|
HC MRI, UPPER EXTREMITY W/CONTRAST - MR HUMERUS W IV CONTRAST
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 73219 TC
|
| Hospital Charge Code |
6147321905
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$935.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$635.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$867.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$935.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$787.13
|
| Rate for Payer: EmblemHealth Commercial |
$271.36
|
| Rate for Payer: Group Health Inc Commercial |
$578.00
|
| Rate for Payer: Group Health Inc Medicare |
$404.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.36
|
| Rate for Payer: Healthfirst Essential Plan |
$864.16
|
| Rate for Payer: United Healthcare Commercial |
$349.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$384.07
|
|
|
HC MRI, UPPER EXTREMITY W/CONTRAST - MR HUMERUS W IV CONTRAST
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 73219 TC
|
| Hospital Charge Code |
6147321905
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
|
|
HC MRI, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA W IV CONTRAST
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 73219 TC
|
| Hospital Charge Code |
6147321901
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$935.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$635.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$867.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$935.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$787.13
|
| Rate for Payer: EmblemHealth Commercial |
$271.36
|
| Rate for Payer: Group Health Inc Commercial |
$578.00
|
| Rate for Payer: Group Health Inc Medicare |
$404.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.36
|
| Rate for Payer: Healthfirst Essential Plan |
$864.16
|
| Rate for Payer: United Healthcare Commercial |
$349.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$384.07
|
|
|
HC MRI, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA W IV CONTRAST
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 73219 TC
|
| Hospital Charge Code |
6147321901
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HAND WO IV CONTRAST
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321803
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$742.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$733.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$617.72
|
| Rate for Payer: EmblemHealth Commercial |
$253.89
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.89
|
| Rate for Payer: Healthfirst Essential Plan |
$742.59
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$330.04
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HAND WO IV CONTRAST
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321803
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS WO IV CONTRAST
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$742.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$733.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$617.72
|
| Rate for Payer: EmblemHealth Commercial |
$253.89
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.89
|
| Rate for Payer: Healthfirst Essential Plan |
$742.59
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$330.04
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS WO IV CONTRAST
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA WO IV CONTRAST
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA WO IV CONTRAST
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 73218 TC
|
| Hospital Charge Code |
6147321802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$742.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$733.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$617.72
|
| Rate for Payer: EmblemHealth Commercial |
$253.89
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.89
|
| Rate for Payer: Healthfirst Essential Plan |
$742.59
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$330.04
|
|
|
HC MRSA, DNA, AMP PROBE - MRSA DNA PROBE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
3068764102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC MRSA, DNA, AMP PROBE - MRSA DNA PROBE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
3068764102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC MRSA, DNA, AMP PROBE - MR STAPH DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
3068764101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC MRSA, DNA, AMP PROBE - MR STAPH DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
3068764101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
3108129501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$389.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$381.70
|
| Rate for Payer: Aetna Government |
$381.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$267.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$267.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$267.19
|
| Rate for Payer: Brighton Health Commercial |
$381.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$381.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$381.70
|
| Rate for Payer: EmblemHealth Commercial |
$381.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$339.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$381.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$339.71
|
| Rate for Payer: Group Health Inc Commercial |
$381.70
|
| Rate for Payer: Group Health Inc Medicare |
$381.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$381.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$381.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.23
|
| Rate for Payer: Healthfirst Essential Plan |
$344.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.70
|
| Rate for Payer: Healthfirst QHP |
$381.70
|
| Rate for Payer: Humana Medicare |
$389.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$381.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$381.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$153.23
|
| Rate for Payer: Wellcare Medicare |
$343.53
|
|
|
HC MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
3108129501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MSH2 (MUTS HOMOLOG 2, COLON CANCER, NONPOLYPOSIS TYPE 1)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81297
|
| Hospital Charge Code |
3108129701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MSH2 (MUTS HOMOLOG 2, COLON CANCER, NONPOLYPOSIS TYPE 1)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81297
|
| Hospital Charge Code |
3108129701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$344.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$213.30
|
| Rate for Payer: Aetna Government |
$213.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$149.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$149.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$149.31
|
| Rate for Payer: Brighton Health Commercial |
$213.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$213.30
|
| Rate for Payer: EmblemHealth Commercial |
$213.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.84
|
| Rate for Payer: Group Health Inc Commercial |
$213.30
|
| Rate for Payer: Group Health Inc Medicare |
$213.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.23
|
| Rate for Payer: Healthfirst Essential Plan |
$344.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.30
|
| Rate for Payer: Healthfirst QHP |
$213.30
|
| Rate for Payer: Humana Medicare |
$217.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$153.23
|
| Rate for Payer: Wellcare Medicare |
$191.97
|
|
|
HC MSH6 (MUTS HOMOLOG 6 E. COLI) DUPLICATION/DELETION VARIANTS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81300
|
| Hospital Charge Code |
3108130001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$367.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$238.00
|
| Rate for Payer: Aetna Government |
$238.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$166.60
|
| Rate for Payer: Brighton Health Commercial |
$238.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$238.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.82
|
| Rate for Payer: Group Health Inc Commercial |
$238.00
|
| Rate for Payer: Group Health Inc Medicare |
$238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.30
|
| Rate for Payer: Healthfirst Essential Plan |
$367.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.00
|
| Rate for Payer: Healthfirst QHP |
$238.00
|
| Rate for Payer: Humana Medicare |
$242.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$163.30
|
| Rate for Payer: Wellcare Medicare |
$214.20
|
|
|
HC MSH6 (MUTS HOMOLOG 6 E. COLI) DUPLICATION/DELETION VARIANTS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81300
|
| Hospital Charge Code |
3108130001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MSH6 (MUTS HOMOLOG 6 E. COLI) FULL SEQUENCE ANALYSIS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81298
|
| Hospital Charge Code |
3108129801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$654.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$641.85
|
| Rate for Payer: Aetna Government |
$641.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$449.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$449.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$449.30
|
| Rate for Payer: Brighton Health Commercial |
$641.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$641.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$641.85
|
| Rate for Payer: EmblemHealth Commercial |
$641.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$577.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$571.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$641.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$571.25
|
| Rate for Payer: Group Health Inc Commercial |
$641.85
|
| Rate for Payer: Group Health Inc Medicare |
$641.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$641.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.71
|
| Rate for Payer: Healthfirst Essential Plan |
$654.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$641.85
|
| Rate for Payer: Healthfirst QHP |
$641.85
|
| Rate for Payer: Humana Medicare |
$654.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$641.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$641.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$641.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.71
|
| Rate for Payer: Wellcare Medicare |
$577.66
|
|
|
HC MSH6 (MUTS HOMOLOG 6 E. COLI) FULL SEQUENCE ANALYSIS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81298
|
| Hospital Charge Code |
3108129801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MTHFR GENE ANALYSIS, COMMON VARIANTS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
3108129101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MTHFR GENE ANALYSIS, COMMON VARIANTS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
3108129101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.34
|
| Rate for Payer: Aetna Government |
$65.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.74
|
| Rate for Payer: Brighton Health Commercial |
$65.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.34
|
| Rate for Payer: EmblemHealth Commercial |
$65.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.15
|
| Rate for Payer: Group Health Inc Commercial |
$65.34
|
| Rate for Payer: Group Health Inc Medicare |
$65.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.34
|
| Rate for Payer: Healthfirst QHP |
$65.34
|
| Rate for Payer: Humana Medicare |
$66.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$62.07
|
| Rate for Payer: Wellcare Medicare |
$58.81
|
|
|
HC MTMS BY PHARM, EST PT, 15 MIN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 99606
|
| Hospital Charge Code |
2599960601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
