|
HC CHORION VILLUS BIOPSY
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
3615901501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$957.00
|
|
|
HC CHROMOSOME ANALYS, AMNIOTIC FLUID/CHORIONIC VILLUS; 15 CELLS,1KARYOTYPE
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
3118826901
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC CHROMOSOME ANALYS, AMNIOTIC FLUID/CHORIONIC VILLUS; 15 CELLS,1KARYOTYPE
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
3118826901
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$282.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$173.66
|
| Rate for Payer: Aetna Government |
$173.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$121.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$121.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$121.56
|
| Rate for Payer: Brighton Health Commercial |
$173.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$282.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$237.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$173.66
|
| Rate for Payer: EmblemHealth Commercial |
$173.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.56
|
| Rate for Payer: Group Health Inc Commercial |
$173.66
|
| Rate for Payer: Group Health Inc Medicare |
$173.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.75
|
| Rate for Payer: Healthfirst Essential Plan |
$170.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.66
|
| Rate for Payer: Healthfirst QHP |
$173.66
|
| Rate for Payer: Humana Medicare |
$177.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$173.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$75.75
|
| Rate for Payer: Wellcare Medicare |
$156.29
|
|
|
HC CHROMOSOME ANALYSIS; 15-20 CELLS, 2 KARYOTYPES
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
3118826201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.50
|
|
|
HC CHROMOSOME ANALYSIS; 15-20 CELLS, 2 KARYOTYPES
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
3118826201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$227.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.49
|
| Rate for Payer: Aetna Government |
$125.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$87.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$87.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$87.84
|
| Rate for Payer: Brighton Health Commercial |
$125.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$211.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$125.49
|
| Rate for Payer: EmblemHealth Commercial |
$125.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.69
|
| Rate for Payer: Group Health Inc Commercial |
$125.49
|
| Rate for Payer: Group Health Inc Medicare |
$125.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.00
|
| Rate for Payer: Healthfirst Essential Plan |
$227.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.49
|
| Rate for Payer: Healthfirst QHP |
$125.49
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.00
|
| Rate for Payer: Wellcare Medicare |
$112.94
|
|
|
HC CHROMOSOME ANALYSIS; ADD'L KARYOTYPES, EACH STUDY
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
3118828001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$45.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.47
|
| Rate for Payer: Aetna Government |
$33.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.43
|
| Rate for Payer: Brighton Health Commercial |
$33.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.47
|
| Rate for Payer: EmblemHealth Commercial |
$33.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.79
|
| Rate for Payer: Group Health Inc Commercial |
$33.47
|
| Rate for Payer: Group Health Inc Medicare |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.47
|
| Rate for Payer: Healthfirst QHP |
$33.47
|
| Rate for Payer: Humana Medicare |
$34.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$30.12
|
|
|
HC CHROMOSOME ANALYSIS; ADD'L KARYOTYPES, EACH STUDY
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
3118828001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.50
|
|
|
HC CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3118826401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.50
|
|
|
HC CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3118826401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$211.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.61
|
| Rate for Payer: Aetna Government |
$144.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$101.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$101.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$101.23
|
| Rate for Payer: Brighton Health Commercial |
$144.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$211.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$144.61
|
| Rate for Payer: EmblemHealth Commercial |
$144.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.70
|
| Rate for Payer: Group Health Inc Commercial |
$144.61
|
| Rate for Payer: Group Health Inc Medicare |
$144.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.61
|
| Rate for Payer: Healthfirst QHP |
$144.61
|
| Rate for Payer: Humana Medicare |
$147.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.38
|
| Rate for Payer: Wellcare Medicare |
$130.15
|
|
|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR, PHARYNGEAL
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR, PHARYNGEAL
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR, RECTAL
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR, RECTAL
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC CINERADIOGRAPHY/VIDEORADIOGRAPHY UNSPECIFIED
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76120 TC
|
| Hospital Charge Code |
3297612001
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.35
|
| Rate for Payer: Aetna Government |
$50.35
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$150.40
|
| Rate for Payer: EmblemHealth Commercial |
$95.58
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.58
|
| Rate for Payer: Healthfirst Essential Plan |
$133.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.47
|
|
|
HC CINERADIOGRAPHY/VIDEORADIOGRAPHY UNSPECIFIED
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76120 TC
|
| Hospital Charge Code |
3297612001
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.24
|
| Rate for Payer: Aetna Government |
$78.24
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.21
|
| Rate for Payer: EmblemHealth Commercial |
$101.52
|
| Rate for Payer: Group Health Inc Commercial |
$275.50
|
| Rate for Payer: Group Health Inc Medicare |
$192.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.52
|
| Rate for Payer: Healthfirst Essential Plan |
$133.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.16
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
3615416101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.43 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,502.91
|
| Rate for Payer: Aetna Government |
$2,502.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,752.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,752.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,752.04
|
| Rate for Payer: Brighton Health Commercial |
$1,090.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,502.91
|
| 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 |
$2,502.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,502.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,252.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,127.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,502.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,502.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,127.47
|
| Rate for Payer: Healthfirst QHP |
$2,502.91
|
| Rate for Payer: Humana Medicare |
$2,552.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,502.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,502.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,377.76
|
| Rate for Payer: Wellcare Medicare |
$2,377.76
|
|
|
HC CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
3615416101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.00 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.00
|
|
|
HC CIRCUMCISION NEONATE
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
3615416001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.00 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.00
|
|
|
HC CIRCUMCISION NEONATE
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
3615416001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.53
|
| Rate for Payer: Aetna Government |
$815.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$570.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$570.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$570.87
|
| Rate for Payer: Brighton Health Commercial |
$1,090.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.53
|
| 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 |
$815.53
|
| Rate for Payer: EmblemHealth Commercial |
$815.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$733.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$693.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.82
|
| Rate for Payer: Group Health Inc Commercial |
$815.53
|
| Rate for Payer: Group Health Inc Medicare |
$815.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.20
|
| Rate for Payer: Healthfirst QHP |
$815.53
|
| Rate for Payer: Humana Medicare |
$831.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.53
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$815.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$774.75
|
| Rate for Payer: Wellcare Medicare |
$774.75
|
|
