|
HC HYSTEROSCOPY,W/ENDO BX
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
3615855801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC HYSTEROSCOPY,W/ENDO BX
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
3615855801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC HYSTEROSCOPY,W/ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$13,901.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
3615856301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,950.50 |
| Max. Negotiated Rate |
$6,950.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,950.50
|
|
|
HC HYSTEROSCOPY,W/ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$13,901.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
3615856301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.18 |
| Max. Negotiated Rate |
$10,425.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,031.45
|
| Rate for Payer: Aetna Government |
$6,031.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,222.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,222.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,222.02
|
| Rate for Payer: Brighton Health Commercial |
$10,425.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,031.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,031.45
|
| Rate for Payer: EmblemHealth Commercial |
$6,031.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,428.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,126.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,367.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,031.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,367.99
|
| Rate for Payer: Group Health Inc Commercial |
$6,031.45
|
| Rate for Payer: Group Health Inc Medicare |
$6,031.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,031.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,126.73
|
| Rate for Payer: Healthfirst QHP |
$6,031.45
|
| Rate for Payer: Humana Medicare |
$6,152.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,031.45
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,031.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,031.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,729.88
|
| Rate for Payer: Wellcare Medicare |
$5,729.88
|
|
|
HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
3068732401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
3068732401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC IAAD IA GIARDIA - GIARDIA LAMBLIA ANTIGEN
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
3068732901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.98
|
| Rate for Payer: Healthfirst Essential Plan |
$26.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
HC IAAD IA GIARDIA - GIARDIA LAMBLIA ANTIGEN
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
3068732901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
3068735001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
3068735001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Healthfirst Essential Plan |
$22.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.20
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
3068734101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$23.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.33
|
| Rate for Payer: Aetna Government |
$10.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.23
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.33
|
| 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 |
$10.33
|
| Rate for Payer: EmblemHealth Commercial |
$10.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.19
|
| Rate for Payer: Group Health Inc Commercial |
$10.33
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.33
|
| Rate for Payer: Healthfirst Essential Plan |
$23.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$10.33
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.33
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
|
|
HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
3068734101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$23.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.33
|
| Rate for Payer: Aetna Government |
$10.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.23
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.33
|
| 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 |
$10.33
|
| Rate for Payer: EmblemHealth Commercial |
$10.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.19
|
| Rate for Payer: Group Health Inc Commercial |
$10.33
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.33
|
| Rate for Payer: Healthfirst Essential Plan |
$23.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$10.33
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.33
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN, SERUM
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
3068738502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN, SERUM
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
3068738502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Healthfirst Essential Plan |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
|
|
HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
3068738501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
3068738501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Healthfirst Essential Plan |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.53
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
|
|
HC IAAD IA HIV-2 HIV1 ANTIGEN W HIV1&2 ANTIBODIES
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
3068738901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Government |
$24.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.86
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.08
|
| Rate for Payer: EmblemHealth Commercial |
$24.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.43
|
| Rate for Payer: Group Health Inc Commercial |
$24.08
|
| Rate for Payer: Group Health Inc Medicare |
$24.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.67
|
| Rate for Payer: Healthfirst Essential Plan |
$42.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.08
|
| Rate for Payer: Healthfirst QHP |
$24.08
|
| Rate for Payer: Humana Medicare |
$24.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare Commercial |
$30.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.67
|
| Rate for Payer: Wellcare Medicare |
$21.67
|
|
|
HC IAAD IA HIV-2 HIV1 ANTIGEN W HIV1&2 ANTIBODIES
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
3068738901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
3068733801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.38
|
| Rate for Payer: Aetna Government |
$14.38
|
| 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 |
$14.38
|
| 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 |
$14.38
|
| Rate for Payer: EmblemHealth Commercial |
$14.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.80
|
| Rate for Payer: Group Health Inc Commercial |
$14.38
|
| Rate for Payer: Group Health Inc Medicare |
$14.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.38
|
| Rate for Payer: Healthfirst QHP |
$14.38
|
| Rate for Payer: Humana Medicare |
$14.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.38
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$12.94
|
|
|
HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
3068733801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3068744901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3068744901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM, L. PNEUMOPHILA SEROGP 1 UR AG
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3068744902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
