|
HC BILIRUBIN DIRECT - ADDITIONAL CHARGE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3018224802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN DIRECT - ADDITIONAL CHARGE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3018224802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN DIRECT - BILIRUBIN DIRECT
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3018224801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN DIRECT - BILIRUBIN DIRECT
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3018224801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - ADDITIONAL CHARGE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - ADDITIONAL CHARGE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN NEONATAL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN NEONATAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL AND DIRECT
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL AND DIRECT
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL, CORD BLOOD
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL, CORD BLOOD
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - POCT BILIRUBINOMETRY
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Essential Plan |
$11.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
HC BILIRUBIN TOTAL - POCT BILIRUBINOMETRY
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3018224707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC BINOCULAR MICROSCOPY
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
5109250401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
|
|
HC BINOCULAR MICROSCOPY
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
5109250401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.18
|
| Rate for Payer: Aetna Government |
$8.18
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.31
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC BIOFIRE RESPIRATORY PANEL 2.1
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
3100202U01
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.35 |
| Max. Negotiated Rate |
$425.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$416.78
|
| Rate for Payer: Aetna Government |
$416.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$291.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$291.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$291.75
|
| Rate for Payer: Brighton Health Commercial |
$416.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$269.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$416.78
|
| Rate for Payer: EmblemHealth Commercial |
$416.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.93
|
| Rate for Payer: Group Health Inc Commercial |
$416.78
|
| Rate for Payer: Group Health Inc Medicare |
$416.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$416.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.26
|
| Rate for Payer: Healthfirst QHP |
$416.78
|
| Rate for Payer: Humana Medicare |
$425.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$395.94
|
| Rate for Payer: Wellcare Medicare |
$375.10
|
|
|
HC BIOFIRE RESPIRATORY PANEL 2.1
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
3100202U01
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$168.50 |
| Max. Negotiated Rate |
$168.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.50
|
|
|
HC BIOIMPEDANCE-DERIVED PHYSIOLOGIC CARDIOVASCULAR ANALYSIS
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93701
|
| Hospital Charge Code |
4809370101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC BIOIMPEDANCE-DERIVED PHYSIOLOGIC CARDIOVASCULAR ANALYSIS
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93701
|
| Hospital Charge Code |
4809370101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - BOOSTER
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 0054A
|
| Hospital Charge Code |
7710054A01
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.36
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
