|
HC IMMUNOASSAY QUANT NOS NONAB - THYROTROPIN RECEPTOR AB SERUM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - THYROTROPIN RECEPTOR AB SERUM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - TRYPTASE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - TRYPTASE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY - SC5B-9 LEVEL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.40
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
HC IMMUNOASSAY - SC5B-9 LEVEL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Essential Plan |
$46.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3028630001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3028630001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Essential Plan |
$46.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3028630002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3028630002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Essential Plan |
$46.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Essential Plan |
$46.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC IMMUNOASSAY,TUMOR ANTIGEN, OTHER ANTIGEN, QUANT
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
3028631601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.77
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC IMMUNOASSAY,TUMOR ANTIGEN, OTHER ANTIGEN, QUANT
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
3028631601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC IMMUNODIFFUSION OUCHTERLONY - HYPER PNEUMO SEROLOGY
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
3028633102
|
|
Hospital Revenue Code
|
302
|
| 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 |
$20.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.14
|
| 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 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 |
$15.17
|
| 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 |
$11.38
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
HC IMMUNODIFFUSION OUCHTERLONY - HYPER PNEUMO SEROLOGY
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
3028633102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC IMMUNOFLUOR ANTB ADDL STAIN (ADDON)
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 88350 TC
|
| Hospital Charge Code |
3128835001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.50
|
|
|
HC IMMUNOFLUOR ANTB ADDL STAIN (ADDON)
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 88350 TC
|
| Hospital Charge Code |
3128835001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.81
|
| Rate for Payer: Aetna Government |
$27.81
|
| Rate for Payer: Brighton Health Commercial |
$209.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$223.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.72
|
| Rate for Payer: EmblemHealth Commercial |
$96.11
|
| Rate for Payer: Group Health Inc Commercial |
$139.50
|
| Rate for Payer: Group Health Inc Medicare |
$97.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Healthfirst Essential Plan |
$36.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
|
|
HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTI RIBONUCLEIC ACID
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3128834601
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTI RIBONUCLEIC ACID
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3128834601
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$209.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$165.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.44
|
| Rate for Payer: Healthfirst Essential Plan |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.44
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC IMMUNOGLOBULIN LIGHT CHAINS
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.46
|
| Rate for Payer: Healthfirst Essential Plan |
$23.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$15.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.46
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOGLOBULIN LIGHT CHAINS
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 88341 TC
|
| Hospital Charge Code |
3128834101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$222.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.66
|
| Rate for Payer: Aetna Government |
$39.66
|
| Rate for Payer: Brighton Health Commercial |
$208.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$222.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.04
|
| Rate for Payer: EmblemHealth Commercial |
$80.35
|
| Rate for Payer: Group Health Inc Commercial |
$139.00
|
| Rate for Payer: Group Health Inc Medicare |
$97.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.62
|
| Rate for Payer: Healthfirst Essential Plan |
$57.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.62
|
|
