|
HC INFECTIOUS AGENT DETECT, POCT, DNA/RNA, INFLUENZA A&B
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750201
|
|
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, POCT, DNA/RNA, INFLUENZA A&B
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3068750201
|
|
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 DRUG SUSCEPTIBILIT - PHENOSENSE GT (R)
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
3018790002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.35
|
| Rate for Payer: Aetna Government |
$130.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$91.25
|
| Rate for Payer: Brighton Health Commercial |
$243.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$130.35
|
| Rate for Payer: EmblemHealth Commercial |
$130.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.01
|
| Rate for Payer: Group Health Inc Commercial |
$130.35
|
| Rate for Payer: Group Health Inc Medicare |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.80
|
| Rate for Payer: Healthfirst Essential Plan |
$181.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.35
|
| Rate for Payer: Healthfirst QHP |
$130.35
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare Commercial |
$165.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$80.80
|
| Rate for Payer: Wellcare Medicare |
$117.31
|
|
|
HC INFECTIOUS AGENT DRUG SUSCEPTIBILIT - PHENOSENSE GT (R)
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
3018790002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
|
|
HC INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
3068790001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
|
|
HC INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
3068790001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.35
|
| Rate for Payer: Aetna Government |
$130.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$91.25
|
| Rate for Payer: Brighton Health Commercial |
$243.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$130.35
|
| Rate for Payer: EmblemHealth Commercial |
$130.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.01
|
| Rate for Payer: Group Health Inc Commercial |
$130.35
|
| Rate for Payer: Group Health Inc Medicare |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.80
|
| Rate for Payer: Healthfirst Essential Plan |
$181.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.35
|
| Rate for Payer: Healthfirst QHP |
$130.35
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare Commercial |
$165.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$80.80
|
| Rate for Payer: Wellcare Medicare |
$117.31
|
|
|
HC INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHER THAN VIRUS
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 87905
|
| Hospital Charge Code |
3068790501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
|
|
HC INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHER THAN VIRUS
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 87905
|
| Hospital Charge Code |
3068790501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.22
|
| Rate for Payer: Aetna Government |
$12.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.55
|
| Rate for Payer: Brighton Health Commercial |
$301.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.22
|
| Rate for Payer: EmblemHealth Commercial |
$12.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$12.22
|
| Rate for Payer: Group Health Inc Medicare |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.22
|
| Rate for Payer: Healthfirst QHP |
$12.22
|
| Rate for Payer: Humana Medicare |
$12.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.22
|
| Rate for Payer: United Healthcare Commercial |
$15.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Wellcare Medicare |
$11.00
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HBV
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
3068791201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$514.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$353.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.45
|
| Rate for Payer: Aetna Government |
$257.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.22
|
| Rate for Payer: Brighton Health Commercial |
$482.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$437.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.45
|
| Rate for Payer: EmblemHealth Commercial |
$257.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.13
|
| Rate for Payer: Group Health Inc Commercial |
$257.45
|
| Rate for Payer: Group Health Inc Medicare |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.45
|
| Rate for Payer: Healthfirst QHP |
$257.45
|
| Rate for Payer: Humana Medicare |
$262.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare Commercial |
$318.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.58
|
| Rate for Payer: Wellcare Medicare |
$231.71
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HBV
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
3068791201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$321.50 |
| Max. Negotiated Rate |
$321.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.50
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HEP C
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$321.50 |
| Max. Negotiated Rate |
$321.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.50
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HEP C
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$579.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$353.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.45
|
| Rate for Payer: Aetna Government |
$257.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.22
|
| Rate for Payer: Brighton Health Commercial |
$482.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$437.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$368.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.45
|
| Rate for Payer: EmblemHealth Commercial |
$257.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.13
|
| Rate for Payer: Group Health Inc Commercial |
$257.45
|
| Rate for Payer: Group Health Inc Medicare |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.45
|
| Rate for Payer: Healthfirst Essential Plan |
$579.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.45
|
| Rate for Payer: Healthfirst QHP |
$257.45
|
| Rate for Payer: Humana Medicare |
$262.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare Commercial |
$326.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$257.45
|
| Rate for Payer: Wellcare Medicare |
$231.71
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HIV1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
3068790601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.11 |
| Max. Negotiated Rate |
$289.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.73
|
| Rate for Payer: Aetna Government |
$128.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.11
|
| Rate for Payer: Brighton Health Commercial |
$240.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$218.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$128.73
|
| Rate for Payer: EmblemHealth Commercial |
$128.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.57
|
| Rate for Payer: Group Health Inc Commercial |
$128.73
|
| Rate for Payer: Group Health Inc Medicare |
$128.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.73
|
| Rate for Payer: Healthfirst Essential Plan |
$289.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.73
|
| Rate for Payer: Healthfirst QHP |
$128.73
|
| Rate for Payer: Humana Medicare |
$131.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.73
|
| Rate for Payer: United Healthcare Commercial |
$163.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128.73
|
| Rate for Payer: Wellcare Medicare |
$115.86
|
|
|
HC INFECTIOUS AGENT GENOTYPE ANALYSIS, DNA/RNA, HIV1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
3068790601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.50
|
|
|
HC INFECTIOUS AGENT PHENOTYPE ANALYSIS BY DNA/RNA W/ DRUG RESISTANCE TISSUE CULTURE ANALYSIS
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 87904
|
| Hospital Charge Code |
3068790401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$315.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$315.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.35
|
| Rate for Payer: Healthfirst Essential Plan |
$34.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$33.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.35
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC INFECTIOUS AGENT PHENOTYPE ANALYSIS BY DNA/RNA W/ DRUG RESISTANCE TISSUE CULTURE ANALYSIS
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 87904
|
| Hospital Charge Code |
3068790401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
|
|
HC INFECTIOUS DISEASE, CHRONIC HCV, FIBROSURE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
3018159601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$131.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.19
|
| Rate for Payer: Aetna Government |
$72.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.53
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.19
|
| Rate for Payer: EmblemHealth Commercial |
$72.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.25
|
| Rate for Payer: Group Health Inc Commercial |
$72.19
|
| Rate for Payer: Group Health Inc Medicare |
$72.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.33
|
| Rate for Payer: Healthfirst Essential Plan |
$131.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.19
|
| Rate for Payer: Healthfirst QHP |
$72.19
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.19
|
| Rate for Payer: United Healthcare Commercial |
$64.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.33
|
| Rate for Payer: Wellcare Medicare |
$64.97
|
|
|
HC INFECTIOUS DISEASE, CHRONIC HCV, FIBROSURE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
3018159601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC INFLUENZA B AG, DFA - INFLUENZA A&B ANTIGEN, DFA
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
3068727501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC INFLUENZA B AG, DFA - INFLUENZA A&B ANTIGEN, DFA
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
3068727501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.57
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Healthfirst Essential Plan |
$27.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.25
|
| Rate for Payer: Wellcare Medicare |
$11.03
|
|
|
HC INFLUENZA VIRUS - INFLUENZA A ANTIBODY, IGM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
3028671004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.55
|
| Rate for Payer: Aetna Government |
$13.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.55
|
| Rate for Payer: EmblemHealth Commercial |
$13.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.06
|
| Rate for Payer: Group Health Inc Commercial |
$13.55
|
| Rate for Payer: Group Health Inc Medicare |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Healthfirst Essential Plan |
$30.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.55
|
| Rate for Payer: Healthfirst QHP |
$13.55
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$12.20
|
|
|
HC INFLUENZA VIRUS - INFLUENZA A ANTIBODY, IGM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
3028671004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC INFLUENZA VIRUS - INFLUENZA TYPE A ANTIBODY IGG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
3028671001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.55
|
| Rate for Payer: Aetna Government |
$13.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.55
|
| Rate for Payer: EmblemHealth Commercial |
$13.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.06
|
| Rate for Payer: Group Health Inc Commercial |
$13.55
|
| Rate for Payer: Group Health Inc Medicare |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Healthfirst Essential Plan |
$30.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.55
|
| Rate for Payer: Healthfirst QHP |
$13.55
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$12.20
|
|
|
HC INFLUENZA VIRUS - INFLUENZA TYPE A ANTIBODY IGG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
3028671001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC INFLUENZA VIRUS - INFLUENZA TYPE A&B ANTIBODIES
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
3028671003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.55
|
| Rate for Payer: Aetna Government |
$13.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.55
|
| Rate for Payer: EmblemHealth Commercial |
$13.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.06
|
| Rate for Payer: Group Health Inc Commercial |
$13.55
|
| Rate for Payer: Group Health Inc Medicare |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Healthfirst Essential Plan |
$30.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.55
|
| Rate for Payer: Healthfirst QHP |
$13.55
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$12.20
|
|
