|
HC COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
HC COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$254.51
|
| Rate for Payer: Aetna Government |
$254.51
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.75
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| Rate for Payer: United Healthcare Commercial |
$160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.50
|
|
|
HC CO-MORBID CONDITION ASSESS
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 1026F
|
| Hospital Charge Code |
9691026F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
HC CO-MORBID CONDITION ASSESS
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 1026F
|
| Hospital Charge Code |
9691026F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC COMPATIBILTY TEST EACH UNIT, ANTIGLOBULINE TECHNIQUE
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC COMPATIBILTY TEST EACH UNIT, ANTIGLOBULINE TECHNIQUE
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$209.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Commercial |
$22.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.90
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC COMPATIBILTY TEST EACH UNIT, ELECTRONIC
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
3008692301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC COMPATIBILTY TEST EACH UNIT, ELECTRONIC
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
3008692301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$209.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.90
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC COMPATIBILTY TEST EACH UNIT, IMMEDIATE SPIN TECHNIQUE
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$209.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.90
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC COMPATIBILTY TEST EACH UNIT, IMMEDIATE SPIN TECHNIQUE
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC COMPLEMENT, ANTIGEN - C1 COMPLEMENT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC COMPLEMENT, ANTIGEN - C1 COMPLEMENT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.40
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.40
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.40
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3028616001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR, FUNCTIONAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
3028616102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.40
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Essential Plan |
$27.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR, FUNCTIONAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
3028616102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$44.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.32
|
| Rate for Payer: Aetna Government |
$20.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.22
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.32
|
| Rate for Payer: EmblemHealth Commercial |
$20.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.08
|
| Rate for Payer: Group Health Inc Commercial |
$20.32
|
| Rate for Payer: Group Health Inc Medicare |
$20.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.58
|
| Rate for Payer: Healthfirst Essential Plan |
$44.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.32
|
| Rate for Payer: Healthfirst QHP |
$20.32
|
| Rate for Payer: Humana Medicare |
$20.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.32
|
| Rate for Payer: United Healthcare Commercial |
$25.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.58
|
| Rate for Payer: Wellcare Medicare |
$18.29
|
|
|
HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
|
|
HC COMPLETE CBC - POCT CBC
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
3058502702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC COMPLETE CBC - POCT CBC
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
3058502702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Healthfirst Essential Plan |
$7.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
HC COMPLETE CBC W/ AUTO DIFF WBC
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.77
|
| Rate for Payer: Aetna Government |
$7.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.44
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.77
|
| Rate for Payer: EmblemHealth Commercial |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.77
|
| Rate for Payer: Group Health Inc Medicare |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Healthfirst Essential Plan |
$7.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.77
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$9.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Wellcare Medicare |
$6.99
|
|
|
HC COMPLETE CBC W/ AUTO DIFF WBC
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC COMPLETE CBC W/ MANUAL DIFF WBC
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.80
|
| Rate for Payer: Aetna Government |
$3.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.66
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$3.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.80
|
| Rate for Payer: Healthfirst QHP |
$3.80
|
| Rate for Payer: Humana Medicare |
$3.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.44
|
| Rate for Payer: Wellcare Medicare |
$3.42
|
|
