|
HC ALLERGY PATCH TESTS
|
Facility
|
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 95044
|
| Hospital Charge Code |
9249504401
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$1,376.00 |
| Max. Negotiated Rate |
$1,376.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.00
|
|
|
HC ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
9249501801
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
9249501802
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.77
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$50.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$45.56
|
|
|
HC ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
9249501802
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
9249501801
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.77
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$50.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$45.56
|
|
|
HC ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 95017
|
| Hospital Charge Code |
9249501701
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$55.20 |
| 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 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| 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 |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| 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 |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$34.50
|
| 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 |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 95017
|
| Hospital Charge Code |
9249501701
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC ALLODERM PER SQ CM
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4116
|
| Hospital Charge Code |
636Q411601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
|
|
HC ALLODERM PER SQ CM
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4116
|
| Hospital Charge Code |
636Q411601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Brighton Health Commercial |
$75.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.45
|
| Rate for Payer: EmblemHealth Commercial |
$63.00
|
| Rate for Payer: Group Health Inc Commercial |
$63.00
|
| Rate for Payer: Group Health Inc Medicare |
$44.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.90
|
|
|
HC ALLOMAX 1MM GRAFT 3.9X5.9
|
Facility
|
OP
|
$13,137.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
636Q410006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$8,539.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,225.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.74
|
| Rate for Payer: Aetna Government |
$9.74
|
| Rate for Payer: Brighton Health Commercial |
$7,882.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,568.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,553.77
|
| Rate for Payer: EmblemHealth Commercial |
$6,568.50
|
| Rate for Payer: Group Health Inc Commercial |
$6,568.50
|
| Rate for Payer: Group Health Inc Medicare |
$4,597.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,568.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,568.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,539.05
|
|
|
HC ALLOMAX 1MM GRAFT 3.9X5.9
|
Facility
|
IP
|
$13,137.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
636Q410006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,568.50 |
| Max. Negotiated Rate |
$6,568.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,568.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,568.50
|
|
|
HC ALPHA-1-ANTITRYPSIN, TOTAL - ALPHA-1-ANTITRYPSIN
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
3018210301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.44
|
| Rate for Payer: Aetna Government |
$13.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.41
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.44
|
| Rate for Payer: EmblemHealth Commercial |
$13.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.96
|
| Rate for Payer: Group Health Inc Commercial |
$13.44
|
| Rate for Payer: Group Health Inc Medicare |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.44
|
| Rate for Payer: Healthfirst QHP |
$13.44
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$17.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$12.10
|
|
|
HC ALPHA-1-ANTITRYPSIN, TOTAL - ALPHA-1-ANTITRYPSIN
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
3018210301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC ALPHA-FETOPROTEIN; AMNIOTIC - ALPHA-FETOPROTEIN, AMNIOTIC FLUID
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
3018210601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.90
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Humana Medicare |
$17.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$21.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
|
|
HC ALPHA-FETOPROTEIN; AMNIOTIC - ALPHA-FETOPROTEIN, AMNIOTIC FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
3018210601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.74
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.57
|
| Rate for Payer: Healthfirst Essential Plan |
$14.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Humana Medicare |
$17.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: United Healthcare Commercial |
$21.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.57
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.74
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.57
|
| Rate for Payer: Healthfirst Essential Plan |
$14.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Humana Medicare |
$17.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: United Healthcare Commercial |
$21.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.57
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
HC ALVEOLOPLASTY IN CONJUNC WITH EXT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT D7310
|
| Hospital Charge Code |
361D731001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,846.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$131.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC ALVEOLOPLASTY IN CONJUNC WITH EXT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT D7310
|
| Hospital Charge Code |
361D731001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
|
|
HC AMB CONTINUOUS GLUCOSE MONITORING
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
9209525001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$193.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.46
|
| Rate for Payer: Aetna Government |
$157.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.22
|
| Rate for Payer: Brighton Health Commercial |
$263.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$157.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.14
|
| Rate for Payer: Group Health Inc Commercial |
$157.46
|
| Rate for Payer: Group Health Inc Medicare |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.84
|
| Rate for Payer: Healthfirst QHP |
$157.46
|
| Rate for Payer: Humana Medicare |
$160.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Wellcare Medicare |
$149.59
|
|
|
HC AMB CONTINUOUS GLUCOSE MONITORING
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
9209525001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.50
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.87
|
| Rate for Payer: Aetna Government |
$16.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.81
|
| Rate for Payer: Brighton Health Commercial |
$36.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.87
|
| Rate for Payer: EmblemHealth Commercial |
$16.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.01
|
| Rate for Payer: Group Health Inc Commercial |
$16.87
|
| Rate for Payer: Group Health Inc Medicare |
$16.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.14
|
| Rate for Payer: Healthfirst Essential Plan |
$31.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.87
|
| Rate for Payer: Healthfirst QHP |
$16.87
|
| Rate for Payer: Humana Medicare |
$17.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.14
|
| Rate for Payer: Wellcare Medicare |
$15.18
|
|
