|
HC FATS/LIPIDS, FECES, QUANTITATIVE - FECAL FAT QUANTITATIVE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
3018271001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.76
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.80
|
| Rate for Payer: Healthfirst Essential Plan |
$37.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.80
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
HC FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$290.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.56
|
| Rate for Payer: Aetna Government |
$53.56
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$73.29
|
| 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 |
$73.29
|
| Rate for Payer: Healthfirst Essential Plan |
$290.20
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128.98
|
|
|
HC FETAL BIOP PROFIL W/O NST - US FETAL BIOPHYS PROF WO NON STRESS TEST
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.91
|
| Rate for Payer: Aetna Government |
$38.91
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$52.47
|
| 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 |
$52.47
|
| Rate for Payer: Healthfirst Essential Plan |
$234.79
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.35
|
|
|
HC FETAL BIOP PROFIL W/O NST - US FETAL BIOPHYS PROF WO NON STRESS TEST
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ ANALYSIS PANEL
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$948.50 |
| Max. Negotiated Rate |
$948.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$948.50
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ ANALYSIS PANEL
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$531.34 |
| Max. Negotiated Rate |
$1,517.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,043.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$759.05
|
| Rate for Payer: Aetna Government |
$759.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$531.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$531.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$531.34
|
| Rate for Payer: Brighton Health Commercial |
$759.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,517.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,289.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$759.05
|
| Rate for Payer: EmblemHealth Commercial |
$759.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.55
|
| Rate for Payer: Group Health Inc Commercial |
$759.05
|
| Rate for Payer: Group Health Inc Medicare |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.05
|
| Rate for Payer: Healthfirst QHP |
$759.05
|
| Rate for Payer: Humana Medicare |
$774.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$721.10
|
| Rate for Payer: Wellcare Medicare |
$683.14
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ - MATERNIT21
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$948.50 |
| Max. Negotiated Rate |
$948.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$948.50
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ - MATERNIT21
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$531.34 |
| Max. Negotiated Rate |
$1,517.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,043.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$759.05
|
| Rate for Payer: Aetna Government |
$759.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$531.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$531.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$531.34
|
| Rate for Payer: Brighton Health Commercial |
$759.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,517.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,289.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$759.05
|
| Rate for Payer: EmblemHealth Commercial |
$759.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.55
|
| Rate for Payer: Group Health Inc Commercial |
$759.05
|
| Rate for Payer: Group Health Inc Medicare |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.05
|
| Rate for Payer: Healthfirst QHP |
$759.05
|
| Rate for Payer: Humana Medicare |
$774.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$721.10
|
| Rate for Payer: Wellcare Medicare |
$683.14
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ - MATERNIT21 PLUS CORE
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$531.34 |
| Max. Negotiated Rate |
$1,517.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,043.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$759.05
|
| Rate for Payer: Aetna Government |
$759.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$531.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$531.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$531.34
|
| Rate for Payer: Brighton Health Commercial |
$759.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,517.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,289.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$759.05
|
| Rate for Payer: EmblemHealth Commercial |
$759.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.55
|
| Rate for Payer: Group Health Inc Commercial |
$759.05
|
| Rate for Payer: Group Health Inc Medicare |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.05
|
| Rate for Payer: Healthfirst QHP |
$759.05
|
| Rate for Payer: Humana Medicare |
$774.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$721.10
|
| Rate for Payer: Wellcare Medicare |
$683.14
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOME SEQ - MATERNIT21 PLUS CORE
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
3108142001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$948.50 |
| Max. Negotiated Rate |
$948.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$948.50
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
3615902501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$311.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.50
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.63
|
| Rate for Payer: Aetna Government |
$21.63
|
| Rate for Payer: Brighton Health Commercial |
$467.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$498.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$423.64
|
| Rate for Payer: EmblemHealth Commercial |
$311.50
|
| Rate for Payer: Group Health Inc Commercial |
$311.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.91
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
3615902501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.63
|
| Rate for Payer: Aetna Government |
$21.63
|
| Rate for Payer: Brighton Health Commercial |
$376.50
|
| 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 |
$251.00
|
| Rate for Payer: Group Health Inc Commercial |
$251.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
5105902501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 59025 TC
|
| Hospital Charge Code |
5105902501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.63
|
| Rate for Payer: Aetna Government |
$21.63
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.91
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.13
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Essential Plan |
$22.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Humana Medicare |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.72
|
| Rate for Payer: Aetna Government |
$9.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.80
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.72
|
| Rate for Payer: EmblemHealth Commercial |
$9.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.72
|
| Rate for Payer: Group Health Inc Medicare |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.97
|
| Rate for Payer: Healthfirst Essential Plan |
$15.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$9.72
|
| Rate for Payer: Humana Medicare |
$9.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$10.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.97
|
| Rate for Payer: Wellcare Medicare |
$8.75
|
|
|
HC FIBRINOGEN, ANTIGEN - FIBRINOGEN ANTIGEN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 85385
|
| Hospital Charge Code |
3058538501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.46
|
| Rate for Payer: Aetna Government |
$14.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.12
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.46
|
| Rate for Payer: EmblemHealth Commercial |
$14.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$14.46
|
| Rate for Payer: Group Health Inc Medicare |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.97
|
| Rate for Payer: Healthfirst Essential Plan |
$15.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.46
|
| Rate for Payer: Healthfirst QHP |
$14.46
|
| Rate for Payer: Humana Medicare |
$14.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.46
|
| Rate for Payer: United Healthcare Commercial |
$10.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.97
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
|
|
HC FIBRINOGEN, ANTIGEN - FIBRINOGEN ANTIGEN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 85385
|
| Hospital Charge Code |
3058538501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC FILTERED SPEECH TEST
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 92571
|
| Hospital Charge Code |
4719257101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.77
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$45.56
|
|
|
HC FILTERED SPEECH TEST
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 92571
|
| Hospital Charge Code |
4719257101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
