|
HC B CELLS, TOTAL COUNT - B CELLS, TOTAL COUNT
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
3028635501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
|
|
HC BCR/ABL1 GENE MAJOR BREAKPOINT, QUAL/QUANT
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
3108120601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$368.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.96
|
| Rate for Payer: Aetna Government |
$163.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$114.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$114.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$114.77
|
| Rate for Payer: Brighton Health Commercial |
$163.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$327.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$163.96
|
| Rate for Payer: EmblemHealth Commercial |
$163.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.92
|
| Rate for Payer: Group Health Inc Commercial |
$163.96
|
| Rate for Payer: Group Health Inc Medicare |
$163.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.96
|
| Rate for Payer: Healthfirst Essential Plan |
$368.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.96
|
| Rate for Payer: Healthfirst QHP |
$163.96
|
| Rate for Payer: Humana Medicare |
$167.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$163.96
|
| Rate for Payer: Wellcare Medicare |
$147.56
|
|
|
HC BCR/ABL1 GENE MAJOR BREAKPOINT, QUAL/QUANT
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
3108120601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$204.50 |
| Max. Negotiated Rate |
$204.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.50
|
|
|
HC BCR/ABL1 GENE MINOR BREAKPOINT, QUAL/QUANT
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
3108120701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$325.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.84
|
| Rate for Payer: Aetna Government |
$144.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$101.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$101.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$101.39
|
| Rate for Payer: Brighton Health Commercial |
$144.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$289.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$144.84
|
| Rate for Payer: EmblemHealth Commercial |
$144.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.91
|
| Rate for Payer: Group Health Inc Commercial |
$144.84
|
| Rate for Payer: Group Health Inc Medicare |
$144.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.84
|
| Rate for Payer: Healthfirst Essential Plan |
$325.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.84
|
| Rate for Payer: Healthfirst QHP |
$144.84
|
| Rate for Payer: Humana Medicare |
$147.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.84
|
| Rate for Payer: Wellcare Medicare |
$130.36
|
|
|
HC BCR/ABL1 GENE MINOR BREAKPOINT, QUAL/QUANT
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
3108120701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.00
|
|
|
HC BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
9189612701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$5.66 |
| 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 |
$5.66
|
| 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 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
9189612701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC BEHAVIORAL HEALTH OUTREACH SVCS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT H0023
|
| Hospital Charge Code |
911H002301
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC BEHAVIORAL HEALTH OUTREACH SVCS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT H0023
|
| Hospital Charge Code |
911H002301
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.95
|
| Rate for Payer: Aetna Government |
$243.95
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
HC BEHAVIORAL HEALTH SCREENING
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT H0002
|
| Hospital Charge Code |
900H000201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
|
|
HC BEHAVIORAL HEALTH SCREENING
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT H0002
|
| Hospital Charge Code |
900H000201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.78
|
| Rate for Payer: Aetna Government |
$45.78
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: EmblemHealth Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$225.00
|
|
|
HC BEHAVIOR COUNSEL OBESITY 15 MIN
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT G0447
|
| Hospital Charge Code |
510G044701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$79.11
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.59
|
| 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 |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$113.02
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$107.37
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC BEHAVIOR COUNSEL OBESITY 15 MIN
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT G0447
|
| Hospital Charge Code |
510G044701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
3028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.45
|
| Rate for Payer: Aetna Government |
$25.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.82
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.45
|
| Rate for Payer: EmblemHealth Commercial |
$25.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$25.45
|
| Rate for Payer: Group Health Inc Medicare |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Healthfirst Essential Plan |
$17.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.45
|
| Rate for Payer: Healthfirst QHP |
$25.45
|
| Rate for Payer: Humana Medicare |
$25.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$32.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.90
|
| Rate for Payer: Wellcare Medicare |
$22.91
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
3028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
|
|
HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
3018223202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.18
|
| Rate for Payer: Aetna Government |
$16.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.33
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$16.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.40
|
| Rate for Payer: Group Health Inc Commercial |
$16.18
|
| Rate for Payer: Group Health Inc Medicare |
$16.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.18
|
| Rate for Payer: Healthfirst QHP |
$16.18
|
| Rate for Payer: Humana Medicare |
$16.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare Commercial |
$20.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$14.56
|
|
|
HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
3018223202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
3018223901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
|
|
HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
3018223901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.12
|
| Rate for Payer: Aetna Government |
$17.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.98
|
| Rate for Payer: Brighton Health Commercial |
$421.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.12
|
| Rate for Payer: EmblemHealth Commercial |
$17.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.24
|
| Rate for Payer: Group Health Inc Commercial |
$17.12
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.18
|
| Rate for Payer: Healthfirst Essential Plan |
$29.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.12
|
| Rate for Payer: Healthfirst QHP |
$17.12
|
| Rate for Payer: Humana Medicare |
$17.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$21.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.18
|
| Rate for Payer: Wellcare Medicare |
$15.41
|
|
|
HC BILIARY ENDOSCOPY PERCUT,BIOPSY
|
Facility
|
IP
|
$9,417.00
|
|
|
Service Code
|
CPT 47553 TC
|
| Hospital Charge Code |
3614755301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,708.50 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
|
|
HC BILIARY ENDOSCOPY PERCUT,BIOPSY
|
Facility
|
OP
|
$9,417.00
|
|
|
Service Code
|
CPT 47553 TC
|
| Hospital Charge Code |
3614755301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$347.17 |
| Max. Negotiated Rate |
$7,062.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$347.17
|
| Rate for Payer: Aetna Government |
$347.17
|
| Rate for Payer: Brighton Health Commercial |
$7,062.75
|
| 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 |
$4,708.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,295.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,171.15
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC BILIARY ENDOSCOPY PERCUT,DIL+STENT
|
Facility
|
OP
|
$14,640.00
|
|
|
Service Code
|
CPT 47556 TC
|
| Hospital Charge Code |
3614755601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.96 |
| Max. Negotiated Rate |
$10,980.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$472.96
|
| Rate for Payer: Aetna Government |
$472.96
|
| Rate for Payer: Brighton Health Commercial |
$10,980.00
|
| 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 |
$7,320.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,564.15
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC BILIARY ENDOSCOPY PERCUT,DIL+STENT
|
Facility
|
IP
|
$14,640.00
|
|
|
Service Code
|
CPT 47556 TC
|
| Hospital Charge Code |
3614755601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,320.00 |
| Max. Negotiated Rate |
$7,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.00
|
|
|
HC BILIARY ENDOSCOPY PERCUT,DIL W/O STENT
|
Facility
|
OP
|
$9,417.00
|
|
|
Service Code
|
CPT 47555 TC
|
| Hospital Charge Code |
3614755501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.62 |
| Max. Negotiated Rate |
$7,062.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.62
|
| Rate for Payer: Aetna Government |
$415.62
|
| Rate for Payer: Brighton Health Commercial |
$7,062.75
|
| 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 |
$4,708.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,295.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,136.33
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC BILIARY ENDOSCOPY PERCUT,DIL W/O STENT
|
Facility
|
IP
|
$9,417.00
|
|
|
Service Code
|
CPT 47555 TC
|
| Hospital Charge Code |
3614755501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,708.50 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
|
