|
CHROMOSOME ANALYSIS TISSUE
|
Facility
|
OP
|
$291.23
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
40607189
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$81.54 |
| 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: Affinity Essential Plan 1&2 |
$81.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$81.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$81.54
|
| 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 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 Medicare Advantage |
$116.49
|
| Rate for Payer: Healthfirst QHP |
$116.49
|
| Rate for Payer: Humana Medicare |
$118.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.49
|
| Rate for Payer: United Healthcare 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 ANALYSIS TISSUE
|
Facility
|
IP
|
$291.23
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
40607189
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$116.49
|
|
|
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: Brighton Health Commercial |
$686.50
|
| 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: Brighton Health Commercial |
$462.52
|
| 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
|
IP
|
$83.68
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30305612
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$33.47
|
|
|
CHROMOSOME KARYOTYPE STUDY
|
Facility
|
OP
|
$83.68
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30305612
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.43 |
| 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: Affinity Essential Plan 1&2 |
$23.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.43
|
| 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 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 Medicare Advantage |
$33.47
|
| Rate for Payer: Healthfirst QHP |
$33.47
|
| Rate for Payer: Humana Medicare |
$34.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.47
|
| Rate for Payer: United Healthcare 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
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
40609028
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$1,160.00
|
|
|
CHROMOSOME MICROARRAY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
40609028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$812.00 |
| 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: Affinity Essential Plan 1&2 |
$812.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$812.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$812.00
|
| 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 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 Medicare Advantage |
$1,160.00
|
| Rate for Payer: Healthfirst QHP |
$1,160.00
|
| Rate for Payer: Humana Medicare |
$1,183.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,160.00
|
| Rate for Payer: United Healthcare 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 |
$11.90 |
| Max. Negotiated Rate |
$31.88 |
| 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: Affinity Essential Plan 1&2 |
$11.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.90
|
| Rate for Payer: Brighton Health Commercial |
$31.88
|
| 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 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 Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Humana Medicare |
$17.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$21.25
|
| Rate for Payer: United Healthcare 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/REL
|
Facility
|
IP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40628261
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.00
|
|
|
CHROMOSOMES, AFP W/RFX
|
Facility
|
IP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40608261
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.00
|
|
|
CHROMOSOMES, AFP W/RFX
|
Facility
|
OP
|
$42.50
|
|
|
Service Code
|
HCPCS 82106
|
| Hospital Charge Code |
40608261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$31.88 |
| 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: Affinity Essential Plan 1&2 |
$11.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.90
|
| Rate for Payer: Brighton Health Commercial |
$31.88
|
| 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 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 Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.00
|
| Rate for Payer: Humana Medicare |
$17.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$21.25
|
| Rate for Payer: United Healthcare 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
|
IP
|
$375.75
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
40628317
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$150.30
|
|
|
CHROMOSOMES, AMNIOTIC FLUID
|
Facility
|
OP
|
$375.75
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
40628317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.21 |
| 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: Affinity Essential Plan 1&2 |
$105.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$105.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$105.21
|
| 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 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 Medicare Advantage |
$150.30
|
| Rate for Payer: Healthfirst QHP |
$150.30
|
| Rate for Payer: Humana Medicare |
$153.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare 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: Brighton Health Commercial |
$3,313.64
|
| 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: EmblemHealth Commercial |
$2,761.37
|
| 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
|
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: Brighton Health Commercial |
$3,313.64
|
| 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: EmblemHealth Commercial |
$2,761.37
|
| 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 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 OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$26,264.23
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$7,280.18 |
| Max. Negotiated Rate |
$26,264.23 |
| 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: Humana Medicare |
$26,264.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,101.26
|
| Rate for Payer: United Healthcare Commercial |
$16,884.06
|
| Rate for Payer: United Healthcare 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
|
$31,088.34
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$9,449.65 |
| Max. Negotiated Rate |
$31,088.34 |
| 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: Humana Medicare |
$31,088.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,609.70
|
| Rate for Payer: United Healthcare Commercial |
$21,915.47
|
| Rate for Payer: United Healthcare 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
|
$22,313.39
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,503.44 |
| Max. Negotiated Rate |
$22,313.39 |
| 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: Humana Medicare |
$22,313.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,227.92
|
| Rate for Payer: United Healthcare Commercial |
$12,763.48
|
| Rate for Payer: United Healthcare 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
|
IP
|
$31.15
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
40729343
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.46
|
|
|
CHRONIC URTICARIA
|
Facility
|
OP
|
$31.15
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
40729343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$23.36 |
| 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: Affinity Essential Plan 1&2 |
$8.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.72
|
| Rate for Payer: Brighton Health Commercial |
$23.36
|
| 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 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 Medicare Advantage |
$12.46
|
| Rate for Payer: Healthfirst QHP |
$12.46
|
| Rate for Payer: Humana Medicare |
$12.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare Commercial |
$15.79
|
| Rate for Payer: United Healthcare 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
|
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: Brighton Health Commercial |
$960.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
| Rate for Payer: EmblemHealth Commercial |
$800.00
|
| 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
|
|
|
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
|
|
