Inc Medicare |
$67.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.36
|
| Rate for Payer: Healthfirst Essential Plan |
$151.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.36
|
| Rate for Payer: Healthfirst QHP |
$67.36
|
| Rate for Payer: Humana Medicare |
$68.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.36
|
| Rate for Payer: United Healthcare Commercial |
$85.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$67.36
|
| Rate for Payer: Wellcare Medicare |
$60.62
|
|
|
HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
3018301301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC HSV, DNA, AMP PROBE - HSV PCR
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
3068752901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$73.06 |
| 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 |
$32.47
|
| Rate for Payer: Healthfirst Essential Plan |
$73.06
|
| 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 |
$32.47
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC HSV, DNA, AMP PROBE - HSV PCR
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
3068752901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
