|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.69
|
| Rate for Payer: Aetna Government |
$15.69
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.66
|
| Rate for Payer: Healthfirst Essential Plan |
$56.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.90
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS W/ OBLIQUES
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3247104605
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.69
|
| Rate for Payer: Aetna Government |
$15.69
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.66
|
| Rate for Payer: Healthfirst Essential Plan |
$56.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.90
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS W/ OBLIQUES
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3247104605
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAM CHEST 3 VIEWS - XR CHEST 3 VIEWS
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
3247104701
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAM CHEST 3 VIEWS - XR CHEST 3 VIEWS
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
3247104701
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.94
|
| Rate for Payer: Aetna Government |
$19.94
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.60
|
| Rate for Payer: Healthfirst Essential Plan |
$71.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.84
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
3247104801
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: EmblemHealth Commercial |
$32.70
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.70
|
| Rate for Payer: Healthfirst Essential Plan |
$76.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.11
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
3247104801
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Government |
$8.60
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$18.37
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Essential Plan |
$36.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST LATERAL DECUBITUS
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3247104501
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Government |
$8.60
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$18.37
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Essential Plan |
$36.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST LATERAL DECUBITUS
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3247104501
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION, ESOPHAGUS, INCL SCOUT CHEST RADIOGRAPH DOUBLE-CONTRAST
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
3207422101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
|
|
HC RADIOLOGIC EXAMINATION, ESOPHAGUS, INCL SCOUT CHEST RADIOGRAPH DOUBLE-CONTRAST
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
3207422101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.51
|
| Rate for Payer: Aetna Government |
$217.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$152.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$152.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$152.26
|
| Rate for Payer: Brighton Health Commercial |
$217.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$367.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$217.51
|
| Rate for Payer: EmblemHealth Commercial |
$111.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.58
|
| Rate for Payer: Group Health Inc Commercial |
$195.76
|
| Rate for Payer: Group Health Inc Medicare |
$195.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.47
|
| Rate for Payer: Healthfirst Essential Plan |
$162.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.51
|
| Rate for Payer: Healthfirst QHP |
$217.51
|
| Rate for Payer: Humana Medicare |
$221.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$72.09
|
| Rate for Payer: Wellcare Medicare |
$206.63
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73551 TC
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Government |
$15.20
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$22.91
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.91
|
| Rate for Payer: Healthfirst Essential Plan |
$51.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.68
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73551 TC
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW RIGHT
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73551 TC
|
| Hospital Charge Code |
3207355102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW RIGHT
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73551 TC
|
| Hospital Charge Code |
3207355102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Government |
$15.20
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$22.91
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.91
|
| Rate for Payer: Healthfirst Essential Plan |
$51.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.68
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW BILAT
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW BILAT
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.99
|
| Rate for Payer: Aetna Government |
$17.99
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.50
|
| Rate for Payer: Healthfirst Essential Plan |
$59.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.44
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW LT
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.99
|
| Rate for Payer: Aetna Government |
$17.99
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.50
|
| Rate for Payer: Healthfirst Essential Plan |
$59.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.44
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW LT
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73552 TC
|
| Hospital Charge Code |
3207355202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$192.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.99
|
| Rate for Payer: Aetna Government |
$17.99
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.50
|
| Rate for Payer: Healthfirst Essential Plan |
$59.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.44
|
|
|
HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$209.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Healthfirst Essential Plan |
$26.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Commercial |
$22.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
