|
BLOOD BAG IN-LINE
|
Facility
OP
|
$94.60
|
|
| Hospital Charge Code |
64902040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$75.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Government |
$47.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.33
|
| Rate for Payer: Group Health Inc Commercial |
$47.30
|
| Rate for Payer: Group Health Inc Medicare |
$33.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.30
|
|
|
BLOOD COLLECTION SET
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40509817
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
BLOOD COUNT COMPLETE (CBC)
|
Facility
OP
|
$19.43
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
40621535
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.77
|
| Rate for Payer: Aetna Government |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.77
|
| Rate for Payer: EmblemHealth Commercial |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.77
|
| Rate for Payer: Group Health Inc Medicare |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.77
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.22
|
| Rate for Payer: Wellcare Medicare |
$6.99
|
|
|
BLOOD CULTURE FOR BACTERIA
|
Facility
OP
|
$25.80
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
40614310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
BLOOD CULTURE NEGATIVE
|
Facility
OP
|
$25.80
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
40614000
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
BLOOD DRAW IMPLANTED VENOUSDEVICE
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
40500010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.91 |
| 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: 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.91
|
| 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 |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| 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 |
$33.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Senior Whole Health 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 |
$132.95
|
|
|
BLOOD FUNGUS CULTURE
|
Facility
OP
|
$51.15
|
|
|
Service Code
|
HCPCS 87103
|
| Hospital Charge Code |
40614319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.46
|
| Rate for Payer: Aetna Government |
$20.46
|
| Rate for Payer: Cash Price |
$20.46
|
| Rate for Payer: Cash Price |
$20.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.46
|
| Rate for Payer: EmblemHealth Commercial |
$20.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.21
|
| Rate for Payer: Group Health Inc Commercial |
$20.46
|
| Rate for Payer: Group Health Inc Medicare |
$20.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.46
|
| Rate for Payer: Healthfirst QHP |
$20.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.37
|
| Rate for Payer: Wellcare Medicare |
$18.41
|
|
|
BLOOD GAS PLUS
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40602311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
BLOOD GAS PLUS ARTERIAL (I-STAT)
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40603310
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
BLOOD GAS PLUS VENOUS (I-STAT)
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40603320
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
BLOOD GROUP-RH FACTOR
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
40711140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$55.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.38
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$41.74
|
|
|
BLOODLINES ARTERIAL & VENOUS
|
Facility
OP
|
$165.00
|
|
| Hospital Charge Code |
64902407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.50
|
| Rate for Payer: Aetna Government |
$82.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.20
|
| Rate for Payer: Group Health Inc Commercial |
$82.50
|
| Rate for Payer: Group Health Inc Medicare |
$57.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
BLOODLINES ARTERIAL&VENOUS 5H9690
|
Facility
OP
|
$7.20
|
|
| Hospital Charge Code |
40209466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.60
|
| Rate for Payer: Aetna Government |
$3.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
|
|
BLOOD PARASITE
|
Facility
OP
|
$14.98
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
40621589
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna Government |
$5.99
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.99
|
| Rate for Payer: EmblemHealth Commercial |
$5.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.99
|
| Rate for Payer: Group Health Inc Medicare |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.79
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
|
|
BLOOD PH
|
Facility
OP
|
$27.50
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
30300143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.00
|
| Rate for Payer: EmblemHealth Commercial |
$11.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.79
|
| Rate for Payer: Group Health Inc Commercial |
$11.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.00
|
| Rate for Payer: Healthfirst QHP |
$11.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.80
|
| Rate for Payer: Wellcare Medicare |
$9.90
|
|
|
BLOOD PUMP
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40200628
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
BLOOD TRANSFER DEVICE
|
Facility
OP
|
$525.08
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64907443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$551.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$262.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.33
|
| Rate for Payer: Group Health Inc Commercial |
$262.54
|
| Rate for Payer: Group Health Inc Medicare |
$183.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.30
|
|
|
BLOOD TRANSFER DEVICE
|
Facility
IP
|
$525.08
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64907443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.54 |
| Max. Negotiated Rate |
$262.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.54
|
|
|
BLOOD TRANSFUSION
|
Facility
OP
|
$1,132.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
30305413
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$502.01
|
| Rate for Payer: Aetna Government |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.01
|
| 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 |
$502.01
|
| Rate for Payer: EmblemHealth Commercial |
$502.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$446.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$446.79
|
| Rate for Payer: Group Health Inc Commercial |
$502.01
|
| Rate for Payer: Group Health Inc Medicare |
$502.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.71
|
| Rate for Payer: Healthfirst QHP |
$502.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$401.61
|
| Rate for Payer: Wellcare Medicare |
$476.91
|
|
|
BLOOD TRANSFUSION SERVICE
|
Facility
OP
|
$1,132.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
40003274
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$502.01
|
| Rate for Payer: Aetna Government |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.01
|
| 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 |
$502.01
|
| Rate for Payer: EmblemHealth Commercial |
$502.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$446.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$446.79
|
| Rate for Payer: Group Health Inc Commercial |
$502.01
|
| Rate for Payer: Group Health Inc Medicare |
$502.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.71
|
| Rate for Payer: Healthfirst QHP |
$502.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$401.61
|
| Rate for Payer: Wellcare Medicare |
$476.91
|
|
|
BLOODTUBING ST W/TRANS PROTECT
|
Facility
OP
|
$16.31
|
|
| Hospital Charge Code |
42905330
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna Government |
$8.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
BLOOD TYPE ATIGEN DONOR EA
|
Facility
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
40701118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$472.11 |
| 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: 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 |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.72
|
| 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 CHP/FHP/Medicaid |
$6.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Senior Whole Health 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
|
|
|
BLOOD Y TRANSFUSION SET
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40509798
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
BLOOM SYNDROME, DNA ANALYSIS
|
Facility
OP
|
$98.28
|
|
|
Service Code
|
HCPCS 81209
|
| Hospital Charge Code |
40603057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.31
|
| Rate for Payer: Aetna Government |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$39.31
|
| Rate for Payer: EmblemHealth Commercial |
$39.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.99
|
| Rate for Payer: Group Health Inc Commercial |
$39.31
|
| Rate for Payer: Group Health Inc Medicare |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.31
|
| Rate for Payer: Healthfirst QHP |
$39.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.45
|
| Rate for Payer: Wellcare Medicare |
$35.38
|
|
|
BLTX BIMALLEOLAR ANKLE FX W/O
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
30305377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$390.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
