|
HC GASTRIC EMPTYING IMAGING STUDY - SMALL BOWL & COLON
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78265 TC
|
| Hospital Charge Code |
3417826501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC GASTRIC INTUBATION/ASPIRATION, FOR POISONS
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
4504375301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC GASTRIC INTUBATION/ASPIRATION, FOR POISONS
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
4504375301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$380.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$380.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$399.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST, W/ MUCOSAL TELEMETRY
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 91035 TC
|
| Hospital Charge Code |
7509103501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.54 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$354.54
|
| Rate for Payer: Aetna Government |
$354.54
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| 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: EmblemHealth Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Medicare |
$514.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$416.18
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST, W/ MUCOSAL TELEMETRY
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 91035 TC
|
| Hospital Charge Code |
7509103501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST, W/ NASAL CATHETER
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 91034 TC
|
| Hospital Charge Code |
7509103401
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$123.80
|
| Rate for Payer: Aetna Government |
$123.80
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| 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: EmblemHealth Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$735.00
|
| Rate for Payer: Group Health Inc Medicare |
$514.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.55
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST, W/ NASAL CATHETER
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 91034 TC
|
| Hospital Charge Code |
7509103401
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC GATED HEART PLANAR SINGLE - NM HEART BLOOD POOL EJECT FRAC WALL MUGA
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78472 TC
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.95
|
| Rate for Payer: Aetna Government |
$124.95
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$623.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$524.89
|
| Rate for Payer: EmblemHealth Commercial |
$169.91
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.91
|
| Rate for Payer: Healthfirst Essential Plan |
$365.99
|
| Rate for Payer: United Healthcare Commercial |
$233.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$162.66
|
|
|
HC GATED HEART PLANAR SINGLE - NM HEART BLOOD POOL EJECT FRAC WALL MUGA
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78472 TC
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC GBA GENE ANALYSIS - GAUCHER DISEASE
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
3108125101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$94.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.25
|
| Rate for Payer: Aetna Government |
$47.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.08
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.25
|
| Rate for Payer: EmblemHealth Commercial |
$47.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.05
|
| Rate for Payer: Group Health Inc Commercial |
$47.25
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.25
|
| Rate for Payer: Healthfirst QHP |
$47.25
|
| Rate for Payer: Humana Medicare |
$48.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.89
|
| Rate for Payer: Wellcare Medicare |
$42.52
|
|
|
HC GBA GENE ANALYSIS - GAUCHER DISEASE
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
3108125101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.00
|
|
|
HC GENERAL ANESTHESIA EACH 15 MINS
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT D9223
|
| Hospital Charge Code |
379D922301
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
|
|
HC GENERAL ANESTHESIA EACH 15 MINS
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT D9223
|
| Hospital Charge Code |
379D922301
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$735.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.36
|
| Rate for Payer: Aetna Government |
$52.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$735.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$735.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$326.94
|
| Rate for Payer: Amida Care Medicaid |
$326.94
|
| Rate for Payer: Brighton Health Commercial |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: EmblemHealth Commercial |
$95.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$735.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$326.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$326.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$735.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$735.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.29
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$326.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.94
|
| Rate for Payer: Healthfirst Essential Plan |
$735.62
|
| Rate for Payer: Healthfirst QHP |
$532.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.94
|
| Rate for Payer: SOMOS Essential |
$735.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$735.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$359.63
|
| Rate for Payer: United Healthcare Medicaid |
$326.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$326.94
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
3018005001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
3018005001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.95
|
| Rate for Payer: Aetna Government |
$28.95
|
| Rate for Payer: Brighton Health Commercial |
$19.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.10
|
| Rate for Payer: EmblemHealth Commercial |
$13.00
|
| Rate for Payer: Group Health Inc Commercial |
$13.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$36.39
|
|
|
HC GENOTYPE DNA HIV REVERSE TRANSCRIPTASE/PROTEASE
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
3068790101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$321.50 |
| Max. Negotiated Rate |
$321.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.50
|
|
|
HC GENOTYPE DNA HIV REVERSE TRANSCRIPTASE/PROTEASE
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
3068790101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$579.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$353.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.45
|
| Rate for Payer: Aetna Government |
$257.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.22
|
| Rate for Payer: Brighton Health Commercial |
$482.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$437.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$368.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.45
|
| Rate for Payer: EmblemHealth Commercial |
$257.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.13
|
| Rate for Payer: Group Health Inc Commercial |
$257.45
|
| Rate for Payer: Group Health Inc Medicare |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.45
|
| Rate for Payer: Healthfirst Essential Plan |
$579.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.45
|
| Rate for Payer: Healthfirst QHP |
$257.45
|
| Rate for Payer: Humana Medicare |
$262.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare Commercial |
$326.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$257.45
|
| Rate for Payer: Wellcare Medicare |
$231.71
|
|
|
HC GLIADIN (DEAMIDATED) (DGP) ANTIBODY, EACH IMMUNOGLOBULIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
3028625801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC GLIADIN (DEAMIDATED) (DGP) ANTIBODY, EACH IMMUNOGLOBULIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
3028625801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.98
|
| Rate for Payer: Healthfirst Essential Plan |
$15.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$10.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.98
|
| Rate for Payer: Wellcare Medicare |
$10.85
|
|
|
HC GLOBAL FEE URGENT CARE CENTERS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT S9083
|
| Hospital Charge Code |
456S908302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.00
|
| Rate for Payer: Aetna Government |
$120.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$140.00
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.00
|
|
|
HC GLOBAL FEE URGENT CARE CENTERS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT S9083
|
| Hospital Charge Code |
456S908302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
|
|
HC GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD), SCREEN
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82960
|
| Hospital Charge Code |
3018296001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD), SCREEN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82960
|
| Hospital Charge Code |
3018296001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna Government |
$6.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.24
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.05
|
| Rate for Payer: EmblemHealth Commercial |
$6.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$6.05
|
| Rate for Payer: Group Health Inc Medicare |
$6.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.03
|
| Rate for Payer: Healthfirst Essential Plan |
$6.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.05
|
| Rate for Payer: Healthfirst QHP |
$6.05
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.03
|
| Rate for Payer: Wellcare Medicare |
$5.45
|
|
|
HC GLUCOSE, BLOOD, REAGENT STRIP
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
3008294801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC GLUCOSE, BLOOD, REAGENT STRIP
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
3008294801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.04
|
| Rate for Payer: Aetna Government |
$5.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.53
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.04
|
| Rate for Payer: EmblemHealth Commercial |
$5.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.49
|
| Rate for Payer: Group Health Inc Commercial |
$5.04
|
| Rate for Payer: Group Health Inc Medicare |
$5.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.04
|
| Rate for Payer: Healthfirst QHP |
$5.04
|
| Rate for Payer: Humana Medicare |
$5.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.04
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$4.54
|
|
