|
HC IV INFUSION, HYDRATION, EA ADD HOUR
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
2609636101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$761.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$338.44
|
| Rate for Payer: Amida Care Medicaid |
$338.44
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$761.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$338.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$761.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.36
|
| Rate for Payer: Group Health Inc Commercial |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Healthfirst Essential Plan |
$761.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$551.66
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: SOMOS Essential |
$761.50
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$761.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$372.28
|
| Rate for Payer: United Healthcare Medicaid |
$338.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
2609636701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
2609636701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$146.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.39
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
2609636801
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
2609636801
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Government |
$18.06
|
| Rate for Payer: Brighton Health Commercial |
$53.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.28
|
| Rate for Payer: EmblemHealth Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.61
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
2609636501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
2609636501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$444.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.43
|
| Rate for Payer: Aetna Government |
$257.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.20
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$444.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.11
|
| Rate for Payer: Group Health Inc Commercial |
$257.43
|
| Rate for Payer: Group Health Inc Medicare |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.82
|
| Rate for Payer: Healthfirst QHP |
$257.43
|
| Rate for Payer: Humana Medicare |
$262.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.43
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.56
|
| Rate for Payer: Wellcare Medicare |
$244.56
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$761.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$338.44
|
| Rate for Payer: Amida Care Medicaid |
$338.44
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$761.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$338.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$761.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.36
|
| Rate for Payer: Group Health Inc Commercial |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Healthfirst Essential Plan |
$761.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$551.66
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: SOMOS Essential |
$761.50
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$761.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$372.28
|
| Rate for Payer: United Healthcare Medicaid |
$338.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC JAK2 GENE ANALYSIS
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
3108127001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$183.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.66
|
| Rate for Payer: Aetna Government |
$91.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$64.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$64.16
|
| Rate for Payer: Brighton Health Commercial |
$91.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$91.66
|
| Rate for Payer: EmblemHealth Commercial |
$91.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.58
|
| Rate for Payer: Group Health Inc Commercial |
$91.66
|
| Rate for Payer: Group Health Inc Medicare |
$91.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.66
|
| Rate for Payer: Healthfirst QHP |
$91.66
|
| Rate for Payer: Humana Medicare |
$93.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$87.08
|
| Rate for Payer: Wellcare Medicare |
$82.49
|
|
|
HC JAK2 GENE ANALYSIS
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
3108127001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$114.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.50
|
|
|
HC JANSSEN COVID19 VAC ADMIN
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
7710031A01
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
|
|
HC JANSSEN COVID19 VAC ADMIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
7710031A01
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.36
|
| 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 |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC JOHN CUNNINGHAM VIRUS ANTIBODY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
3028671101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC JOHN CUNNINGHAM VIRUS ANTIBODY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
3028671101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.89
|
| Rate for Payer: Aetna Government |
$16.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.82
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.89
|
| Rate for Payer: EmblemHealth Commercial |
$16.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$16.89
|
| Rate for Payer: Group Health Inc Medicare |
$16.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.89
|
| Rate for Payer: Healthfirst QHP |
$16.89
|
| Rate for Payer: Humana Medicare |
$17.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.89
|
| Rate for Payer: United Healthcare Commercial |
$17.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.05
|
| Rate for Payer: Wellcare Medicare |
$15.20
|
|
|
HC KETONE BODIES SERUM QUALITATIVE - ACETONE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
3018200901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.52
|
| Rate for Payer: Aetna Government |
$4.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.16
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.52
|
| Rate for Payer: EmblemHealth Commercial |
$4.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.52
|
| Rate for Payer: Group Health Inc Medicare |
$4.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.52
|
| Rate for Payer: Healthfirst QHP |
$4.52
|
| Rate for Payer: Humana Medicare |
$4.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.52
|
| Rate for Payer: United Healthcare Commercial |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Wellcare Medicare |
$4.07
|
|
|
HC KETONE BODIES SERUM QUALITATIVE - ACETONE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
3018200901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC KETONE BODIES SERUM QUALITATIVE - KETONES, QUALITATIVE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
3018200903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC KETONE BODIES SERUM QUALITATIVE - KETONES, QUALITATIVE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
3018200903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.52
|
| Rate for Payer: Aetna Government |
$4.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.16
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.52
|
| Rate for Payer: EmblemHealth Commercial |
$4.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.52
|
| Rate for Payer: Group Health Inc Medicare |
$4.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.52
|
| Rate for Payer: Healthfirst QHP |
$4.52
|
| Rate for Payer: Humana Medicare |
$4.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.52
|
| Rate for Payer: United Healthcare Commercial |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.51
|
| Rate for Payer: Wellcare Medicare |
$4.07
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$8.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.27
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.17
|
| Rate for Payer: Healthfirst QHP |
$8.17
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.76
|
| Rate for Payer: Wellcare Medicare |
$7.35
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - POCT KETONE, BLOOD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
3018201003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$8.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.27
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.17
|
| Rate for Payer: Healthfirst QHP |
$8.17
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.76
|
| Rate for Payer: Wellcare Medicare |
$7.35
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - POCT KETONE, BLOOD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
3018201003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78709 TC
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78709 TC
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$202.82
|
| Rate for Payer: Aetna Government |
$202.82
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$579.04
|
| Rate for Payer: EmblemHealth Commercial |
$281.20
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.20
|
| Rate for Payer: Healthfirst Essential Plan |
$532.26
|
| Rate for Payer: United Healthcare Commercial |
$257.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$236.56
|
|
