|
HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.41
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$16.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.51
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Healthfirst Essential Plan |
$36.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.30
|
| Rate for Payer: Healthfirst QHP |
$16.30
|
| Rate for Payer: Humana Medicare |
$16.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Wellcare Medicare |
$14.67
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION BASELINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.41
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$16.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.51
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Healthfirst Essential Plan |
$36.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.30
|
| Rate for Payer: Healthfirst QHP |
$16.30
|
| Rate for Payer: Humana Medicare |
$16.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Wellcare Medicare |
$14.67
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION BASELINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC TOTAL CORTISOL - CORTISOL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC TOTAL CORTISOL - CORTISOL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3018253301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.41
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$16.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.51
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Healthfirst Essential Plan |
$36.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.30
|
| Rate for Payer: Healthfirst QHP |
$16.30
|
| Rate for Payer: Humana Medicare |
$16.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.30
|
| Rate for Payer: Wellcare Medicare |
$14.67
|
|
|
HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
3028677801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
3028677801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$32.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.41
|
| Rate for Payer: Aetna Government |
$14.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.09
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.41
|
| Rate for Payer: EmblemHealth Commercial |
$14.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$14.41
|
| Rate for Payer: Group Health Inc Medicare |
$14.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.26
|
| Rate for Payer: Healthfirst Essential Plan |
$32.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.41
|
| Rate for Payer: Healthfirst QHP |
$14.41
|
| Rate for Payer: Humana Medicare |
$14.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.41
|
| Rate for Payer: United Healthcare Commercial |
$18.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.26
|
| Rate for Payer: Wellcare Medicare |
$12.97
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Essential Plan |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC TP53 (TUMOR PROTEIN 53) FULL SEQUENCE
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 81351
|
| Hospital Charge Code |
3108135101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.50 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.50
|
|
|
HC TP53 (TUMOR PROTEIN 53) FULL SEQUENCE
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 81351
|
| Hospital Charge Code |
3108135101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$875.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$108.35
|
| 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 |
$157.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$133.96
|
| 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 |
$388.96
|
| Rate for Payer: Healthfirst Essential Plan |
$875.16
|
| 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 |
$388.96
|
| Rate for Payer: Wellcare Medicare |
$577.66
|
|
|
HC TPMT (THIOPURINE S-METHYLTRANSFERASE) (EG, DRUG METABOLISM), GENE ANALYSIS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 81335
|
| Hospital Charge Code |
3108133501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.10 |
| Max. Negotiated Rate |
$178.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.81
|
| Rate for Payer: Aetna Government |
$174.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$122.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$122.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$122.37
|
| Rate for Payer: Brighton Health Commercial |
$174.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$174.81
|
| Rate for Payer: EmblemHealth Commercial |
$174.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.58
|
| Rate for Payer: Group Health Inc Commercial |
$174.81
|
| Rate for Payer: Group Health Inc Medicare |
$174.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.81
|
| Rate for Payer: Healthfirst QHP |
$174.81
|
| Rate for Payer: Humana Medicare |
$178.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$166.07
|
| Rate for Payer: Wellcare Medicare |
$157.33
|
|
|
HC TPMT (THIOPURINE S-METHYLTRANSFERASE) (EG, DRUG METABOLISM), GENE ANALYSIS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 81335
|
| Hospital Charge Code |
3108133501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.00
|
|
|
HC TRABECULOPLASTY BY LASER SURGERY
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
3616585501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.50 |
| Max. Negotiated Rate |
$928.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$928.50
|
|
|
HC TRABECULOPLASTY BY LASER SURGERY
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
3616585501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,536.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$682.93
|
| Rate for Payer: Amida Care Medicaid |
$682.93
|
| Rate for Payer: Brighton Health Commercial |
$1,392.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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: Elderplan Medicare Advantage |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$670.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$682.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,536.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.07
|
| Rate for Payer: Group Health Inc Commercial |
$670.29
|
| Rate for Payer: Group Health Inc Medicare |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$1,113.17
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: SOMOS Essential |
$1,536.59
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$751.21
|
| Rate for Payer: United Healthcare Medicaid |
$682.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC TRACHEOSTOMY, EMERG, CRICOTHYROID MEMBRANE
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
3613160501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$462.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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: Elderplan Medicare Advantage |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$283.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| Rate for Payer: Group Health Inc Commercial |
$283.73
|
| Rate for Payer: Group Health Inc Medicare |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC TRACHEOSTOMY, EMERG, CRICOTHYROID MEMBRANE
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
3613160501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC TRACHEOSTOMY,EMERG,XTRACH
|
Facility
|
IP
|
$4,163.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
7613160301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,081.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,081.50
|
|
|
HC TRACHEOSTOMY,EMERG,XTRACH
|
Facility
|
IP
|
$7,933.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
3613160001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,966.50 |
| Max. Negotiated Rate |
$3,966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.50
|
|
|
HC TRACHEOSTOMY,EMERG,XTRACH
|
Facility
|
OP
|
$7,933.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
3613160001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$352.09 |
| Max. Negotiated Rate |
$5,949.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,962.45
|
| Rate for Payer: Aetna Government |
$3,962.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,773.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,773.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,773.72
|
| Rate for Payer: Brighton Health Commercial |
$5,949.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,962.45
|
| 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: Elderplan Medicare Advantage |
$3,962.45
|
| Rate for Payer: EmblemHealth Commercial |
$3,962.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,566.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,368.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,526.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,962.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,526.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,962.45
|
| Rate for Payer: Group Health Inc Medicare |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,962.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$352.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,368.08
|
| Rate for Payer: Healthfirst QHP |
$3,962.45
|
| Rate for Payer: Humana Medicare |
$4,041.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,962.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,962.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,764.33
|
| Rate for Payer: Wellcare Medicare |
$3,764.33
|
|
|
HC TRACHEOSTOMY,EMERG,XTRACH
|
Facility
|
OP
|
$4,163.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
7613160301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,122.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$3,122.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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: Elderplan Medicare Advantage |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| 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 |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC TRACH PUNCT, PERC W TT ASP OR INJ
|
Facility
|
OP
|
$7,933.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
3613161201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$5,949.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,962.45
|
| Rate for Payer: Aetna Government |
$3,962.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,773.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,773.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,773.72
|
| Rate for Payer: Brighton Health Commercial |
$5,949.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,962.45
|
| 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: Elderplan Medicare Advantage |
$3,962.45
|
| Rate for Payer: EmblemHealth Commercial |
$3,962.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,566.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,368.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,526.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,962.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,526.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,962.45
|
| Rate for Payer: Group Health Inc Medicare |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,394.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,368.08
|
| Rate for Payer: Healthfirst QHP |
$3,962.45
|
| Rate for Payer: Humana Medicare |
$4,041.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,962.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,962.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,764.33
|
| Rate for Payer: Wellcare Medicare |
$3,764.33
|
|
|
HC TRACH PUNCT, PERC W TT ASP OR INJ
|
Facility
|
IP
|
$7,933.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
3613161201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,966.50 |
| Max. Negotiated Rate |
$3,966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.50
|
|
