|
HC BONE MARROW IMAGING, MULT - NM BONE MARROW MULTIPLE AREAS
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78103 TC
|
| Hospital Charge Code |
3407810301
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC BONE MARROW IMAGING, MULT - NM BONE MARROW MULTIPLE AREAS
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78103 TC
|
| Hospital Charge Code |
3407810301
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$127.99 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.99
|
| Rate for Payer: Aetna Government |
$127.99
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$550.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$462.97
|
| Rate for Payer: EmblemHealth Commercial |
$146.85
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.85
|
| Rate for Payer: Healthfirst Essential Plan |
$318.87
|
| Rate for Payer: United Healthcare Commercial |
$205.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$141.72
|
|
|
HC BONE MARROW,SMEAR INTERPRETATION - BONE MARROW CELL DIFFERENTIAL
|
Facility
|
OP
|
$2,017.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
3058509701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$1,512.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,109.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$998.10
|
| Rate for Payer: Aetna Government |
$998.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$242.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$242.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.71
|
| Rate for Payer: Amida Care Medicaid |
$107.71
|
| Rate for Payer: Brighton Health Commercial |
$1,512.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$998.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$998.10
|
| Rate for Payer: EmblemHealth Commercial |
$51.16
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$242.34
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$107.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$998.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.09
|
| Rate for Payer: Group Health Inc Commercial |
$998.10
|
| Rate for Payer: Group Health Inc Medicare |
$998.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$998.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.71
|
| Rate for Payer: Healthfirst Essential Plan |
$242.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.10
|
| Rate for Payer: Healthfirst QHP |
$175.56
|
| Rate for Payer: Humana Medicare |
$1,018.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$998.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.71
|
| Rate for Payer: SOMOS Essential |
$242.34
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$242.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$118.48
|
| Rate for Payer: United Healthcare Medicaid |
$107.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$998.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$998.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$107.71
|
| Rate for Payer: Wellcare Medicare |
$898.29
|
|
|
HC BONE MARROW,SMEAR INTERPRETATION - BONE MARROW CELL DIFFERENTIAL
|
Facility
|
IP
|
$2,017.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
3058509701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1,008.50 |
| Max. Negotiated Rate |
$1,008.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,008.50
|
|
|
HC BOWEL IMAGING - NM MECKELS DIVERTICULUM
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78290 TC
|
| Hospital Charge Code |
3417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$205.86
|
| Rate for Payer: Aetna Government |
$205.86
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.05
|
| Rate for Payer: EmblemHealth Commercial |
$277.36
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.36
|
| Rate for Payer: Healthfirst Essential Plan |
$464.81
|
| Rate for Payer: United Healthcare Commercial |
$191.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$206.58
|
|
|
HC BOWEL IMAGING - NM MECKELS DIVERTICULUM
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78290 TC
|
| Hospital Charge Code |
3417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM CEREBRAL FLOW
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78610 TC
|
| Hospital Charge Code |
3407861002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$109.72
|
| Rate for Payer: Aetna Government |
$109.72
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.72
|
| Rate for Payer: EmblemHealth Commercial |
$153.84
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.84
|
| Rate for Payer: Healthfirst Essential Plan |
$258.64
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$114.95
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM CEREBRAL FLOW
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78610 TC
|
| Hospital Charge Code |
3407861002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC BRAIN IMAGE 4+ VIEWS - NM BRAIN 4 OR MORE VIEWS
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78605 TC
|
| Hospital Charge Code |
3417860501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC BRAIN IMAGE 4+ VIEWS - NM BRAIN 4 OR MORE VIEWS
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78605 TC
|
| Hospital Charge Code |
3417860501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.39 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.39
|
| Rate for Payer: Aetna Government |
$118.39
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.72
|
| Rate for Payer: EmblemHealth Commercial |
$166.76
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.76
|
| Rate for Payer: Healthfirst Essential Plan |
$287.21
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$127.65
|
|
|
HC BRAIN IMAGE < 4 VIEWS - NM BRAIN LIMITED
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78600 TC
|
| Hospital Charge Code |
3417860001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$111.83 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.83
|
| Rate for Payer: Aetna Government |
$111.83
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.72
|
| Rate for Payer: EmblemHealth Commercial |
$153.84
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.84
|
| Rate for Payer: Healthfirst Essential Plan |
$295.27
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$131.23
|
|
|
HC BRAIN IMAGE < 4 VIEWS - NM BRAIN LIMITED
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78600 TC
|
| Hospital Charge Code |
3417860001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC BRAIN IMAGE W/FLOW 4 + VIEWS - NM BRAIN WITH FLOW 4 OR MORE VIEWS
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
CPT 78606 TC
|
| Hospital Charge Code |
3417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$205.63 |
| Max. Negotiated Rate |
$1,276.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$787.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$205.63
|
| Rate for Payer: Aetna Government |
$205.63
|
| Rate for Payer: Brighton Health Commercial |
$1,073.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,276.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,074.06
|
| Rate for Payer: EmblemHealth Commercial |
$279.11
|
| Rate for Payer: Group Health Inc Commercial |
$715.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.11
|
| Rate for Payer: Healthfirst Essential Plan |
$493.33
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$219.26
|
|
|
HC BRAIN IMAGE W/FLOW 4 + VIEWS - NM BRAIN WITH FLOW 4 OR MORE VIEWS
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
CPT 78606 TC
|
| Hospital Charge Code |
3417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$715.50 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.50
|
|
|
HC BRAIN IMAGE W/FLOW < 4 VIEWS - NM BRAIN WITH FLOW LESS THAN 4 VIEWS
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 78601 TC
|
| Hospital Charge Code |
3417860101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.50 |
| Max. Negotiated Rate |
$539.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
|
|
HC BRAIN IMAGE W/FLOW < 4 VIEWS - NM BRAIN WITH FLOW LESS THAN 4 VIEWS
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 78601 TC
|
| Hospital Charge Code |
3417860101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$129.63 |
| Max. Negotiated Rate |
$1,276.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.63
|
| Rate for Payer: Aetna Government |
$129.63
|
| Rate for Payer: Brighton Health Commercial |
$809.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,276.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,074.06
|
| Rate for Payer: EmblemHealth Commercial |
$182.13
|
| Rate for Payer: Group Health Inc Commercial |
$539.50
|
| Rate for Payer: Group Health Inc Medicare |
$377.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.13
|
| Rate for Payer: Healthfirst Essential Plan |
$310.66
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$138.07
|
|
|
HC BRAIN IMAGING (PET) - PT BRAIN METABOLIC
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 78608 TC
|
| Hospital Charge Code |
4047860802
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,185.00 |
| Max. Negotiated Rate |
$2,185.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,185.00
|
|
|
HC BRAIN IMAGING (PET) - PT BRAIN METABOLIC
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 78608 TC
|
| Hospital Charge Code |
4047860802
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$599.94 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,403.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$875.00
|
| Rate for Payer: Aetna Government |
$875.00
|
| Rate for Payer: Brighton Health Commercial |
$3,277.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,229.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,876.93
|
| Rate for Payer: EmblemHealth Commercial |
$2,185.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,185.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,529.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,185.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,185.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,349.87
|
| Rate for Payer: United Healthcare Commercial |
$833.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$599.94
|
|
|
HC BRAIN SHUNT TUBE/RESERV INJECTN
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
3616107002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,449.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$371.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC BRAIN SHUNT TUBE/RESERV INJECTN
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
3616107002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.00
|
|
|
HC BRCA1&2 GENE ANALYSIS - FULL DUP/DEL ANALYSIS
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
CPT 81164
|
| Hospital Charge Code |
3108116401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$408.96 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$803.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$584.23
|
| Rate for Payer: Aetna Government |
$584.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$408.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$408.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$408.96
|
| Rate for Payer: Brighton Health Commercial |
$584.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$584.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$992.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$584.23
|
| Rate for Payer: EmblemHealth Commercial |
$584.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$525.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$519.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$584.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$519.96
|
| Rate for Payer: Group Health Inc Commercial |
$584.23
|
| Rate for Payer: Group Health Inc Medicare |
$584.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$584.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$584.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$584.23
|
| Rate for Payer: Healthfirst QHP |
$584.23
|
| Rate for Payer: Humana Medicare |
$595.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$584.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$584.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$584.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$555.02
|
| Rate for Payer: Wellcare Medicare |
$525.81
|
|
|
HC BRCA1&2 GENE ANALYSIS - FULL DUP/DEL ANALYSIS
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
CPT 81164
|
| Hospital Charge Code |
3108116401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.00
|
|
|
HC BRCA1&2 GENE ANALYSIS - FULL SEQUENCE ANALYSIS
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 81163
|
| Hospital Charge Code |
3108116301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$585.00
|
|
|
HC BRCA1&2 GENE ANALYSIS - FULL SEQUENCE ANALYSIS
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 81163
|
| Hospital Charge Code |
3108116301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.00
|
| Rate for Payer: Aetna Government |
$468.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$327.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$327.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$327.60
|
| Rate for Payer: Brighton Health Commercial |
$468.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$468.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$936.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$795.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$468.00
|
| Rate for Payer: EmblemHealth Commercial |
$468.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$421.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$397.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$468.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.52
|
| Rate for Payer: Group Health Inc Commercial |
$468.00
|
| Rate for Payer: Group Health Inc Medicare |
$468.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$468.00
|
| Rate for Payer: Healthfirst QHP |
$468.00
|
| Rate for Payer: Humana Medicare |
$477.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$468.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$444.60
|
| Rate for Payer: Wellcare Medicare |
$421.20
|
|
|
HC BRCA1&2 GENE ANALYSIS - FULL SEQUENCE & DUP/DEL ANALYSIS
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 81162
|
| Hospital Charge Code |
3108116202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$1,861.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,824.88
|
| Rate for Payer: Aetna Government |
$1,824.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,277.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,277.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,277.42
|
| Rate for Payer: Brighton Health Commercial |
$1,824.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,824.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$936.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$795.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,824.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,824.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,642.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,551.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,624.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,824.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,624.14
|
| Rate for Payer: Group Health Inc Commercial |
$1,824.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,824.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,824.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,824.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,824.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,824.88
|
| Rate for Payer: Healthfirst QHP |
$1,824.88
|
| Rate for Payer: Humana Medicare |
$1,861.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,824.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,824.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,824.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,733.64
|
| Rate for Payer: Wellcare Medicare |
$1,642.39
|
|
