|
HC CLOSURE OF EYELID BY SUTURE
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
5106787501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$1,242.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
|
HC CLOT FACTOR FLETCHER FACT - PREKALLIKREIN FACTOR ACTIVITY
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85292
|
| Hospital Charge Code |
3058529201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$42.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.93
|
| Rate for Payer: Aetna Government |
$18.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.25
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.93
|
| Rate for Payer: EmblemHealth Commercial |
$18.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.85
|
| Rate for Payer: Group Health Inc Commercial |
$18.93
|
| Rate for Payer: Group Health Inc Medicare |
$18.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.93
|
| Rate for Payer: Healthfirst Essential Plan |
$42.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.93
|
| Rate for Payer: Healthfirst QHP |
$18.93
|
| Rate for Payer: Humana Medicare |
$19.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.93
|
| Rate for Payer: United Healthcare Commercial |
$23.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.93
|
| Rate for Payer: Wellcare Medicare |
$17.04
|
|
|
HC CLOT FACTOR FLETCHER FACT - PREKALLIKREIN FACTOR ACTIVITY
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85292
|
| Hospital Charge Code |
3058529201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
3058521001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$29.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.98
|
| Rate for Payer: Aetna Government |
$12.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.09
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.98
|
| Rate for Payer: EmblemHealth Commercial |
$12.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.55
|
| Rate for Payer: Group Health Inc Commercial |
$12.98
|
| Rate for Payer: Group Health Inc Medicare |
$12.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.98
|
| Rate for Payer: Healthfirst Essential Plan |
$29.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.98
|
| Rate for Payer: Healthfirst QHP |
$12.98
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.98
|
| Rate for Payer: Wellcare Medicare |
$11.68
|
|
|
HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
3058521001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
3058525001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
|
|
HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
3058525001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.04
|
| Rate for Payer: Aetna Government |
$19.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.33
|
| Rate for Payer: Brighton Health Commercial |
$35.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.04
|
| Rate for Payer: EmblemHealth Commercial |
$19.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.95
|
| Rate for Payer: Group Health Inc Commercial |
$19.04
|
| Rate for Payer: Group Health Inc Medicare |
$19.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.04
|
| Rate for Payer: Healthfirst Essential Plan |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.04
|
| Rate for Payer: Healthfirst QHP |
$19.04
|
| Rate for Payer: Humana Medicare |
$19.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.04
|
| Rate for Payer: Wellcare Medicare |
$17.14
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR 8 ACTIVITY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
3058524001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR 8 ACTIVITY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
3058524001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - VON WILLEBRAND PANEL
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
3058524002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - VON WILLEBRAND PANEL
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
3058524002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
HC CLOT FACTOR VIII VON WILLEBRAND FACTOR MULTIMETRIC
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
3058524701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC CLOT FACTOR VIII VON WILLEBRAND FACTOR MULTIMETRIC
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
3058524701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.06
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.89
|
| Rate for Payer: Healthfirst Essential Plan |
$26.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.89
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - FACTOR 8 CARRIER PANEL
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - FACTOR 8 CARRIER PANEL
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.06
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.06
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND SCREEN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.06
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND SCREEN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3058524602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.06
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.90
|
| Rate for Payer: Healthfirst Essential Plan |
$40.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.90
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC CLOT FACTOR XII HAGEMAN - FACTOR 12 ACTIVITY
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
3058528001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC CLOT FACTOR XII HAGEMAN - FACTOR 12 ACTIVITY
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
3058528001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| 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 |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Healthfirst Essential Plan |
$43.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$17.41
|
|
