|
HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIXING STUDY
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
3058573202
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.25
|
| Rate for Payer: Healthfirst Essential Plan |
$14.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.25
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3028680001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
|
|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3028680001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$30.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.91
|
| Rate for Payer: Aetna Government |
$15.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.14
|
| Rate for Payer: Brighton Health Commercial |
$29.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.91
|
| Rate for Payer: EmblemHealth Commercial |
$15.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.16
|
| Rate for Payer: Group Health Inc Commercial |
$15.91
|
| Rate for Payer: Group Health Inc Medicare |
$15.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Healthfirst Essential Plan |
$30.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.91
|
| Rate for Payer: Healthfirst QHP |
$15.91
|
| Rate for Payer: Humana Medicare |
$16.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare Commercial |
$20.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Wellcare Medicare |
$14.32
|
|
|
HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
3018447901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
3018447901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.33
|
| Rate for Payer: Healthfirst Essential Plan |
$7.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.33
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID SCAN
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78013 TC
|
| Hospital Charge Code |
3417801301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID SCAN
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78013 TC
|
| Hospital Charge Code |
3417801301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.39 |
| Max. Negotiated Rate |
$891.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.39
|
| Rate for Payer: Aetna Government |
$118.39
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$891.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$757.52
|
| Rate for Payer: EmblemHealth Commercial |
$159.43
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.43
|
| Rate for Payer: Healthfirst Essential Plan |
$303.32
|
| Rate for Payer: United Healthcare Commercial |
$120.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$134.81
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78014 TC
|
| Hospital Charge Code |
3417801401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78014 TC
|
| Hospital Charge Code |
3417801401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$891.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.83
|
| Rate for Payer: Aetna Government |
$148.83
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$891.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$757.52
|
| Rate for Payer: EmblemHealth Commercial |
$200.66
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.66
|
| Rate for Payer: Healthfirst Essential Plan |
$438.82
|
| Rate for Payer: United Healthcare Commercial |
$186.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$195.03
|
|
|
HC THYROID MET IMAGING BODY - FOLLOW UP
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78099 TC
|
| Hospital Charge Code |
3407809901
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$106.23 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$557.00
|
| Rate for Payer: Aetna Government |
$557.00
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$284.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$239.19
|
| Rate for Payer: EmblemHealth Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: United Healthcare Commercial |
$106.23
|
|
|
HC THYROID MET IMAGING BODY - FOLLOW UP
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78099 TC
|
| Hospital Charge Code |
3407809901
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC THYROID MET IMAGING BODY - NM THYROID WHOLE BODY TUMOR
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78018 TC
|
| Hospital Charge Code |
3417801801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC THYROID MET IMAGING BODY - NM THYROID WHOLE BODY TUMOR
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78018 TC
|
| Hospital Charge Code |
3417801801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$186.19
|
| Rate for Payer: Aetna Government |
$186.19
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$522.58
|
| Rate for Payer: EmblemHealth Commercial |
$253.40
|
| 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 |
$253.40
|
| Rate for Payer: Healthfirst Essential Plan |
$463.84
|
| Rate for Payer: United Healthcare Commercial |
$232.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$206.15
|
|
|
HC THYROID MET IMAGING - NM THYROID TUMOR METASTASES LIMITED
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78015 TC
|
| Hospital Charge Code |
3427801501
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.69
|
| Rate for Payer: Aetna Government |
$128.69
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$522.58
|
| Rate for Payer: EmblemHealth Commercial |
$186.68
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.68
|
| Rate for Payer: Healthfirst Essential Plan |
$334.91
|
| Rate for Payer: United Healthcare Commercial |
$232.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$148.85
|
|
|
HC THYROID MET IMAGING - NM THYROID TUMOR METASTASES LIMITED
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78015 TC
|
| Hospital Charge Code |
3427801501
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC THYROTROPIN RELEASING HORMONE(TRH) STIMULATION PANEL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80439
|
| Hospital Charge Code |
3018043901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.00
|
|
|
HC THYROTROPIN RELEASING HORMONE(TRH) STIMULATION PANEL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80439
|
| Hospital Charge Code |
3018043901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.21
|
| Rate for Payer: Aetna Government |
$67.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$47.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.05
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.21
|
| Rate for Payer: EmblemHealth Commercial |
$67.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.82
|
| Rate for Payer: Group Health Inc Commercial |
$67.21
|
| Rate for Payer: Group Health Inc Medicare |
$67.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.21
|
| Rate for Payer: Healthfirst QHP |
$67.21
|
| Rate for Payer: Humana Medicare |
$68.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.21
|
| Rate for Payer: United Healthcare Commercial |
$85.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.85
|
| Rate for Payer: Wellcare Medicare |
$60.49
|
|
|
HC TILT TABLE EVALUATION - TILT TABLE
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
4809366001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$184.56 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC TILT TABLE EVALUATION - TILT TABLE
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
4809366001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC TIPS EXCLUDING EMBOLIZATION
|
Facility
|
IP
|
$6,574.00
|
|
|
Service Code
|
CPT 37182 TC
|
| Hospital Charge Code |
3613718201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,287.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,287.00
|
|
|
HC TIPS EXCLUDING EMBOLIZATION
|
Facility
|
OP
|
$6,574.00
|
|
|
Service Code
|
CPT 37182 TC
|
| Hospital Charge Code |
3613718201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.45 |
| Max. Negotiated Rate |
$4,930.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,615.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$887.45
|
| Rate for Payer: Aetna Government |
$887.45
|
| Rate for Payer: Brighton Health Commercial |
$4,930.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,287.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,287.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,300.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,287.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,287.00
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC TIPS REVISION
|
Facility
|
OP
|
$15,004.00
|
|
|
Service Code
|
CPT 37183 TC
|
| Hospital Charge Code |
3613718301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.13 |
| Max. Negotiated Rate |
$11,253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$419.13
|
| Rate for Payer: Aetna Government |
$419.13
|
| Rate for Payer: Brighton Health Commercial |
$11,253.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$7,502.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,502.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,251.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,502.00
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC TIPS REVISION
|
Facility
|
IP
|
$15,004.00
|
|
|
Service Code
|
CPT 37183 TC
|
| Hospital Charge Code |
3613718301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,502.00 |
| Max. Negotiated Rate |
$7,502.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
|
|
HC TISSUE CULTURE, AMNIOTIC FLUID/CHORIONIC VILLUS
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
3118823501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$299.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.30
|
| Rate for Payer: Aetna Government |
$150.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$105.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$105.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$105.21
|
| Rate for Payer: Brighton Health Commercial |
$150.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$150.30
|
| Rate for Payer: EmblemHealth Commercial |
$150.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.77
|
| Rate for Payer: Group Health Inc Commercial |
$150.30
|
| Rate for Payer: Group Health Inc Medicare |
$150.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.23
|
| Rate for Payer: Healthfirst Essential Plan |
$299.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.30
|
| Rate for Payer: Healthfirst QHP |
$150.30
|
| Rate for Payer: Humana Medicare |
$153.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$133.23
|
| Rate for Payer: Wellcare Medicare |
$135.27
|
|
|
HC TISSUE CULTURE, AMNIOTIC FLUID/CHORIONIC VILLUS
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
3118823501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
|
