|
HC LUNG FUNCTION TEST (MBC/MVV) - TRANS-DIAPHRAGMATIC PRESSURE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
4609420001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC LUNG FUNCTION TEST (MBC/MVV) - TRANS-DIAPHRAGMATIC PRESSURE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
4609420001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$83.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 78580 TC
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.34 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$139.47
|
| Rate for Payer: Aetna Government |
$139.47
|
| Rate for Payer: Brighton Health Commercial |
$809.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$421.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$354.56
|
| Rate for Payer: EmblemHealth Commercial |
$188.07
|
| Rate for Payer: Group Health Inc Commercial |
$539.50
|
| Rate for Payer: Group Health Inc Medicare |
$377.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.07
|
| Rate for Payer: Healthfirst Essential Plan |
$309.01
|
| Rate for Payer: United Healthcare Commercial |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.34
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 78580 TC
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.50 |
| Max. Negotiated Rate |
$539.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL MULTIPLE
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78579 TC
|
| Hospital Charge Code |
3417857902
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL MULTIPLE
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78579 TC
|
| Hospital Charge Code |
3417857902
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$101.63 |
| Max. Negotiated Rate |
$891.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.07
|
| Rate for Payer: Aetna Government |
$112.07
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$891.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$757.52
|
| Rate for Payer: EmblemHealth Commercial |
$153.98
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.98
|
| Rate for Payer: Healthfirst Essential Plan |
$228.67
|
| Rate for Payer: United Healthcare Commercial |
$161.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.63
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
CPT 78582 TC
|
| Hospital Charge Code |
3417858201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$715.50 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.50
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
CPT 78582 TC
|
| Hospital Charge Code |
3417858201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.03 |
| Max. Negotiated Rate |
$1,144.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$787.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$194.15
|
| Rate for Payer: Aetna Government |
$194.15
|
| Rate for Payer: Brighton Health Commercial |
$1,073.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,144.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$973.08
|
| Rate for Payer: EmblemHealth Commercial |
$260.04
|
| Rate for Payer: Group Health Inc Commercial |
$715.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.04
|
| Rate for Payer: Healthfirst Essential Plan |
$420.82
|
| Rate for Payer: United Healthcare Commercial |
$253.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$187.03
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - BOTH EYES
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - BOTH EYES
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - LEFT EYE
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - LEFT EYE
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - RIGHT EYE
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC LVL 2 EYE EXAM WITH PHOTOS - RIGHT EYE
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 92230
|
| Hospital Charge Code |
9209223003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$38.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.03
|
| Rate for Payer: Aetna Government |
$17.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.92
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$17.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Group Health Inc Commercial |
$17.03
|
| Rate for Payer: Group Health Inc Medicare |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.03
|
| Rate for Payer: Healthfirst Essential Plan |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.03
|
| Rate for Payer: Healthfirst QHP |
$17.03
|
| Rate for Payer: Humana Medicare |
$17.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.03
|
| Rate for Payer: Wellcare Medicare |
$15.33
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - B. BURGDORFERI ANTIBODIES WB
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3028661702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Healthfirst Essential Plan |
$34.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - B. BURGDORFERI ANTIBODIES WB
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3028661702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3028661701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3028661701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.49
|
| Rate for Payer: Aetna Government |
$15.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$15.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Healthfirst Essential Plan |
$34.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.49
|
| Rate for Payer: Healthfirst QHP |
$15.49
|
| Rate for Payer: Humana Medicare |
$15.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.49
|
| Rate for Payer: Wellcare Medicare |
$13.94
|
|
|
HC LYME DISEASE ANTIBODY - LYME DISEASE (BORRELIA BURGDORFERI), QUANT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3028661803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC LYME DISEASE ANTIBODY - LYME DISEASE (BORRELIA BURGDORFERI), QUANT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3028661803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$38.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.03
|
| Rate for Payer: Aetna Government |
$17.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.92
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$17.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Group Health Inc Commercial |
$17.03
|
| Rate for Payer: Group Health Inc Medicare |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.03
|
| Rate for Payer: Healthfirst Essential Plan |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.03
|
| Rate for Payer: Healthfirst QHP |
$17.03
|
| Rate for Payer: Humana Medicare |
$17.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.03
|
| Rate for Payer: Wellcare Medicare |
$15.33
|
|
|
HC LYMPHANGIO ABD/PELV BILAT - IR LYMPHANGIOGRAM ABDOMEN PELVIS BILAT
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75807 TC
|
| Hospital Charge Code |
3207580702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,112.52
|
| Rate for Payer: Aetna Government |
$2,112.52
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$871.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$733.32
|
| Rate for Payer: EmblemHealth Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst Essential Plan |
$545.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$242.57
|
|
|
HC LYMPHANGIO ABD/PELV BILAT - IR LYMPHANGIOGRAM ABDOMEN PELVIS BILAT
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75807 TC
|
| Hospital Charge Code |
3207580702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC LYMPHANGIO ABD/PELV UNILAT - IR LYMPHANGIOGRAM ABDOMEN PELVIS
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 75805 TC
|
| Hospital Charge Code |
3207580501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.83 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$518.96
|
| Rate for Payer: Aetna Government |
$518.96
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$871.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$733.32
|
| Rate for Payer: EmblemHealth Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.00
|
| Rate for Payer: Healthfirst Essential Plan |
$521.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.83
|
|
