|
Q FEVER ANTIBODIES, IGG
|
Facility
|
OP
|
$30.30
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
40729355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.12
|
| Rate for Payer: Aetna Government |
$12.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$22.72
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.12
|
| Rate for Payer: EmblemHealth Commercial |
$12.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.79
|
| Rate for Payer: Group Health Inc Commercial |
$12.12
|
| Rate for Payer: Group Health Inc Medicare |
$12.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.12
|
| Rate for Payer: Healthfirst QHP |
$12.12
|
| Rate for Payer: Humana Medicare |
$12.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare Commercial |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.70
|
| Rate for Payer: Wellcare Medicare |
$10.91
|
|
|
Q FEVER ANTIBODIES, IGG
|
Facility
|
IP
|
$30.30
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
40729355
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.12
|
|
|
QLTD ADULT BRIEFS, LG 45-58
|
Facility
|
OP
|
$0.68
|
|
| Hospital Charge Code |
64902227
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
|
|
QLTD ADULT BRIEFS, MED 32-44
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
64902225
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
|
QLTD ADULT BRIEFS, XL 59-64
|
Facility
|
OP
|
$0.81
|
|
| Hospital Charge Code |
64902229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$0.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
|
|
QUAD CANE
|
Facility
|
OP
|
$88.24
|
|
| Hospital Charge Code |
40200065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$70.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.12
|
| Rate for Payer: Aetna Government |
$44.12
|
| Rate for Payer: Brighton Health Commercial |
$66.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.00
|
| Rate for Payer: Group Health Inc Commercial |
$44.12
|
| Rate for Payer: Group Health Inc Medicare |
$30.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.12
|
|
|
QUALITY MEASURE BMI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3008F
|
| Hospital Charge Code |
30302514
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP 130-139 MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3075F
|
| Hospital Charge Code |
30302516
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP <130MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3074F
|
| Hospital Charge Code |
30302515
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP >140MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3077F
|
| Hospital Charge Code |
30302517
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP 80-89MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3079F
|
| Hospital Charge Code |
30302519
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP <80MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3078F
|
| Hospital Charge Code |
30302518
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUALITY MEASURE BP > 90MM HG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3080F
|
| Hospital Charge Code |
30302520
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
IP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
40618410
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$61.98
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
IP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
30303384
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$61.98
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
IP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
40615600
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$61.98
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
OP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
30303384
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.22
|
| 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 |
$233.00
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| 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 |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,047.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.99
|
| 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 |
$70.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.47
|
| Rate for Payer: Healthfirst Essential Plan |
$158.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.98
|
| Rate for Payer: Healthfirst QHP |
$70.47
|
| Rate for Payer: Humana Medicare |
$63.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.47
|
| Rate for Payer: SOMOS Essential |
$70.47
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 |
$49.58
|
| Rate for Payer: Wellcare Medicare |
$58.88
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
OP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
40615600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.22
|
| 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 |
$116.21
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| 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 |
$98.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.98
|
| Rate for Payer: EmblemHealth Commercial |
$61.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,047.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.47
|
| 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 |
$70.47
|
| Rate for Payer: Healthfirst Essential Plan |
$158.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.98
|
| Rate for Payer: Healthfirst QHP |
$70.47
|
| 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 |
$70.47
|
| 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 |
$49.58
|
| Rate for Payer: Wellcare Medicare |
$55.78
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
OP
|
$154.95
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
40618410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.22
|
| 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 |
$116.21
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| 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 |
$98.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.98
|
| Rate for Payer: EmblemHealth Commercial |
$61.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,047.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.47
|
| 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 |
$70.47
|
| Rate for Payer: Healthfirst Essential Plan |
$158.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.98
|
| Rate for Payer: Healthfirst QHP |
$70.47
|
| 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 |
$70.47
|
| 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 |
$49.58
|
| Rate for Payer: Wellcare Medicare |
$55.78
|
|
|
QUANTITATIVE D-DIMER
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
40621592
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.13
|
| Rate for Payer: Brighton Health Commercial |
$19.09
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Humana Medicare |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
QUANTITATIVE D-DIMER
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
40621592
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$10.18
|
|
|
QUETIAPINE 100 MG TAB
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
41642012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
QUETIAPINE 100 MG TAB
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
41652012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
QUETIAPINE 200 MG TAB
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
41642745
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| 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: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
|
QUETIAPINE 200 MG TAB
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
41652745
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| 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: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
