|
HC TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,955.41
|
| Rate for Payer: Aetna Government |
$1,955.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,368.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,368.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,368.79
|
| Rate for Payer: Brighton Health Commercial |
$3,226.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,955.41
|
| 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 |
$1,955.41
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,759.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,662.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,740.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,955.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,740.31
|
| 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 |
$1,955.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,662.10
|
| Rate for Payer: Healthfirst QHP |
$1,955.41
|
| Rate for Payer: Humana Medicare |
$1,994.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,955.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,955.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,955.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,857.64
|
| Rate for Payer: Wellcare Medicare |
$1,857.64
|
|
|
HC TRG@ GENE REARRANGE ANALYSIS
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
3108134201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$251.50 |
| Max. Negotiated Rate |
$251.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.50
|
|
|
HC TRG@ GENE REARRANGE ANALYSIS
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
3108134201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$402.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$201.50
|
| Rate for Payer: Aetna Government |
$201.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$141.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$141.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$141.05
|
| Rate for Payer: Brighton Health Commercial |
$201.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$402.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$342.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$201.50
|
| Rate for Payer: EmblemHealth Commercial |
$201.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.34
|
| Rate for Payer: Group Health Inc Commercial |
$201.50
|
| Rate for Payer: Group Health Inc Medicare |
$201.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.50
|
| Rate for Payer: Healthfirst QHP |
$201.50
|
| Rate for Payer: Humana Medicare |
$205.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.43
|
| Rate for Payer: Wellcare Medicare |
$181.35
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.94
|
| Rate for Payer: Aetna Government |
$16.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.86
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$16.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$16.94
|
| Rate for Payer: Group Health Inc Medicare |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Essential Plan |
$20.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.94
|
| Rate for Payer: Healthfirst QHP |
$16.94
|
| Rate for Payer: Humana Medicare |
$17.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$21.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$15.25
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
3018448201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.76
|
| Rate for Payer: Aetna Government |
$15.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.03
|
| Rate for Payer: Brighton Health Commercial |
$29.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.76
|
| Rate for Payer: EmblemHealth Commercial |
$15.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$15.76
|
| Rate for Payer: Group Health Inc Medicare |
$15.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Healthfirst Essential Plan |
$12.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.76
|
| Rate for Payer: Healthfirst QHP |
$15.76
|
| Rate for Payer: Humana Medicare |
$16.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.76
|
| Rate for Payer: United Healthcare Commercial |
$19.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
|
|
HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
3018448201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
|
|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.93
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.18
|
| Rate for Payer: EmblemHealth Commercial |
$14.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.62
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Healthfirst Essential Plan |
$12.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.18
|
| Rate for Payer: Healthfirst QHP |
$14.18
|
| Rate for Payer: Humana Medicare |
$14.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$17.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
|
|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
3611105602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
3611105602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC TRIM HYPERKERATOTIC SKIN LESION, ONE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
3611105502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC TRIM HYPERKERATOTIC SKIN LESION, ONE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
3611105502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$376.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC TRIM NON DYSTROPHIC NAIL(S)
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| 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 |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC TRIM NON DYSTROPHIC NAIL(S)
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC TRLUML PERIP ATHRC BRACHIO
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
3610237T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC TRLUML PERIP ATHRC BRACHIO
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
3610237T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,190.00 |
| Max. Negotiated Rate |
$24,008.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,008.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,406.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13,856.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC TRLUML PERIP ATHRC ILIAC ART
|
Facility
|
IP
|
$48,278.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
3610238T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,139.00 |
| Max. Negotiated Rate |
$24,139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
|
|
HC TRLUML PERIP ATHRC ILIAC ART
|
Facility
|
OP
|
$48,278.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
3610238T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,190.00 |
| Max. Negotiated Rate |
$38,622.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,939.88
|
| Rate for Payer: Aetna Government |
$21,939.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15,357.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,357.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,357.92
|
| Rate for Payer: Brighton Health Commercial |
$36,208.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,939.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,622.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,829.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,939.88
|
| Rate for Payer: EmblemHealth Commercial |
$21,939.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,745.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,648.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,526.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,939.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,526.49
|
| Rate for Payer: Group Health Inc Commercial |
$21,939.88
|
| Rate for Payer: Group Health Inc Medicare |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,532.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,648.90
|
| Rate for Payer: Healthfirst QHP |
$21,939.88
|
| Rate for Payer: Humana Medicare |
$22,378.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,939.88
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,939.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,939.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,842.89
|
| Rate for Payer: Wellcare Medicare |
$20,842.89
|
|
|
HC TRLUML PERIP ATHRC RENAL ART
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
3610234T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,190.00 |
| Max. Negotiated Rate |
$24,008.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,008.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,406.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13,856.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC TRLUML PERIP ATHRC RENAL ART
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
3610234T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC TRLUML PERIP ATHRC VISCERAL - IR ATHERECTOMY EA ADDL VISCERAL ARTERY
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
3610235T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
|
|
HC TRLUML PERIP ATHRC VISCERAL - IR ATHERECTOMY EA ADDL VISCERAL ARTERY
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
3610235T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,836.80 |
| Max. Negotiated Rate |
$4,198.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,162.54
|
| Rate for Payer: Aetna Government |
$2,162.54
|
| Rate for Payer: Brighton Health Commercial |
$3,936.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,198.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,568.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,624.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,836.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.00
|
|
|
HC TROFILE®; HIV CORECEPTOR USAGE ASSAY
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
3068799901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2,450.00 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,450.00
|
|
|
HC TROFILE®; HIV CORECEPTOR USAGE ASSAY
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
3068799901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,695.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,450.00
|
| Rate for Payer: Aetna Government |
$2,450.00
|
| Rate for Payer: Brighton Health Commercial |
$3,675.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: EmblemHealth Commercial |
$2,450.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,450.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,715.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,450.00
|
|
