|
HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$439.51
|
| Rate for Payer: Aetna Government |
$439.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$307.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$307.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.66
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$439.51
|
| Rate for Payer: EmblemHealth Commercial |
$439.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.16
|
| Rate for Payer: Group Health Inc Commercial |
$439.51
|
| Rate for Payer: Group Health Inc Medicare |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.24
|
| Rate for Payer: Healthfirst Essential Plan |
$32.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.51
|
| Rate for Payer: Healthfirst QHP |
$439.51
|
| Rate for Payer: Humana Medicare |
$448.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.51
|
| Rate for Payer: United Healthcare Commercial |
$22.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.24
|
| Rate for Payer: Wellcare Medicare |
$395.56
|
|
|
HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.77
|
| Rate for Payer: Aetna Government |
$9.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.84
|
| Rate for Payer: Brighton Health Commercial |
$111.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.77
|
| Rate for Payer: EmblemHealth Commercial |
$9.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.70
|
| Rate for Payer: Group Health Inc Commercial |
$9.77
|
| Rate for Payer: Group Health Inc Medicare |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.61
|
| Rate for Payer: Healthfirst Essential Plan |
$12.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.77
|
| Rate for Payer: Healthfirst QHP |
$9.77
|
| Rate for Payer: Humana Medicare |
$9.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.61
|
| Rate for Payer: Wellcare Medicare |
$8.79
|
|
|
HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
3058565201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.70
|
| Rate for Payer: Aetna Government |
$2.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.89
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.70
|
| Rate for Payer: EmblemHealth Commercial |
$2.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.70
|
| Rate for Payer: Group Health Inc Medicare |
$2.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.70
|
| Rate for Payer: Healthfirst QHP |
$2.70
|
| Rate for Payer: Humana Medicare |
$2.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.70
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$2.43
|
|
|
HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
3058565201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.99
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Humana Medicare |
$4.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$4.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
3058566001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.51
|
| Rate for Payer: Aetna Government |
$5.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.86
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.51
|
| Rate for Payer: EmblemHealth Commercial |
$5.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.51
|
| Rate for Payer: Group Health Inc Medicare |
$5.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.51
|
| Rate for Payer: Healthfirst QHP |
$5.51
|
| Rate for Payer: Humana Medicare |
$5.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare Commercial |
$6.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.23
|
| Rate for Payer: Wellcare Medicare |
$4.96
|
|
|
HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
3058566001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC RECONSTRUCTION OF NAIL BED W/GRAFT
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 11762
|
| Hospital Charge Code |
3611176201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC RECONSTRUCTION OF NAIL BED W/GRAFT
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 11762
|
| Hospital Charge Code |
3611176201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.67 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC RED BLOOD CELL (RBC) COUNT - RED BLOOD CELL COUNT
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
3058504101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.11
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Healthfirst Essential Plan |
$6.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Humana Medicare |
$3.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
HC RED BLOOD CELL (RBC) COUNT - RED BLOOD CELL COUNT
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
3058504101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
|
|
HC RED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
381P903901
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$814.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$798.75
|
| Rate for Payer: Aetna Government |
$798.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.12
|
| Rate for Payer: Brighton Health Commercial |
$798.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$798.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$798.75
|
| Rate for Payer: EmblemHealth Commercial |
$798.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$718.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$678.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$710.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$798.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$710.89
|
| Rate for Payer: Group Health Inc Commercial |
$798.75
|
| Rate for Payer: Group Health Inc Medicare |
$798.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$798.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$798.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$678.94
|
| Rate for Payer: Healthfirst QHP |
$798.75
|
| Rate for Payer: Humana Medicare |
$814.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$798.75
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$798.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$758.81
|
| Rate for Payer: Wellcare Medicare |
$718.88
|
|
|
HC RED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
381P903901
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
|
|
HC RED BLOOD CELLS, EACH UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9021
|
| Hospital Charge Code |
381P902101
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$176.33
|
| Rate for Payer: Aetna Government |
$176.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$123.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$123.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$123.43
|
| Rate for Payer: Brighton Health Commercial |
$176.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$176.33
|
| Rate for Payer: EmblemHealth Commercial |
$176.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.93
|
| Rate for Payer: Group Health Inc Commercial |
$176.33
|
| Rate for Payer: Group Health Inc Medicare |
$176.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.88
|
| Rate for Payer: Healthfirst QHP |
$176.33
|
| Rate for Payer: Humana Medicare |
$179.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.33
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$167.51
|
| Rate for Payer: Wellcare Medicare |
$158.70
|
|
|
HC RED BLOOD CELLS, EACH UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9021
|
| Hospital Charge Code |
381P902101
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
|
|
HC RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
381P901601
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
|
|
HC RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
381P901601
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$155.66 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$222.37
|
| Rate for Payer: Aetna Government |
$222.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$155.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$155.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$155.66
|
| Rate for Payer: Brighton Health Commercial |
$222.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$222.37
|
| Rate for Payer: EmblemHealth Commercial |
$222.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.91
|
| Rate for Payer: Group Health Inc Commercial |
$222.37
|
| Rate for Payer: Group Health Inc Medicare |
$222.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.01
|
| Rate for Payer: Healthfirst QHP |
$222.37
|
| Rate for Payer: Humana Medicare |
$226.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.37
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$211.25
|
| Rate for Payer: Wellcare Medicare |
$200.13
|
|
|
HC RED BLOOD CELLS, WASHED, EACH UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9022
|
| Hospital Charge Code |
381P902201
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$494.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$484.90
|
| Rate for Payer: Aetna Government |
$484.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$339.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$339.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$339.43
|
| Rate for Payer: Brighton Health Commercial |
$484.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$484.90
|
| Rate for Payer: EmblemHealth Commercial |
$484.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$412.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$431.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$431.56
|
| Rate for Payer: Group Health Inc Commercial |
$484.90
|
| Rate for Payer: Group Health Inc Medicare |
$484.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$412.17
|
| Rate for Payer: Healthfirst QHP |
$484.90
|
| Rate for Payer: Humana Medicare |
$494.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.90
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$484.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$460.65
|
| Rate for Payer: Wellcare Medicare |
$436.41
|
|
|
HC RED BLOOD CELLS, WASHED, EACH UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9022
|
| Hospital Charge Code |
381P902201
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
|
|
HC REDUCTION OF RECTAL PROLAPSE
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
7504590001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$255.56 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$1,734.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| 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 |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$1,113.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| Rate for Payer: Group Health Inc Commercial |
$1,113.95
|
| Rate for Payer: Group Health Inc Medicare |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC REDUCTION OF RECTAL PROLAPSE
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
7504590001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,156.50 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.50
|
|
|
HC REDUCTION OF TORSION OF TESTIS
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 54600
|
| Hospital Charge Code |
3615460001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.34 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,214.02
|
| Rate for Payer: Aetna Government |
$4,214.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,949.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,949.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,949.81
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,214.02
|
| 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 |
$4,214.02
|
| Rate for Payer: EmblemHealth Commercial |
$4,214.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,792.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,581.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,750.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,214.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,750.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,214.02
|
| Rate for Payer: Group Health Inc Medicare |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,581.92
|
| Rate for Payer: Healthfirst QHP |
$4,214.02
|
| Rate for Payer: Humana Medicare |
$4,298.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,214.02
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,214.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,003.32
|
| Rate for Payer: Wellcare Medicare |
$4,003.32
|
|
