|
HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.56
|
| Rate for Payer: Aetna Government |
$10.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.39
|
| Rate for Payer: Brighton Health Commercial |
$19.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.56
|
| Rate for Payer: EmblemHealth Commercial |
$10.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.40
|
| Rate for Payer: Group Health Inc Commercial |
$10.56
|
| Rate for Payer: Group Health Inc Medicare |
$10.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.56
|
| Rate for Payer: Healthfirst QHP |
$10.56
|
| Rate for Payer: Humana Medicare |
$10.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$9.50
|
|
|
HC METHADONE DISPENSE BUNDLE WK1,3,4
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT G2067
|
| Hospital Charge Code |
900G206702
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$620.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$233.15
|
| Rate for Payer: Aetna Government |
$233.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$620.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$620.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$275.66
|
| Rate for Payer: Amida Care Medicaid |
$275.66
|
| Rate for Payer: Brighton Health Commercial |
$156.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.12
|
| Rate for Payer: EmblemHealth Commercial |
$104.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$620.23
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$275.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.44
|
| Rate for Payer: Group Health Inc Commercial |
$104.50
|
| Rate for Payer: Group Health Inc Medicare |
$73.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.66
|
| Rate for Payer: Healthfirst Essential Plan |
$620.23
|
| Rate for Payer: Healthfirst QHP |
$449.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.66
|
| Rate for Payer: SOMOS Essential |
$620.23
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$620.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$303.22
|
| Rate for Payer: United Healthcare Medicaid |
$275.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$275.66
|
|
|
HC METHADONE DISPENSE BUNDLE WK1,3,4
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT G2067
|
| Hospital Charge Code |
900G206702
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.50
|
|
|
HC METHADONE TAKE-HOME ADMIN WK2
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT H0020
|
| Hospital Charge Code |
900H002002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.64
|
| Rate for Payer: Aetna Government |
$24.64
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.80
|
| Rate for Payer: EmblemHealth Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$17.50
|
|
|
HC METHADONE TAKE-HOME ADMIN WK2
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT H0020
|
| Hospital Charge Code |
900H002002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC METHYLENEDIOXYAMPHETAMINES (MDA, MDEA, MDMA)
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
3018035901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: EmblemHealth Commercial |
$77.50
|
| Rate for Payer: Group Health Inc Commercial |
$77.50
|
| Rate for Payer: Group Health Inc Medicare |
$54.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$19.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
|
HC METHYLENEDIOXYAMPHETAMINES (MDA, MDEA, MDMA)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
3018035901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3018204303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.78
|
| Rate for Payer: Aetna Government |
$5.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.05
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.78
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: Humana Medicare |
$5.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3018204303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC MICROALBUMIN, SEMIQUANT - POCT MICROALBUMIN
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 82044
|
| Hospital Charge Code |
3018204401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC MICROALBUMIN, SEMIQUANT - POCT MICROALBUMIN
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82044
|
| Hospital Charge Code |
3018204401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.23
|
| Rate for Payer: Aetna Government |
$6.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.36
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.23
|
| Rate for Payer: EmblemHealth Commercial |
$6.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$6.23
|
| Rate for Payer: Group Health Inc Medicare |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.23
|
| Rate for Payer: Healthfirst QHP |
$6.23
|
| Rate for Payer: Humana Medicare |
$6.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.23
|
| Rate for Payer: United Healthcare Commercial |
$5.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Wellcare Medicare |
$5.61
|
|
|
HC MICRODISSECTION; MANUAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
3128838101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.00
|
|
|
HC MICRODISSECTION; MANUAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
3128838101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$225.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.36
|
| Rate for Payer: Aetna Government |
$74.36
|
| Rate for Payer: Brighton Health Commercial |
$147.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$158.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.99
|
| Rate for Payer: EmblemHealth Commercial |
$225.13
|
| Rate for Payer: Group Health Inc Commercial |
$98.00
|
| Rate for Payer: Group Health Inc Medicare |
$68.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.13
|
|
|
HC MICROSLIDE CONSULT - LAB MICROSLIDE CONSULT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 88321 TC
|
| Hospital Charge Code |
3128832101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$98.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.11
|
| Rate for Payer: Aetna Government |
$63.11
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.56
|
| Rate for Payer: EmblemHealth Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
|
HC MICROSLIDE CONSULT - LAB MICROSLIDE CONSULT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88321 TC
|
| Hospital Charge Code |
3128832101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC MICROSLIDE CONSULT W SLIDE PREP - LAB MICROSLIDE CONSULT W SLD PREP
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 88323 TC
|
| Hospital Charge Code |
3128832301
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
|
|
HC MICROSLIDE CONSULT W SLIDE PREP - LAB MICROSLIDE CONSULT W SLD PREP
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 88323 TC
|
| Hospital Charge Code |
3128832301
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.48
|
| Rate for Payer: Aetna Government |
$32.48
|
| Rate for Payer: Brighton Health Commercial |
$96.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.75
|
| Rate for Payer: EmblemHealth Commercial |
$35.16
|
| Rate for Payer: Group Health Inc Commercial |
$64.50
|
| Rate for Payer: Group Health Inc Medicare |
$45.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.16
|
|
|
HC MICROSOMAL ANTIBODY - GLOMERULAR BASEMENT MEMBRANE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC MICROSOMAL ANTIBODY - GLOMERULAR BASEMENT MEMBRANE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.19
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Healthfirst Essential Plan |
$32.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
HC MICROSOMAL ANTIBODY - LIVER-KIDNEY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC MICROSOMAL ANTIBODY - LIVER-KIDNEY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.19
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Healthfirst Essential Plan |
$32.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.19
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Healthfirst Essential Plan |
$32.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3028637602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC MICROVOLT T-WAVE ALTERNANS - T WAVE ALTERNANS
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
4809302501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC MICROVOLT T-WAVE ALTERNANS - T WAVE ALTERNANS
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
4809302501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$133.82 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
