|
HC BLOOD GASES: PH, PO2 & PCO2 - I-STAT, VENOUS
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - I-STAT, VENOUS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.75
|
| 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 |
$32.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.67
|
| 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 |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.36
|
| Rate for Payer: Healthfirst Essential Plan |
$36.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare 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 |
$16.36
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.75
|
| 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 |
$32.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.67
|
| 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 |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.36
|
| Rate for Payer: Healthfirst Essential Plan |
$36.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare 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 |
$16.36
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT VENOUS BLOOD GAS
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT VENOUS BLOOD GAS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3018280307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.75
|
| 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 |
$32.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.67
|
| 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 |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.36
|
| Rate for Payer: Healthfirst Essential Plan |
$36.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare 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 |
$16.36
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.38
|
| Rate for Payer: Aetna Government |
$4.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.07
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.38
|
| Rate for Payer: EmblemHealth Commercial |
$4.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.90
|
| Rate for Payer: Group Health Inc Commercial |
$4.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.38
|
| Rate for Payer: Healthfirst QHP |
$4.38
|
| Rate for Payer: Humana Medicare |
$4.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$3.94
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
3018227001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
3018227001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.38
|
| Rate for Payer: Aetna Government |
$4.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.07
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.38
|
| Rate for Payer: EmblemHealth Commercial |
$4.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.90
|
| Rate for Payer: Group Health Inc Commercial |
$4.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.38
|
| Rate for Payer: Healthfirst QHP |
$4.38
|
| Rate for Payer: Humana Medicare |
$4.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$3.94
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.92
|
| Rate for Payer: Aetna Government |
$15.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.14
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.17
|
| Rate for Payer: Group Health Inc Commercial |
$15.92
|
| Rate for Payer: Group Health Inc Medicare |
$15.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.92
|
| Rate for Payer: Healthfirst QHP |
$15.92
|
| Rate for Payer: Humana Medicare |
$16.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.92
|
| Rate for Payer: United Healthcare Commercial |
$20.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.43
|
| Rate for Payer: Wellcare Medicare |
$14.33
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.70
|
| Rate for Payer: Brighton Health Commercial |
$20.25
|
| 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 |
$14.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.11
|
| 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 |
$11.00
|
| 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: Humana Medicare |
$11.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$10.72
|
| Rate for Payer: United Healthcare 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 |
$10.45
|
| Rate for Payer: Wellcare Medicare |
$9.90
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
|
|
HC BLOOD PLATELET AGGREGATION - P2Y12 PROFILE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
|
|
HC BLOOD PLATELET AGGREGATION - P2Y12 PROFILE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.91
|
| Rate for Payer: Aetna Government |
$24.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.44
|
| Rate for Payer: Brighton Health Commercial |
$42.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.91
|
| Rate for Payer: EmblemHealth Commercial |
$24.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.17
|
| Rate for Payer: Group Health Inc Commercial |
$24.91
|
| Rate for Payer: Group Health Inc Medicare |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Healthfirst Essential Plan |
$24.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.91
|
| Rate for Payer: Healthfirst QHP |
$24.91
|
| Rate for Payer: Humana Medicare |
$25.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.91
|
| Rate for Payer: United Healthcare Commercial |
$27.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Wellcare Medicare |
$22.42
|
|
|
HC BLOOD PLATELET AGGREGATION - PLATELET FUNCTION PANEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.91
|
| Rate for Payer: Aetna Government |
$24.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.44
|
| Rate for Payer: Brighton Health Commercial |
$42.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.91
|
| Rate for Payer: EmblemHealth Commercial |
$24.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.17
|
| Rate for Payer: Group Health Inc Commercial |
$24.91
|
| Rate for Payer: Group Health Inc Medicare |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Healthfirst Essential Plan |
$24.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.91
|
| Rate for Payer: Healthfirst QHP |
$24.91
|
| Rate for Payer: Humana Medicare |
$25.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.91
|
| Rate for Payer: United Healthcare Commercial |
$27.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Wellcare Medicare |
$22.42
|
|
|
HC BLOOD PLATELET AGGREGATION - PLATELET FUNCTION PANEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
|
|
HC BLOOD PLATELET AGGREGATION - POCT PLATELET AGGREGATION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
|
|
HC BLOOD PLATELET AGGREGATION - POCT PLATELET AGGREGATION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
3058557603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.91
|
| Rate for Payer: Aetna Government |
$24.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.44
|
| Rate for Payer: Brighton Health Commercial |
$42.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.91
|
| Rate for Payer: EmblemHealth Commercial |
$24.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.17
|
| Rate for Payer: Group Health Inc Commercial |
$24.91
|
| Rate for Payer: Group Health Inc Medicare |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Healthfirst Essential Plan |
$24.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.91
|
| Rate for Payer: Healthfirst QHP |
$24.91
|
| Rate for Payer: Humana Medicare |
$25.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.91
|
| Rate for Payer: United Healthcare Commercial |
$27.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Wellcare Medicare |
$22.42
|
|
|
HC BLOOD PROTEIN MARKER TEST, CYSTATIN C
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
3008261001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC BLOOD PROTEIN MARKER TEST, CYSTATIN C
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
3008261001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.96
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.52
|
| Rate for Payer: EmblemHealth Commercial |
$18.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.48
|
| Rate for Payer: Group Health Inc Commercial |
$18.52
|
| Rate for Payer: Group Health Inc Medicare |
$18.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.52
|
| Rate for Payer: Healthfirst QHP |
$18.52
|
| Rate for Payer: Humana Medicare |
$18.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.59
|
| Rate for Payer: Wellcare Medicare |
$16.67
|
|
|
HC BLOOD, SPLIT UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
381P901101
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
|
|
HC BLOOD, SPLIT UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
381P901101
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$173.25
|
| Rate for Payer: Aetna Government |
$173.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$121.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$121.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$121.28
|
| Rate for Payer: Brighton Health Commercial |
$173.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$173.25
|
| Rate for Payer: EmblemHealth Commercial |
$173.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.19
|
| Rate for Payer: Group Health Inc Commercial |
$173.25
|
| Rate for Payer: Group Health Inc Medicare |
$173.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.26
|
| Rate for Payer: Healthfirst QHP |
$173.25
|
| Rate for Payer: Humana Medicare |
$176.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.25
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$173.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$164.59
|
| Rate for Payer: Wellcare Medicare |
$155.93
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3613643001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$566.00 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.00
|
|
