|
HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3068720601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC SMEAR,FLUOR STAIN,INTERP - FUNGAL STAIN
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3068720602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.77
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.39
|
| Rate for Payer: EmblemHealth Commercial |
$5.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.39
|
| Rate for Payer: Healthfirst Essential Plan |
$12.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.39
|
| Rate for Payer: Healthfirst QHP |
$5.39
|
| Rate for Payer: Humana Medicare |
$5.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$6.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.39
|
| Rate for Payer: Wellcare Medicare |
$4.85
|
|
|
HC SMEAR,FLUOR STAIN,INTERP - FUNGAL STAIN
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3068720602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC SMEAR, GRAM/GIEMSA STAIN, BACTERIA/FUNGI/CELL TYPES
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3058720501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.99
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Humana Medicare |
$4.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
HC SMEAR, GRAM/GIEMSA STAIN, BACTERIA/FUNGI/CELL TYPES
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3058720501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - BLOOD PARASITE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - BLOOD PARASITE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna Government |
$5.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.19
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.99
|
| Rate for Payer: EmblemHealth Commercial |
$5.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.99
|
| Rate for Payer: Group Health Inc Medicare |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Healthfirst Essential Plan |
$13.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Humana Medicare |
$6.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - CRYPTOSPORDIA/ISOPORA
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna Government |
$5.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.19
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.99
|
| Rate for Payer: EmblemHealth Commercial |
$5.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.99
|
| Rate for Payer: Group Health Inc Medicare |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Healthfirst Essential Plan |
$13.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Humana Medicare |
$6.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - CRYPTOSPORDIA/ISOPORA
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - OTHER CYTOSMEARS
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720703
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna Government |
$5.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.19
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.99
|
| Rate for Payer: EmblemHealth Commercial |
$5.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.99
|
| Rate for Payer: Group Health Inc Medicare |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Healthfirst Essential Plan |
$13.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Humana Medicare |
$6.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - OTHER CYTOSMEARS
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3068720703
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.98
|
| Rate for Payer: Aetna Government |
$17.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.59
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.98
|
| Rate for Payer: EmblemHealth Commercial |
$17.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.00
|
| Rate for Payer: Group Health Inc Commercial |
$17.98
|
| Rate for Payer: Group Health Inc Medicare |
$17.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Essential Plan |
$13.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.98
|
| Rate for Payer: Healthfirst QHP |
$17.98
|
| Rate for Payer: Humana Medicare |
$18.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare Commercial |
$22.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Wellcare Medicare |
$16.18
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - INDIA-INK PREPARATION
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - INDIA-INK PREPARATION
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.82
|
| Rate for Payer: Aetna Government |
$5.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.07
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.82
|
| Rate for Payer: EmblemHealth Commercial |
$5.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.18
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.82
|
| Rate for Payer: Healthfirst QHP |
$5.82
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - KOH PREPARATION
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.82
|
| Rate for Payer: Aetna Government |
$5.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.07
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.82
|
| Rate for Payer: EmblemHealth Commercial |
$5.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.18
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.82
|
| Rate for Payer: Healthfirst QHP |
$5.82
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - KOH PREPARATION
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - SALINE PREPARATION
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.82
|
| Rate for Payer: Aetna Government |
$5.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.07
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.82
|
| Rate for Payer: EmblemHealth Commercial |
$5.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.18
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.82
|
| Rate for Payer: Healthfirst QHP |
$5.82
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - SALINE PREPARATION
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3068721003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC SMN1 (SURVIVAL OF MOTOR NEURON 1, TELOMERIC) (EG, SPINAL MUSCULAR ATROPHY) GENE ANALYSIS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
3108132901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$188.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.00
|
| Rate for Payer: Aetna Government |
$137.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$95.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$95.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95.90
|
| Rate for Payer: Brighton Health Commercial |
$137.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.00
|
| Rate for Payer: EmblemHealth Commercial |
$137.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.93
|
| Rate for Payer: Group Health Inc Commercial |
$137.00
|
| Rate for Payer: Group Health Inc Medicare |
$137.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.83
|
| Rate for Payer: Healthfirst Essential Plan |
$188.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.00
|
| Rate for Payer: Healthfirst QHP |
$137.00
|
| Rate for Payer: Humana Medicare |
$139.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$83.83
|
| Rate for Payer: Wellcare Medicare |
$123.30
|
|
|
HC SMN1 (SURVIVAL OF MOTOR NEURON 1, TELOMERIC) (EG, SPINAL MUSCULAR ATROPHY) GENE ANALYSIS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
3108132901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.50
|
|
|
HC SMOKING CESSATION CLASS, NON PHYS PROVIDER
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT S9453
|
| Hospital Charge Code |
942S945301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC SMOKING CESSATION CLASS, NON PHYS PROVIDER
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT S9453
|
| Hospital Charge Code |
942S945301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.43
|
| Rate for Payer: Aetna Government |
$9.43
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
HC SMPD1 GENE ANALYSIS - NIEMANN-PICK DISEASE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 81330
|
| Hospital Charge Code |
3108133001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.50
|
|
|
HC SMPD1 GENE ANALYSIS - NIEMANN-PICK DISEASE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 81330
|
| Hospital Charge Code |
3108133001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.00
|
| Rate for Payer: Aetna Government |
$47.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.90
|
| Rate for Payer: Brighton Health Commercial |
$47.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.00
|
| Rate for Payer: EmblemHealth Commercial |
$47.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.83
|
| Rate for Payer: Group Health Inc Commercial |
$47.00
|
| Rate for Payer: Group Health Inc Medicare |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.00
|
| Rate for Payer: Healthfirst QHP |
$47.00
|
| Rate for Payer: Humana Medicare |
$47.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.65
|
| Rate for Payer: Wellcare Medicare |
$42.30
|
|
