|
HC INFACTIOUS AGENT DETECT, DNA/RNA, HPV, HIGH-RISK
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3068762401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC INFACTIOUS AGENT DETECT, DNA/RNA, TRICHOMONAS VAGINALIS
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
3068766101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$69.60 |
| 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 |
$69.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.16
|
| 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 |
$43.08
|
| 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 INFACTIOUS AGENT DETECT, DNA/RNA, TRICHOMONAS VAGINALIS
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
3068766101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC INF AGENT, FLUOR, ADENOVIRUS - ADENOVIRUS ANTIGEN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
3068726001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC INF AGENT, FLUOR, ADENOVIRUS - ADENOVIRUS ANTIGEN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
3068726001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.43
|
| Rate for Payer: Aetna Government |
$14.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.43
|
| 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 |
$14.43
|
| Rate for Payer: EmblemHealth Commercial |
$14.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.84
|
| Rate for Payer: Group Health Inc Commercial |
$14.43
|
| Rate for Payer: Group Health Inc Medicare |
$14.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.43
|
| Rate for Payer: Healthfirst QHP |
$14.43
|
| Rate for Payer: Humana Medicare |
$14.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.43
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$12.99
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, C. DIFFICILE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.50
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, C. DIFFICILE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.27
|
| Rate for Payer: Aetna Government |
$37.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.09
|
| Rate for Payer: Brighton Health Commercial |
$69.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.27
|
| 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 |
$37.27
|
| Rate for Payer: EmblemHealth Commercial |
$37.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.17
|
| Rate for Payer: Group Health Inc Commercial |
$37.27
|
| Rate for Payer: Group Health Inc Medicare |
$37.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.27
|
| Rate for Payer: Healthfirst QHP |
$37.27
|
| Rate for Payer: Humana Medicare |
$38.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.41
|
| Rate for Payer: Wellcare Medicare |
$33.54
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, INFLUENZA A&B
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, INFLUENZA A&B
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.80
|
| Rate for Payer: Aetna Government |
$95.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.06
|
| Rate for Payer: Brighton Health Commercial |
$179.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.80
|
| 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 |
$95.80
|
| Rate for Payer: EmblemHealth Commercial |
$95.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.26
|
| Rate for Payer: Group Health Inc Commercial |
$95.80
|
| Rate for Payer: Group Health Inc Medicare |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.98
|
| Rate for Payer: Healthfirst Essential Plan |
$121.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.80
|
| Rate for Payer: Healthfirst QHP |
$95.80
|
| Rate for Payer: Humana Medicare |
$97.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.98
|
| Rate for Payer: Wellcare Medicare |
$86.22
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, INFLUENZA A&H1N1
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
|
|
HC INFECTIOUS AGENT DETECT, DNA/RNA, INFLUENZA A&H1N1
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.80
|
| Rate for Payer: Aetna Government |
$95.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.06
|
| Rate for Payer: Brighton Health Commercial |
$179.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.80
|
| 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 |
$95.80
|
| Rate for Payer: EmblemHealth Commercial |
$95.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.26
|
| Rate for Payer: Group Health Inc Commercial |
$95.80
|
| Rate for Payer: Group Health Inc Medicare |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.98
|
| Rate for Payer: Healthfirst Essential Plan |
$121.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.80
|
| Rate for Payer: Healthfirst QHP |
$95.80
|
| Rate for Payer: Humana Medicare |
$97.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.98
|
| Rate for Payer: Wellcare Medicare |
$86.22
|
|
|
HC INFECTIOUS AGENT DETECTION BY DNA; MYCOPLASMA GENITALIUM, AMPLIFIED PROBE TECHNIQUE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
|
|
HC INFECTIOUS AGENT DETECTION BY DNA; MYCOPLASMA GENITALIUM, AMPLIFIED PROBE TECHNIQUE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
| 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 |
$78.00
|
| 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 |
$83.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.72
|
| 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 |
$31.58
|
| 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 INFECTIOUS AGENT DETECTION BY DNA OR RNA;CENTRAL NERVOUS SYSTEM PATHOGEN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
3068748301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$514.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$416.78
|
| Rate for Payer: Aetna Government |
$416.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$291.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$291.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$291.75
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$416.78
|
| Rate for Payer: EmblemHealth Commercial |
$416.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.93
|
| Rate for Payer: Group Health Inc Commercial |
$416.78
|
| Rate for Payer: Group Health Inc Medicare |
$416.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$416.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.78
|
| Rate for Payer: Healthfirst QHP |
$416.78
|
| Rate for Payer: Humana Medicare |
$425.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare Commercial |
$514.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$395.94
|
| Rate for Payer: Wellcare Medicare |
$375.10
|
|
|
HC INFECTIOUS AGENT DETECTION BY DNA OR RNA;CENTRAL NERVOUS SYSTEM PATHOGEN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
3068748301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC INFECTIOUS AGENT DETECTION BY DNA/RNA; HPV TYPES 16, 18 & 45
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87625
|
| Hospital Charge Code |
3068762501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.55
|
| Rate for Payer: Aetna Government |
$40.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.39
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.55
|
| Rate for Payer: EmblemHealth Commercial |
$40.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.09
|
| Rate for Payer: Group Health Inc Commercial |
$40.55
|
| Rate for Payer: Group Health Inc Medicare |
$40.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.13
|
| Rate for Payer: Healthfirst Essential Plan |
$63.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.55
|
| Rate for Payer: Healthfirst QHP |
$40.55
|
| Rate for Payer: Humana Medicare |
$41.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.55
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.13
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
|
|
HC INFECTIOUS AGENT DETECTION BY DNA/RNA; HPV TYPES 16, 18 & 45
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87625
|
| Hospital Charge Code |
3068762501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT U0005
|
| Hospital Charge Code |
306U000501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT U0005
|
| Hospital Charge Code |
306U000501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87468
|
| Hospital Charge Code |
3068746801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| 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 |
$34.50
|
| 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 |
$36.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.28
|
| 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 |
$31.58
|
| 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 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87468
|
| Hospital Charge Code |
3068746801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA) BABESIA MICROTI
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 87469
|
| Hospital Charge Code |
3008746901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA) BABESIA MICROTI
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 87469
|
| Hospital Charge Code |
3008746901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| 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 |
$14.25
|
| 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 |
$15.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.92
|
| 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 |
$31.58
|
| 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 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3008779801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3008779801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$59.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| 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 |
$12.75
|
| 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
|
|
