|
HC GONADOTROPIN (FSH) - FSH
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
3018300101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC GONADOTROPIN (LH) - LUTEINIZING HORMONE
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
3018300201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.96
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.52
|
| Rate for Payer: EmblemHealth Commercial |
$18.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.48
|
| Rate for Payer: Group Health Inc Commercial |
$18.52
|
| Rate for Payer: Group Health Inc Medicare |
$18.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.52
|
| Rate for Payer: Healthfirst Essential Plan |
$41.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.52
|
| Rate for Payer: Healthfirst QHP |
$18.52
|
| Rate for Payer: Humana Medicare |
$18.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.52
|
| Rate for Payer: Wellcare Medicare |
$16.67
|
|
|
HC GONADOTROPIN (LH) - LUTEINIZING HORMONE
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
3018300201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC GONIOSCOPY
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92020
|
| Hospital Charge Code |
9209202001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC GONIOSCOPY
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92020
|
| Hospital Charge Code |
9209202001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC GRAFTJACKET, PER SQ CM
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
636Q410701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.00
|
|
|
HC GRAFTJACKET, PER SQ CM
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
636Q410701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.78
|
| Rate for Payer: Aetna Government |
$69.78
|
| Rate for Payer: Brighton Health Commercial |
$110.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.80
|
| Rate for Payer: EmblemHealth Commercial |
$92.00
|
| Rate for Payer: Group Health Inc Commercial |
$92.00
|
| Rate for Payer: Group Health Inc Medicare |
$64.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.60
|
|
|
HC GRANULOCYTES, PHERESIS, EACH UNIT
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
386P905001
|
|
Hospital Revenue Code
|
386
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$973.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$973.77
|
| Rate for Payer: Aetna Government |
$973.77
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
|
|
HC GRANULOCYTES, PHERESIS, EACH UNIT
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
386P905001
|
|
Hospital Revenue Code
|
386
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9159085301
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$74.22
|
| Rate for Payer: Amida Care Medicaid |
$74.22
|
| Rate for Payer: Brighton Health Commercial |
$177.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$74.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$113.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$113.02
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$166.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$74.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.93
|
| Rate for Payer: Group Health Inc Commercial |
$113.02
|
| Rate for Payer: Group Health Inc Medicare |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Healthfirst Essential Plan |
$166.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$120.98
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.99
|
| Rate for Payer: Optum Medicaid |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: SOMOS Essential |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.64
|
| Rate for Payer: United Healthcare Medicaid |
$74.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9159085301
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9069085301
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$74.22
|
| Rate for Payer: Amida Care Medicaid |
$74.22
|
| Rate for Payer: Brighton Health Commercial |
$177.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$74.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$113.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$113.02
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$166.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$74.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.93
|
| Rate for Payer: Group Health Inc Commercial |
$113.02
|
| Rate for Payer: Group Health Inc Medicare |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Healthfirst Essential Plan |
$166.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$120.98
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.99
|
| Rate for Payer: Optum Medicaid |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: SOMOS Essential |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.64
|
| Rate for Payer: United Healthcare Medicaid |
$74.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9069085301
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9059085301
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9059085301
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$74.22
|
| Rate for Payer: Amida Care Medicaid |
$74.22
|
| Rate for Payer: Brighton Health Commercial |
$177.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$74.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$113.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$113.02
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$166.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$74.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.93
|
| Rate for Payer: Group Health Inc Commercial |
$113.02
|
| Rate for Payer: Group Health Inc Medicare |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Healthfirst Essential Plan |
$166.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$120.98
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.99
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.22
|
| Rate for Payer: SOMOS Essential |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.64
|
| Rate for Payer: United Healthcare Medicaid |
$74.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$74.22
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC GTT-ADDED SAMPLES - BUNDLED CHARGE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC GTT-ADDED SAMPLES - BUNDLED CHARGE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.92
|
| Rate for Payer: Aetna Government |
$3.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.74
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.92
|
| Rate for Payer: EmblemHealth Commercial |
$3.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.49
|
| Rate for Payer: Group Health Inc Commercial |
$3.92
|
| Rate for Payer: Group Health Inc Medicare |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.92
|
| Rate for Payer: Healthfirst QHP |
$3.92
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$4.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Wellcare Medicare |
$3.53
|
|
|
HC GTT-ADDED SAMPLES - GTT 3 HOUR
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.92
|
| Rate for Payer: Aetna Government |
$3.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.74
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.92
|
| Rate for Payer: EmblemHealth Commercial |
$3.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.49
|
| Rate for Payer: Group Health Inc Commercial |
$3.92
|
| Rate for Payer: Group Health Inc Medicare |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.92
|
| Rate for Payer: Healthfirst QHP |
$3.92
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$4.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Wellcare Medicare |
$3.53
|
|
|
HC GTT-ADDED SAMPLES - GTT 3 HOUR
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC GTT-ADDED SAMPLES - GTT 5 HOUR
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.92
|
| Rate for Payer: Aetna Government |
$3.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.74
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.92
|
| Rate for Payer: EmblemHealth Commercial |
$3.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.49
|
| Rate for Payer: Group Health Inc Commercial |
$3.92
|
| Rate for Payer: Group Health Inc Medicare |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.92
|
| Rate for Payer: Healthfirst QHP |
$3.92
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$4.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.41
|
| Rate for Payer: Wellcare Medicare |
$3.53
|
|
|
HC GTT-ADDED SAMPLES - GTT 5 HOUR
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
3018295203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC HBA1/HBA2 GENE ANALYSIS - ALPHA THALASSEMIA
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
3108125701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.58 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.26
|
| Rate for Payer: Aetna Government |
$102.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$71.58
|
| Rate for Payer: Brighton Health Commercial |
$102.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.26
|
| Rate for Payer: EmblemHealth Commercial |
$102.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.01
|
| Rate for Payer: Group Health Inc Commercial |
$102.26
|
| Rate for Payer: Group Health Inc Medicare |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.26
|
| Rate for Payer: Healthfirst QHP |
$102.26
|
| Rate for Payer: Humana Medicare |
$104.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.15
|
| Rate for Payer: Wellcare Medicare |
$92.03
|
|
|
HC HBA1/HBA2 GENE ANALYSIS - ALPHA THALASSEMIA
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
3108125701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
|
|
HC HBA1/HBA2 GENE - GENE TEST BETA-THALASSEMIA
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
3108125702
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
|
|
HC HBA1/HBA2 GENE - GENE TEST BETA-THALASSEMIA
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
3008125701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.58 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.26
|
| Rate for Payer: Aetna Government |
$102.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$71.58
|
| Rate for Payer: Brighton Health Commercial |
$191.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.26
|
| Rate for Payer: EmblemHealth Commercial |
$102.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.01
|
| Rate for Payer: Group Health Inc Commercial |
$102.26
|
| Rate for Payer: Group Health Inc Medicare |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.26
|
| Rate for Payer: Healthfirst QHP |
$102.26
|
| Rate for Payer: Humana Medicare |
$104.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.26
|
| Rate for Payer: United Healthcare Commercial |
$92.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.15
|
| Rate for Payer: Wellcare Medicare |
$92.03
|
|
