|
HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 50430 TC
|
| Hospital Charge Code |
3615043001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.16
|
| Rate for Payer: Aetna Government |
$637.16
|
| Rate for Payer: Brighton Health Commercial |
$1,263.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$842.50
|
| Rate for Payer: Group Health Inc Commercial |
$842.50
|
| Rate for Payer: Group Health Inc Medicare |
$589.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.50
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
|
|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.73
|
| Rate for Payer: Aetna Government |
$37.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.41
|
| Rate for Payer: Brighton Health Commercial |
$70.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$37.73
|
| Rate for Payer: EmblemHealth Commercial |
$37.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.58
|
| Rate for Payer: Group Health Inc Commercial |
$37.73
|
| Rate for Payer: Group Health Inc Medicare |
$37.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Healthfirst Essential Plan |
$52.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.73
|
| Rate for Payer: Healthfirst QHP |
$37.73
|
| Rate for Payer: Humana Medicare |
$38.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$47.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Wellcare Medicare |
$33.96
|
|
|
HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
9209392301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| 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 |
$150.87
|
| 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 |
$94.00
|
| 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
|
|
|
HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
9209392301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC NONINVASV OXYGEN SATUR,MULTIPLE - PULSE OXIMETRY, WITH EXERCISE
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4609476101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
|
|
HC NONINVASV OXYGEN SATUR,MULTIPLE - PULSE OXIMETRY, WITH EXERCISE
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4609476101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$133.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Brighton Health Commercial |
$125.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.56
|
| Rate for Payer: EmblemHealth Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Medicare |
$58.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$83.50
|
|
|
HC NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
|
|
HC NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$133.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$125.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.56
|
| Rate for Payer: EmblemHealth Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Medicare |
$58.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Commercial |
$83.50
|
|
|
HC NONVASCULAR SHUNTOGRAM - IR NONVASCULAR SHUNTOGRAM
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 75809 TC
|
| Hospital Charge Code |
3207580901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.28
|
| Rate for Payer: Aetna Government |
$59.28
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$162.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.66
|
| Rate for Payer: EmblemHealth Commercial |
$61.34
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.34
|
| Rate for Payer: Healthfirst Essential Plan |
$142.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.22
|
|
|
HC NONVASCULAR SHUNTOGRAM - IR NONVASCULAR SHUNTOGRAM
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 75809 TC
|
| Hospital Charge Code |
3207580901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC NRPSYC TST EVAL PHYS/QHP 1ST HR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
9189613201
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$661.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.41
|
| Rate for Payer: Amida Care Medicaid |
$106.41
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$106.41
|
| 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 |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.73
|
| 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 |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.41
|
| Rate for Payer: Healthfirst Essential Plan |
$239.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.43
|
| Rate for Payer: Optum Medicaid |
$0.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: SOMOS Essential |
$239.43
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$117.05
|
| Rate for Payer: United Healthcare Medicaid |
$106.41
|
| 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 |
$106.41
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC NRPSYC TST EVAL PHYS/QHP 1ST HR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
9189613201
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC NRPSYC TST EVAL PHYS/QHP ADD'L HR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
9189613301
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC NRPSYC TST EVAL PHYS/QHP ADD'L HR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
9189613301
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.27
|
| Rate for Payer: Aetna Government |
$69.27
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: EmblemHealth Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Medicare |
$146.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.70
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTIHISTONE ANTIBODIES
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTIHISTONE ANTIBODIES
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - CENTROMERE B ANTIBODIES
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - CENTROMERE B ANTIBODIES
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - RIBONUCLEIC PROTEIN ANTIBODY, IGG
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - RIBONUCLEIC PROTEIN ANTIBODY, IGG
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3028623507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
