|
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
|
|
|
HC BRCA1&2 GENE ANALYSIS - VISTASEQ HEREDITARY CANCER PANEL
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 81162
|
| Hospital Charge Code |
3108116201
|
|
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
|
|
|
HC BRCA1&2 GENE ANALYSIS - VISTASEQ HEREDITARY CANCER PANEL
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 81162
|
| Hospital Charge Code |
3108116201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$585.00
|
|
|
HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS BIL
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77062 TC
|
| Hospital Charge Code |
4017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS BIL
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77062 TC
|
| Hospital Charge Code |
4017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.14
|
| Rate for Payer: Aetna Government |
$94.14
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$75.33
|
|
|
HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 77063 TC
|
| Hospital Charge Code |
4037706301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.80
|
| Rate for Payer: Aetna Government |
$19.80
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.80
|
| Rate for Payer: EmblemHealth Commercial |
$25.16
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.16
|
| Rate for Payer: Healthfirst Essential Plan |
$101.39
|
| Rate for Payer: United Healthcare Commercial |
$20.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.06
|
|
|
HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 77063 TC
|
| Hospital Charge Code |
4037706301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77061 TC
|
| Hospital Charge Code |
4017706102
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$96.23
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77061 TC
|
| Hospital Charge Code |
4017706101
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$96.23
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77061 TC
|
| Hospital Charge Code |
4017706101
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77061 TC
|
| Hospital Charge Code |
4017706102
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 91065 TC
|
| Hospital Charge Code |
7509106501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 91065 TC
|
| Hospital Charge Code |
7509106501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,113.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.87
|
| Rate for Payer: Aetna Government |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: EmblemHealth Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Medicare |
$146.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.25
|
| Rate for Payer: Healthfirst Essential Plan |
$56.81
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.25
|
|
|
HC BREATHING CAPACITY TEST - BREATHING CAPACITY TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC BREATHING CAPACITY TEST - BREATHING CAPACITY TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
3613165201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,447.50 |
| Max. Negotiated Rate |
$4,447.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.50
|
|
|
HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
3613165201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.94 |
| Max. Negotiated Rate |
$6,671.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,504.79
|
| Rate for Payer: Aetna Government |
$4,504.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,153.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,153.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,153.35
|
| Rate for Payer: Brighton Health Commercial |
$6,671.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,504.79
|
| 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 |
$4,504.79
|
| Rate for Payer: EmblemHealth Commercial |
$4,504.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,054.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,829.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,009.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,504.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,009.26
|
| Rate for Payer: Group Health Inc Commercial |
$4,504.79
|
| Rate for Payer: Group Health Inc Medicare |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,610.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,829.07
|
| Rate for Payer: Healthfirst QHP |
$4,504.79
|
| Rate for Payer: Humana Medicare |
$4,594.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,504.79
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,504.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,504.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,279.55
|
| Rate for Payer: Wellcare Medicare |
$4,279.55
|
|
|
HC BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
3613165301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,447.50 |
| Max. Negotiated Rate |
$4,447.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.50
|
|
|
HC BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
3613165301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.31 |
| Max. Negotiated Rate |
$6,671.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,504.79
|
| Rate for Payer: Aetna Government |
$4,504.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,153.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,153.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,153.35
|
| Rate for Payer: Brighton Health Commercial |
$6,671.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,504.79
|
| 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 |
$4,504.79
|
| Rate for Payer: EmblemHealth Commercial |
$4,504.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,054.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,829.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,009.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,504.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,009.26
|
| Rate for Payer: Group Health Inc Commercial |
$4,504.79
|
| Rate for Payer: Group Health Inc Medicare |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,610.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,829.07
|
| Rate for Payer: Healthfirst QHP |
$4,504.79
|
| Rate for Payer: Humana Medicare |
$4,594.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,504.79
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,504.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,504.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,279.55
|
| Rate for Payer: Wellcare Medicare |
$4,279.55
|
|
|
HC BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Facility
|
OP
|
$3,872.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
3613165401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.87 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.87
|
| Rate for Payer: Aetna Government |
$69.87
|
| Rate for Payer: Brighton Health Commercial |
$2,904.00
|
| 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 |
$1,936.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,936.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,355.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,936.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,936.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Facility
|
IP
|
$3,872.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
3613165401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,936.00
|
|
|
HC BRONCHIAL ALLERGY TESTS,DRUGS
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
9249507001
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$735.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC BRONCHIAL ALLERGY TESTS,DRUGS
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
9249507001
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
