|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| 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 |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
3611602002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
3611602002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DRUG ASSAY CAFFEINE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3018015501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.57
|
| Rate for Payer: Aetna Government |
$38.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.00
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.57
|
| Rate for Payer: EmblemHealth Commercial |
$38.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.33
|
| Rate for Payer: Group Health Inc Commercial |
$38.57
|
| Rate for Payer: Group Health Inc Medicare |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.57
|
| Rate for Payer: Healthfirst QHP |
$38.57
|
| Rate for Payer: Humana Medicare |
$39.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$17.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36.64
|
| Rate for Payer: Wellcare Medicare |
$34.71
|
|
|
HC DRUG ASSAY CAFFEINE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3018015501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC DRUG ASSAY LACOSAMIDE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 80235
|
| Hospital Charge Code |
3018023501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
|
|
HC DRUG ASSAY LACOSAMIDE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 80235
|
| Hospital Charge Code |
3018023501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.11
|
| Rate for Payer: Aetna Government |
$27.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.98
|
| Rate for Payer: Brighton Health Commercial |
$29.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.11
|
| Rate for Payer: EmblemHealth Commercial |
$27.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.13
|
| Rate for Payer: Group Health Inc Commercial |
$27.11
|
| Rate for Payer: Group Health Inc Medicare |
$27.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.11
|
| Rate for Payer: Healthfirst QHP |
$27.11
|
| Rate for Payer: Humana Medicare |
$27.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare Commercial |
$24.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$24.40
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1-2 SALICYLATE- BUNDLED CHARGE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1-2 SALICYLATE- BUNDLED CHARGE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: EmblemHealth Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Medicare |
$37.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - ACETAMINOPHEN
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: EmblemHealth Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Medicare |
$37.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - ACETAMINOPHEN
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - IBUPROFEN
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - IBUPROFEN
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: EmblemHealth Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Medicare |
$37.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - SALICYLATE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: EmblemHealth Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Commercial |
$53.50
|
| Rate for Payer: Group Health Inc Medicare |
$37.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - SALICYLATE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
3018032901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 3-5 ACETAMINOPHEN - BUNDLED CHARGE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 80330
|
| Hospital Charge Code |
3018033001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$107.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 3-5 ACETAMINOPHEN - BUNDLED CHARGE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 80330
|
| Hospital Charge Code |
3018033001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$161.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.20
|
| Rate for Payer: EmblemHealth Commercial |
$107.50
|
| Rate for Payer: Group Health Inc Commercial |
$107.50
|
| Rate for Payer: Group Health Inc Medicare |
$75.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 3-5 SALICYLATE - BUNDLED CHARGE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 80330
|
| Hospital Charge Code |
3018033002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$107.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 3-5 SALICYLATE - BUNDLED CHARGE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 80330
|
| Hospital Charge Code |
3018033002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$161.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.20
|
| Rate for Payer: EmblemHealth Commercial |
$107.50
|
| Rate for Payer: Group Health Inc Commercial |
$107.50
|
| Rate for Payer: Group Health Inc Medicare |
$75.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.50
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 6+ ACETAMINOPHEN - BUNDLED CHARGE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 80331
|
| Hospital Charge Code |
3018033101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$241.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$257.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.96
|
| Rate for Payer: EmblemHealth Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 6+ ACETAMINOPHEN - BUNDLED CHARGE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 80331
|
| Hospital Charge Code |
3018033101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 6+ SALICYLATE - BUNDLED CHARGE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 80331
|
| Hospital Charge Code |
3018033102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 6+ SALICYLATE - BUNDLED CHARGE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 80331
|
| Hospital Charge Code |
3018033102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$241.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$257.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.96
|
| Rate for Payer: EmblemHealth Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$24.79
|
|
|
HC DRUG SCREENING BARBITURATES - BARBITURATE URINE CONF
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3018034502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$70.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$66.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.84
|
| Rate for Payer: EmblemHealth Commercial |
$44.00
|
| Rate for Payer: Group Health Inc Commercial |
$44.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$14.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.05
|
|
