|
HC CLOT FACTOR XIII FIBRIN STAB - FACTOR 13 ACTIVITY
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
3058529001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Government |
$16.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.44
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.34
|
| Rate for Payer: EmblemHealth Commercial |
$16.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.54
|
| Rate for Payer: Group Health Inc Commercial |
$16.34
|
| Rate for Payer: Group Health Inc Medicare |
$16.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.01
|
| Rate for Payer: Healthfirst Essential Plan |
$18.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.34
|
| Rate for Payer: Healthfirst QHP |
$16.34
|
| Rate for Payer: Humana Medicare |
$16.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.01
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
|
|
HC CLOT FACTOR XIII FIBRIN STAB - FACTOR 13 ACTIVITY
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
3058529001
|
|
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 XI PTA - FACTOR 11 ACTIVITY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
3058527001
|
|
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 XI PTA - FACTOR 11 ACTIVITY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
3058527001
|
|
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 X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
3058526001
|
|
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 X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
3058526001
|
|
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 INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$31.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.84
|
| Rate for Payer: Aetna Government |
$13.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.69
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.84
|
| Rate for Payer: EmblemHealth Commercial |
$13.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.32
|
| Rate for Payer: Group Health Inc Commercial |
$13.84
|
| Rate for Payer: Group Health Inc Medicare |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.84
|
| Rate for Payer: Healthfirst Essential Plan |
$31.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.84
|
| Rate for Payer: Healthfirst QHP |
$13.84
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.84
|
| Rate for Payer: United Healthcare Commercial |
$17.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.84
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
|
|
HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
3058530201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
3058530201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.01
|
| Rate for Payer: Aetna Government |
$12.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.41
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.01
|
| Rate for Payer: EmblemHealth Commercial |
$12.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.69
|
| Rate for Payer: Group Health Inc Commercial |
$12.01
|
| Rate for Payer: Group Health Inc Medicare |
$12.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.01
|
| Rate for Payer: Healthfirst Essential Plan |
$27.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.01
|
| Rate for Payer: Healthfirst QHP |
$12.01
|
| Rate for Payer: Humana Medicare |
$12.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$10.81
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.32
|
| Rate for Payer: Aetna Government |
$15.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.72
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$15.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.63
|
| Rate for Payer: Group Health Inc Commercial |
$15.32
|
| Rate for Payer: Group Health Inc Medicare |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.32
|
| Rate for Payer: Healthfirst Essential Plan |
$34.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.32
|
| Rate for Payer: Healthfirst QHP |
$15.32
|
| Rate for Payer: Humana Medicare |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare Commercial |
$19.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.32
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.32
|
| Rate for Payer: Aetna Government |
$15.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.72
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$15.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.63
|
| Rate for Payer: Group Health Inc Commercial |
$15.32
|
| Rate for Payer: Group Health Inc Medicare |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.32
|
| Rate for Payer: Healthfirst Essential Plan |
$34.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.32
|
| Rate for Payer: Healthfirst QHP |
$15.32
|
| Rate for Payer: Humana Medicare |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare Commercial |
$19.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.32
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S ANTIGEN TOTAL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
3058530502
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S ANTIGEN TOTAL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
3058530502
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.61
|
| Rate for Payer: Aetna Government |
$11.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.13
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.61
|
| Rate for Payer: EmblemHealth Commercial |
$11.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.33
|
| Rate for Payer: Group Health Inc Commercial |
$11.61
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Healthfirst Essential Plan |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.61
|
| Rate for Payer: Healthfirst QHP |
$11.61
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Wellcare Medicare |
$10.45
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S,TOTAL & FREE
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
3058530501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.61
|
| Rate for Payer: Aetna Government |
$11.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.13
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.61
|
| Rate for Payer: EmblemHealth Commercial |
$11.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.33
|
| Rate for Payer: Group Health Inc Commercial |
$11.61
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Healthfirst Essential Plan |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.61
|
| Rate for Payer: Healthfirst QHP |
$11.61
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Wellcare Medicare |
$10.45
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S,TOTAL & FREE
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
3058530501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC CLSD TREAT FINGER DISLOCATION W/MANIP, W/ANES
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
3612677501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.53 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$522.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$324.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| Rate for Payer: Group Health Inc Commercial |
$324.49
|
| Rate for Payer: Group Health Inc Medicare |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$433.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC CLSD TREAT FINGER DISLOCATION W/MANIP, W/ANES
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
3612677501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC CLSD TREAT FINGER DISLOCATION W/MANIP, W/O ANES
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
3612677001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$501.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$325.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLSD TREAT FINGER DISLOCATION W/MANIP, W/O ANES
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
3612677001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$334.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.50
|
|
|
HC CLSD TRTMNT DISTAL FRAC W/O MANIP
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
3612560001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$489.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLSD TRTMNT DISTAL FRAC W/O MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
3612560001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC CLSD TX ACROMIOCLAVICULAR DISLOC W/O MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
3612354001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
