|
ANTERIOR DISCECTOMY
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 63075
|
| Hospital Charge Code |
40000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
ANTERIOR NASAL PACK BILATERAL
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
30103316
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
ANTERIOR NASAL PACK BILATERAL
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
30103316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
ANTERIOR RESECTION
|
Facility
|
OP
|
$6,154.58
|
|
|
Service Code
|
HCPCS 45114
|
| Hospital Charge Code |
40010580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$4,615.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,385.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,164.06
|
| Rate for Payer: Aetna Government |
$2,164.06
|
| Rate for Payer: Brighton Health Commercial |
$4,615.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,077.29
|
| Rate for Payer: Group Health Inc Medicare |
$2,154.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,077.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,077.29
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
ANTERIOR VESICOURETHROPEXY/URETHR
|
Facility
|
OP
|
$1,871.15
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
40129652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$654.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,029.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$800.50
|
| Rate for Payer: Aetna Government |
$800.50
|
| Rate for Payer: Brighton Health Commercial |
$1,403.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$935.58
|
| Rate for Payer: Group Health Inc Medicare |
$654.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$935.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$935.58
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
ANTHROSCOPY JAW
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29804
|
| Hospital Charge Code |
40029411
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
ANTHROSCOPY JAW
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29804
|
| Hospital Charge Code |
40029411
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
ANTI ALLERGIC TAPE
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
40200345
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
ANTIBODY DETECTION NOS IF
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
HCPCS 87299
|
| Hospital Charge Code |
40613062
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.10
|
|
|
ANTIBODY DETECTION NOS IF
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
HCPCS 87299
|
| Hospital Charge Code |
40613062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$30.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Government |
$16.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.27
|
| Rate for Payer: Brighton Health Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.10
|
| Rate for Payer: EmblemHealth Commercial |
$16.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.33
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.10
|
| Rate for Payer: Healthfirst QHP |
$16.10
|
| Rate for Payer: Humana Medicare |
$16.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.10
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$14.49
|
|
|
ANTIBODY (RBC ELUTION ANY MTHD
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
40701055
|
|
Hospital Revenue Code
|
309
|
| Rate for Payer: Cash Price |
$197.52
|
|
|
ANTIBODY (RBC ELUTION ANY MTHD
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
40701055
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$325.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$325.97
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Commercial |
$22.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
ANTIBODY_SCREEN
|
Facility
|
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
40709826
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$112.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.86
|
| Rate for Payer: Brighton Health Commercial |
$112.37
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Humana Medicare |
$63.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
ANTIBODY_SCREEN
|
Facility
|
IP
|
$149.83
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
40709826
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
ANTIBODY SCREENING
|
Facility
|
IP
|
$149.83
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
40711135
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
ANTIBODY SCREENING
|
Facility
|
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
40711135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$112.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.86
|
| Rate for Payer: Brighton Health Commercial |
$112.37
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Humana Medicare |
$63.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
ANTIBODY STUDIES
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
40711150
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
ANTIBODY STUDIES
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
40711150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$22.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
ANTIBODY TITER
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
40701119
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$197.52
|
|
|
ANTIBODY TITER
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
40701119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$325.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$325.97
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
ANTICARDIOLIPIN AB, IGG/M QN
|
Facility
|
IP
|
$63.63
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
40729326
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$25.45
|
|
|
ANTICARDIOLIPIN AB, IGG/M QN
|
Facility
|
OP
|
$63.63
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
40729326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$47.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.45
|
| Rate for Payer: Aetna Government |
$25.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.82
|
| Rate for Payer: Brighton Health Commercial |
$47.72
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.45
|
| Rate for Payer: EmblemHealth Commercial |
$25.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$25.45
|
| Rate for Payer: Group Health Inc Medicare |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.45
|
| Rate for Payer: Healthfirst QHP |
$25.45
|
| Rate for Payer: Humana Medicare |
$25.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$32.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.36
|
| Rate for Payer: Wellcare Medicare |
$22.90
|
|
|
ANTI-CENTROMERE B ANTIBODIES
|
Facility
|
IP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729334
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.93
|
|
|
ANTI-CENTROMERE B ANTIBODIES
|
Facility
|
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.55
|
| Rate for Payer: Brighton Health Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
ANTI-DNASE B STREP ANTIBODIES
|
Facility
|
OP
|
$33.13
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
40729329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.85
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.60
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
