|
HC BLOOD TYPING RBC ANTIGENS, LITTLE C ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LITTLE C ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LITTLE E ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LITTLE E ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LITTLE S ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LITTLE S ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, M ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, M ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, N ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, N ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, P1 ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, P1 ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, S ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, S ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.99
|
| Rate for Payer: Aetna Government |
$2.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.99
|
| Rate for Payer: EmblemHealth Commercial |
$2.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.66
|
| Rate for Payer: Group Health Inc Commercial |
$2.99
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Healthfirst Essential Plan |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.99
|
| Rate for Payer: Healthfirst QHP |
$2.99
|
| Rate for Payer: Humana Medicare |
$3.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Wellcare Medicare |
$2.69
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - BLOOD TYPE AND SCREEN
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - BLOOD TYPE AND SCREEN
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.99
|
| Rate for Payer: Aetna Government |
$2.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.99
|
| Rate for Payer: EmblemHealth Commercial |
$2.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.66
|
| Rate for Payer: Group Health Inc Commercial |
$2.99
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Healthfirst Essential Plan |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.99
|
| Rate for Payer: Healthfirst QHP |
$2.99
|
| Rate for Payer: Humana Medicare |
$3.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Wellcare Medicare |
$2.69
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.99
|
| Rate for Payer: Aetna Government |
$2.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.99
|
| Rate for Payer: EmblemHealth Commercial |
$2.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.66
|
| Rate for Payer: Group Health Inc Commercial |
$2.99
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Healthfirst Essential Plan |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.99
|
| Rate for Payer: Healthfirst QHP |
$2.99
|
| Rate for Payer: Humana Medicare |
$3.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Wellcare Medicare |
$2.69
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$26.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.67
|
| Rate for Payer: Aetna Government |
$11.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.17
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.67
|
| Rate for Payer: EmblemHealth Commercial |
$11.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.67
|
| Rate for Payer: Healthfirst Essential Plan |
$26.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.67
|
| Rate for Payer: Healthfirst QHP |
$11.67
|
| Rate for Payer: Humana Medicare |
$11.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.67
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.67
|
| Rate for Payer: Wellcare Medicare |
$10.50
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.60
|
| Rate for Payer: Aetna Government |
$5.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.92
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.60
|
| Rate for Payer: EmblemHealth Commercial |
$5.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.98
|
| Rate for Payer: Group Health Inc Commercial |
$5.60
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.83
|
| Rate for Payer: Healthfirst Essential Plan |
$6.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.60
|
| Rate for Payer: Healthfirst QHP |
$5.60
|
| Rate for Payer: Humana Medicare |
$5.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.83
|
| Rate for Payer: Wellcare Medicare |
$5.04
|
|
|
HC BODY FLUID CELL COUNT W DIFF - SYNOVIAL FLUID CELL COUNT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
3008905101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.60
|
| Rate for Payer: Aetna Government |
$5.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.92
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.60
|
| Rate for Payer: EmblemHealth Commercial |
$5.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.98
|
| Rate for Payer: Group Health Inc Commercial |
$5.60
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.83
|
| Rate for Payer: Healthfirst Essential Plan |
$6.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.60
|
| Rate for Payer: Healthfirst QHP |
$5.60
|
| Rate for Payer: Humana Medicare |
$5.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.83
|
| Rate for Payer: Wellcare Medicare |
$5.04
|
|
