|
HC MTMS BY PHARM, EST PT, 15 MIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 99606
|
| Hospital Charge Code |
2599960601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.06
|
| Rate for Payer: Aetna Government |
$28.06
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.30
|
|
|
HC MTMS BY PHARM, EST PT, ADD'L 15 MIN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 99607
|
| Hospital Charge Code |
2599960701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC MTMS BY PHARM, EST PT, ADD'L 15 MIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 99607
|
| Hospital Charge Code |
2599960701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.28
|
| Rate for Payer: Aetna Government |
$26.28
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.30
|
|
|
HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
3068755601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$93.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.68
|
| Rate for Payer: Aetna Government |
$41.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.18
|
| Rate for Payer: Brighton Health Commercial |
$78.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.68
|
| 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 |
$41.68
|
| Rate for Payer: EmblemHealth Commercial |
$41.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.10
|
| Rate for Payer: Group Health Inc Commercial |
$41.68
|
| Rate for Payer: Group Health Inc Medicare |
$41.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.68
|
| Rate for Payer: Healthfirst Essential Plan |
$93.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.68
|
| Rate for Payer: Healthfirst QHP |
$41.68
|
| Rate for Payer: Humana Medicare |
$42.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.68
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.68
|
| Rate for Payer: Wellcare Medicare |
$37.51
|
|
|
HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
3068755601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
|
|
HC MULTIP FAMILY-GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
9169084901
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC MULTIP FAMILY-GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
9169084901
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.31
|
| Rate for Payer: Aetna Government |
$196.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$74.22
|
| Rate for Payer: Amida Care Medicaid |
$74.22
|
| Rate for Payer: Brighton Health Commercial |
$297.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$74.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$269.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$196.31
|
| Rate for Payer: EmblemHealth Commercial |
$196.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$166.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$74.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.93
|
| Rate for Payer: Group Health Inc Commercial |
$196.31
|
| Rate for Payer: Group Health Inc Medicare |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Healthfirst Essential Plan |
$166.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.86
|
| Rate for Payer: Healthfirst QHP |
$120.98
|
| Rate for Payer: Humana Medicare |
$200.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.99
|
| Rate for Payer: Optum Medicaid |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: SOMOS Essential |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.64
|
| Rate for Payer: United Healthcare Medicaid |
$74.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Wellcare Medicare |
$186.49
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 95805 TC
|
| Hospital Charge Code |
3619580501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.99 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$331.99
|
| Rate for Payer: Aetna Government |
$331.99
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| 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: EmblemHealth Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Medicare |
$514.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$448.60
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 95805 TC
|
| Hospital Charge Code |
9209580501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 95805 TC
|
| Hospital Charge Code |
3619580501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 95805 TC
|
| Hospital Charge Code |
9209580501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$331.99 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$331.99
|
| Rate for Payer: Aetna Government |
$331.99
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| 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: EmblemHealth Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Medicare |
$514.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$448.60
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
|
|
HC MUMPS - MUMPS IGG ANTIBODY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3028673501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.05
|
| Rate for Payer: Aetna Government |
$13.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.13
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$13.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.61
|
| Rate for Payer: Group Health Inc Commercial |
$13.05
|
| Rate for Payer: Group Health Inc Medicare |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.05
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.74
|
|
|
HC MUMPS - MUMPS IGG ANTIBODY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3028673501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.05
|
| Rate for Payer: Aetna Government |
$13.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.13
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$13.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.61
|
| Rate for Payer: Group Health Inc Commercial |
$13.05
|
| Rate for Payer: Group Health Inc Medicare |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.05
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.74
|
|
|
HC MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC MURAMIDASE - LYSOZYME, SERUM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
3058554901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC MURAMIDASE - LYSOZYME, SERUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
3058554901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.75
|
| Rate for Payer: Aetna Government |
$18.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.12
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.75
|
| Rate for Payer: EmblemHealth Commercial |
$18.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.69
|
| Rate for Payer: Group Health Inc Commercial |
$18.75
|
| Rate for Payer: Group Health Inc Medicare |
$18.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.75
|
| Rate for Payer: Healthfirst Essential Plan |
$42.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.75
|
| Rate for Payer: Healthfirst QHP |
$18.75
|
| Rate for Payer: Humana Medicare |
$19.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$23.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.75
|
| Rate for Payer: Wellcare Medicare |
$16.88
|
|
|
HC MUSCLE-SPECIFIC KINASE ANTB
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
3028636601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna Government |
$18.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.88
|
| Rate for Payer: Brighton Health Commercial |
$20.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.38
|
| Rate for Payer: Group Health Inc Commercial |
$18.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.40
|
| Rate for Payer: Healthfirst Essential Plan |
$25.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.40
|
| Rate for Payer: Healthfirst QHP |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.40
|
| Rate for Payer: Wellcare Medicare |
$16.56
|
|
|
HC MUSCLE-SPECIFIC KINASE ANTB
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
3028636601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
|
|
HC MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
3068711801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
3068711801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.61
|
| Rate for Payer: Aetna Government |
$14.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.23
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.61
|
| Rate for Payer: EmblemHealth Commercial |
$14.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.00
|
| Rate for Payer: Group Health Inc Commercial |
$14.61
|
| Rate for Payer: Group Health Inc Medicare |
$14.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.61
|
| Rate for Payer: Healthfirst Essential Plan |
$32.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.61
|
| Rate for Payer: Healthfirst QHP |
$14.61
|
| Rate for Payer: Humana Medicare |
$14.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.61
|
| Rate for Payer: Wellcare Medicare |
$13.15
|
|
|
HC MYCOPLASMA CULTURE - MYCOPLASMA / UREAPLASMA CULTURE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
3068710901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC MYCOPLASMA CULTURE - MYCOPLASMA / UREAPLASMA CULTURE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
3068710901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.39
|
| Rate for Payer: Aetna Government |
$15.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.77
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.39
|
| Rate for Payer: EmblemHealth Commercial |
$15.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.70
|
| Rate for Payer: Group Health Inc Commercial |
$15.39
|
| Rate for Payer: Group Health Inc Medicare |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.39
|
| Rate for Payer: Healthfirst QHP |
$15.39
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.39
|
| Rate for Payer: United Healthcare Commercial |
$19.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$13.85
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Healthfirst Essential Plan |
$29.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
