|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL CSF
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3028659201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$7.50 |
| 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 |
$3.30
|
| Rate for Payer: Healthfirst Essential Plan |
$7.42
|
| 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 |
$3.30
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL CSF
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3028659201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC SYPHILIS TEST, QUANTITATIVE - TREPONEMA PALLIDUM (SYPHILIS)
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
3028659301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.40
|
| Rate for Payer: EmblemHealth Commercial |
$4.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.92
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.74
|
| Rate for Payer: Healthfirst Essential Plan |
$8.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.40
|
| Rate for Payer: Healthfirst QHP |
$4.40
|
| Rate for Payer: Humana Medicare |
$4.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.40
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.74
|
| Rate for Payer: Wellcare Medicare |
$3.96
|
|
|
HC SYPHILIS TEST, QUANTITATIVE - TREPONEMA PALLIDUM (SYPHILIS)
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
3028659301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC TANGNTL BIOPSY, SKIN, EACH ADD'L LESION (ADDON)
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
3611110301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.00
|
|
|
HC TANGNTL BIOPSY, SKIN, EACH ADD'L LESION (ADDON)
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
3611110301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Government |
$19.78
|
| Rate for Payer: Brighton Health Commercial |
$267.00
|
| 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 |
$178.00
|
| Rate for Payer: Group Health Inc Commercial |
$178.00
|
| Rate for Payer: Group Health Inc Medicare |
$124.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC TANGNTL BIOPSY, SKIN, SINGLE LESION
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
3611110201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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: Elderplan Medicare Advantage |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC TANGNTL BIOPSY, SKIN, SINGLE LESION
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
3611110201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC TAP BLOCK BI BY INFUSION - BILATERAL
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 64489
|
| Hospital Charge Code |
3616448901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.58
|
| Rate for Payer: Aetna Government |
$102.58
|
| Rate for Payer: Brighton Health Commercial |
$1,146.75
|
| 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 |
$764.50
|
| Rate for Payer: Group Health Inc Commercial |
$764.50
|
| Rate for Payer: Group Health Inc Medicare |
$535.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.99
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC TAP BLOCK BI BY INFUSION - BILATERAL
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 64489
|
| Hospital Charge Code |
3616448901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.50 |
| Max. Negotiated Rate |
$764.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
|
|
HC TAP BLOCK BI INJECTION - BILATERAL
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
3616448801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.93
|
| Rate for Payer: Aetna Government |
$175.93
|
| Rate for Payer: Brighton Health Commercial |
$1,146.75
|
| 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 |
$764.50
|
| Rate for Payer: Group Health Inc Commercial |
$764.50
|
| Rate for Payer: Group Health Inc Medicare |
$535.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.74
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC TAP BLOCK BI INJECTION - BILATERAL
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
3616448801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.50 |
| Max. Negotiated Rate |
$764.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
|
|
HC TAP BLOCK UNI BY INFUSION - UNILATERAL
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 64487
|
| Hospital Charge Code |
3616448701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.41
|
| Rate for Payer: Aetna Government |
$84.41
|
| Rate for Payer: Brighton Health Commercial |
$1,146.75
|
| 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 |
$764.50
|
| Rate for Payer: Group Health Inc Commercial |
$764.50
|
| Rate for Payer: Group Health Inc Medicare |
$535.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.01
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC TAP BLOCK UNI BY INFUSION - UNILATERAL
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 64487
|
| Hospital Charge Code |
3616448701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.50 |
| Max. Negotiated Rate |
$764.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
|
|
HC TAP BLOCK UNIL BY INJECTION - UNILATERAL
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
3616448601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.93
|
| Rate for Payer: Aetna Government |
$71.93
|
| Rate for Payer: Brighton Health Commercial |
$1,146.75
|
| 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 |
$764.50
|
| Rate for Payer: Group Health Inc Commercial |
$764.50
|
| Rate for Payer: Group Health Inc Medicare |
$535.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.22
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC TAP BLOCK UNIL BY INJECTION - UNILATERAL
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
3616448601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.50 |
| Max. Negotiated Rate |
$764.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.50
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3028658001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.05
|
| Rate for Payer: Amida Care Medicaid |
$5.05
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$11.87
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$11.36
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$5.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$505.00
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.92
|
| Rate for Payer: Healthfirst QHP |
$8.23
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.05
|
| Rate for Payer: SOMOS Essential |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$5.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$11.36
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$5.55
|
| Rate for Payer: United Healthcare Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Wellcare Medicare |
$26.93
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3028658001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.78 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.98
|
| Rate for Payer: Aetna Government |
$61.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$158.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$158.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$70.47
|
| Rate for Payer: Amida Care Medicaid |
$70.47
|
| Rate for Payer: Brighton Health Commercial |
$115.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.98
|
| Rate for Payer: EmblemHealth Commercial |
$61.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$158.56
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$70.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.99
|
| Rate for Payer: Group Health Inc Commercial |
$61.98
|
| Rate for Payer: Group Health Inc Medicare |
$61.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7,047.00
|
| Rate for Payer: Healthfirst Essential Plan |
$158.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.98
|
| Rate for Payer: Healthfirst QHP |
$114.87
|
| Rate for Payer: Humana Medicare |
$63.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.47
|
| Rate for Payer: SOMOS Essential |
$158.56
|
| Rate for Payer: United Healthcare Commercial |
$78.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$158.56
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77.52
|
| Rate for Payer: United Healthcare Medicaid |
$70.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$70.47
|
| Rate for Payer: Wellcare Medicare |
$55.78
|
|
|
HC TCD EMBOLI DETECT W/O INJ - US TC DPLR IC ART EMB DET WO IV MB INJ
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
4029389201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$337.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$129.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$303.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$116.94
|
| Rate for Payer: Group Health Inc Medicare |
$116.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$337.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC TCD EMBOLI DETECT W/O INJ - US TC DPLR IC ART EMB DET WO IV MB INJ
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
4029389201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO - T-HELPER CELLS CD4/CD8 %
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
3028636001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.50
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO - T-HELPER CELLS CD4/CD8 %
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
3028636001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.89 |
| Max. Negotiated Rate |
$105.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.98
|
| Rate for Payer: Aetna Government |
$46.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.89
|
| Rate for Payer: Brighton Health Commercial |
$87.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.98
|
| Rate for Payer: EmblemHealth Commercial |
$46.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.81
|
| Rate for Payer: Group Health Inc Commercial |
$46.98
|
| Rate for Payer: Group Health Inc Medicare |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: Healthfirst Essential Plan |
$105.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.98
|
| Rate for Payer: Healthfirst QHP |
$46.98
|
| Rate for Payer: Humana Medicare |
$47.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$59.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: Wellcare Medicare |
$42.28
|
|
