|
CHROMIC CHLORIDE
|
Facility
OP
|
$44.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$28.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.06
|
| Rate for Payer: Aetna Government |
$22.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.36
|
| Rate for Payer: Group Health Inc Commercial |
$22.06
|
| Rate for Payer: Group Health Inc Medicare |
$15.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.67
|
|
|
CHROMIC GUT UNDYED
|
Facility
OP
|
$113.40
|
|
| Hospital Charge Code |
64907065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.70
|
| Rate for Payer: Aetna Government |
$56.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.11
|
| Rate for Payer: Group Health Inc Commercial |
$56.70
|
| Rate for Payer: Group Health Inc Medicare |
$39.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.70
|
|
|
CHROMIUM PLASMA
|
Facility
OP
|
$50.70
|
|
|
Service Code
|
HCPCS 82495
|
| Hospital Charge Code |
40609726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$32.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.28
|
| Rate for Payer: Aetna Government |
$20.28
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.28
|
| Rate for Payer: EmblemHealth Commercial |
$20.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.05
|
| Rate for Payer: Group Health Inc Commercial |
$20.28
|
| Rate for Payer: Group Health Inc Medicare |
$20.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.28
|
| Rate for Payer: Healthfirst QHP |
$20.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.22
|
| Rate for Payer: Wellcare Medicare |
$18.25
|
|
|
CHROMOGRANIN A
|
Facility
OP
|
$52.03
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
40609144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
CHROMOSOME, AFP, AMNIOTIC FL
|
Facility
OP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40609040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
|
|
CHROMOSOME ANALYS AMNIOTIC
|
Facility
OP
|
$434.15
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
30305611
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$138.93 |
| Max. Negotiated Rate |
$264.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$173.66
|
| Rate for Payer: Aetna Government |
$173.66
|
| Rate for Payer: Brighton Health Commercial |
$173.66
|
| Rate for Payer: Cash Price |
$173.66
|
| Rate for Payer: Cash Price |
$173.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$173.66
|
| Rate for Payer: EmblemHealth Commercial |
$173.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.56
|
| Rate for Payer: Group Health Inc Commercial |
$173.66
|
| Rate for Payer: Group Health Inc Medicare |
$173.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.66
|
| Rate for Payer: Healthfirst QHP |
$173.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$138.93
|
| Rate for Payer: Wellcare Medicare |
$156.29
|
|
|
CHROMOSOME ANALYSIS COUNT15-20
|
Facility
OP
|
$313.73
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
40607183
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$198.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.49
|
| Rate for Payer: Aetna Government |
$125.49
|
| Rate for Payer: Brighton Health Commercial |
$125.49
|
| Rate for Payer: Cash Price |
$125.49
|
| Rate for Payer: Cash Price |
$125.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$198.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$125.49
|
| Rate for Payer: EmblemHealth Commercial |
$125.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.69
|
| Rate for Payer: Group Health Inc Commercial |
$125.49
|
| Rate for Payer: Group Health Inc Medicare |
$125.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.49
|
| Rate for Payer: Healthfirst QHP |
$125.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$100.39
|
| Rate for Payer: Wellcare Medicare |
$112.94
|
|
|
CHROMOSOME ANALYSIS TISSUE
|
Facility
OP
|
$291.23
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
40607189
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$185.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.49
|
| Rate for Payer: Aetna Government |
$116.49
|
| Rate for Payer: Brighton Health Commercial |
$116.49
|
| Rate for Payer: Cash Price |
$116.49
|
| Rate for Payer: Cash Price |
$116.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$116.49
|
| Rate for Payer: EmblemHealth Commercial |
$116.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.68
|
| Rate for Payer: Group Health Inc Commercial |
$116.49
|
| Rate for Payer: Group Health Inc Medicare |
$116.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.49
|
| Rate for Payer: Healthfirst QHP |
$116.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$93.19
|
| Rate for Payer: Wellcare Medicare |
$104.84
|
|
|
CHROMOSOME, BIOPSIES, POC/SKIN
|
Facility
OP
|
$915.33
|
|
| Hospital Charge Code |
40609157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.37 |
| Max. Negotiated Rate |
$732.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$503.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$457.66
|
| Rate for Payer: Aetna Government |
$457.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$732.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$622.42
|
| Rate for Payer: Group Health Inc Commercial |
$457.66
|
| Rate for Payer: Group Health Inc Medicare |
$320.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$457.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$457.66
|
|
|
CHROMOSOME, BLOOD, ROUTINE
|
Facility
OP
|
$616.70
|
|
| Hospital Charge Code |
40609158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.84 |
| Max. Negotiated Rate |
$493.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$339.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$308.35
|
| Rate for Payer: Aetna Government |
$308.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$493.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$419.36
|
| Rate for Payer: Group Health Inc Commercial |
$308.35
|
| Rate for Payer: Group Health Inc Medicare |
$215.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.35
|
|
|
CHROMOSOME KARYOTYPE STUDY
|
Facility
OP
|
$83.68
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30305612
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$46.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.47
|
| Rate for Payer: Aetna Government |
$33.47
|
| Rate for Payer: Brighton Health Commercial |
$33.47
|
| Rate for Payer: Cash Price |
$33.47
|
| Rate for Payer: Cash Price |
$33.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.47
|
| Rate for Payer: EmblemHealth Commercial |
$33.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.79
|
| Rate for Payer: Group Health Inc Commercial |
$33.47
|
| Rate for Payer: Group Health Inc Medicare |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.47
|
| Rate for Payer: Healthfirst QHP |
$33.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.78
|
| Rate for Payer: Wellcare Medicare |
$30.12
|
|
|
CHROMOSOME MICROARRAY
|
Facility
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
40609028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$928.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,160.00
|
| Rate for Payer: Aetna Government |
$1,160.00
|
| Rate for Payer: Brighton Health Commercial |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,160.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,040.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,160.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,160.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,044.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$986.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,032.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,160.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,032.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,160.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,160.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,160.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,160.00
|
| Rate for Payer: Healthfirst QHP |
$1,160.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,160.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$928.00
|
| Rate for Payer: Wellcare Medicare |
$1,044.00
|
|
|
CHROMOSOMES, AFP W/REL
|
Facility
OP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40628261
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
|
|
CHROMOSOMES, AFP W/RFX
|
Facility
OP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40608261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
|
|
CHROMOSOMES, AMNIOTIC FLUID
|
Facility
OP
|
$375.75
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
40628317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.24 |
| Max. Negotiated Rate |
$234.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.30
|
| Rate for Payer: Aetna Government |
$150.30
|
| Rate for Payer: Brighton Health Commercial |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$234.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$150.30
|
| Rate for Payer: EmblemHealth Commercial |
$150.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.77
|
| Rate for Payer: Group Health Inc Commercial |
$150.30
|
| Rate for Payer: Group Health Inc Medicare |
$150.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.30
|
| Rate for Payer: Healthfirst QHP |
$150.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$120.24
|
| Rate for Payer: Wellcare Medicare |
$135.27
|
|
|
CHRONIC DIALYSIS CAT 15.5FR X24CM
|
Facility
OP
|
$5,522.74
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$5,798.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,037.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,761.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,175.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,798.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,761.37
|
| Rate for Payer: Group Health Inc Medicare |
$1,932.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,589.78
|
|
|
CHRONIC DIALYSIS CAT 15.5FR X24CM
|
Facility
IP
|
$5,522.74
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.37 |
| Max. Negotiated Rate |
$2,761.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.37
|
|
|
CHRONIC DIALYSIS CAT 15.5FR X28CM
|
Facility
IP
|
$5,522.74
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.37 |
| Max. Negotiated Rate |
$2,761.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.37
|
|
|
CHRONIC DIALYSIS CAT 15.5FR X28CM
|
Facility
OP
|
$5,522.74
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40009112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$5,798.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,037.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,761.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,175.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,798.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,761.37
|
| Rate for Payer: Group Health Inc Medicare |
$1,932.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,589.78
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
IP
|
$19,483.29
|
|
|
Service Code
|
MS-DRG 191
|
| Min. Negotiated Rate |
$7,280.18 |
| Max. Negotiated Rate |
$19,483.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,518.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,101.26
|
| Rate for Payer: Aetna Government |
$19,101.26
|
| Rate for Payer: Brighton Health Commercial |
$12,310.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,483.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,661.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,099.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,146.20
|
| Rate for Payer: EmblemHealth Commercial |
$7,280.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,101.26
|
| Rate for Payer: Group Health Inc Commercial |
$19,101.26
|
| Rate for Payer: Group Health Inc Medicare |
$19,101.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,101.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,882.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,101.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,101.26
|
| Rate for Payer: Wellcare Medicare |
$18,146.20
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
IP
|
$23,061.89
|
|
|
Service Code
|
MS-DRG 190
|
| Min. Negotiated Rate |
$9,449.65 |
| Max. Negotiated Rate |
$23,061.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,248.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,609.70
|
| Rate for Payer: Aetna Government |
$22,609.70
|
| Rate for Payer: Brighton Health Commercial |
$15,979.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,061.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,030.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,704.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,479.22
|
| Rate for Payer: EmblemHealth Commercial |
$9,449.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,609.70
|
| Rate for Payer: Group Health Inc Commercial |
$22,609.70
|
| Rate for Payer: Group Health Inc Medicare |
$22,609.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,609.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,513.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,609.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,609.70
|
| Rate for Payer: Wellcare Medicare |
$21,479.22
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
IP
|
$16,552.48
|
|
|
Service Code
|
MS-DRG 192
|
| Min. Negotiated Rate |
$5,503.44 |
| Max. Negotiated Rate |
$16,552.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,463.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,227.92
|
| Rate for Payer: Aetna Government |
$16,227.92
|
| Rate for Payer: Brighton Health Commercial |
$9,306.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,552.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,083.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,146.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,416.52
|
| Rate for Payer: EmblemHealth Commercial |
$5,503.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,227.92
|
| Rate for Payer: Group Health Inc Commercial |
$16,227.92
|
| Rate for Payer: Group Health Inc Medicare |
$16,227.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,227.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,545.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,227.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,227.92
|
| Rate for Payer: Wellcare Medicare |
$15,416.52
|
|
|
CHRONIC URTICARIA
|
Facility
OP
|
$31.15
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
40729343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$19.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.46
|
| Rate for Payer: Aetna Government |
$12.46
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.46
|
| Rate for Payer: EmblemHealth Commercial |
$12.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$12.46
|
| Rate for Payer: Group Health Inc Medicare |
$12.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.46
|
| Rate for Payer: Healthfirst QHP |
$12.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.97
|
| Rate for Payer: Wellcare Medicare |
$11.21
|
|
|
CHRONOS POR TRICAL PHOS GRAN 5ML
|
Facility
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
|
CHRONOS POR TRICAL PHOS GRAN 5ML
|
Facility
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,680.00
|
| Rate for Payer: Group Health Inc Commercial |
$800.00
|
| Rate for Payer: Group Health Inc Medicare |
$560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.00
|
|
