|
FACTOR IX/500IU
|
Facility
|
IP
|
$47.60
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
40701006
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$19.04
|
|
|
FACTOR IX ACTIVITY
|
Facility
|
IP
|
$47.60
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
40629212
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$19.04
|
|
|
FACTOR IX ACTIVITY
|
Facility
|
OP
|
$47.60
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
40629212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.04
|
| Rate for Payer: Aetna Government |
$19.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.33
|
| Rate for Payer: Brighton Health Commercial |
$35.70
|
| Rate for Payer: Cash Price |
$19.04
|
| Rate for Payer: Cash Price |
$19.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.04
|
| Rate for Payer: EmblemHealth Commercial |
$19.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.95
|
| Rate for Payer: Group Health Inc Commercial |
$19.04
|
| Rate for Payer: Group Health Inc Medicare |
$19.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.04
|
| Rate for Payer: Healthfirst QHP |
$19.04
|
| Rate for Payer: Humana Medicare |
$19.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.23
|
| Rate for Payer: Wellcare Medicare |
$17.14
|
|
|
FACTOR_V_ACTIVITY
|
Facility
|
OP
|
$44.13
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
40629733
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$33.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.65
|
| Rate for Payer: Aetna Government |
$17.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.36
|
| Rate for Payer: Brighton Health Commercial |
$33.10
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.65
|
| Rate for Payer: EmblemHealth Commercial |
$17.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.71
|
| Rate for Payer: Group Health Inc Commercial |
$17.65
|
| Rate for Payer: Group Health Inc Medicare |
$17.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.65
|
| Rate for Payer: Healthfirst QHP |
$17.65
|
| Rate for Payer: Humana Medicare |
$18.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare Commercial |
$22.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.12
|
| Rate for Payer: Wellcare Medicare |
$15.88
|
|
|
FACTOR_V_ACTIVITY
|
Facility
|
IP
|
$44.13
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
40629733
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$17.65
|
|
|
FACTOR_VII_ACTIVITY
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
40629814
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR_VII_ACTIVITY
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
40629814
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR VIIA RECOMB NOVOSEVEN
|
Facility
|
IP
|
$7,236.00
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
40701077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,618.00 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,618.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,618.00
|
|
|
FACTOR VIIA RECOMB NOVOSEVEN
|
Facility
|
OP
|
$7,236.00
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
40701077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,979.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.43
|
| Rate for Payer: Aetna Government |
$2.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$4,341.60
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,618.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,160.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.43
|
| Rate for Payer: EmblemHealth Commercial |
$2.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$2.43
|
| Rate for Payer: Group Health Inc Medicare |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,618.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,618.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.06
|
| Rate for Payer: Healthfirst QHP |
$2.43
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.60
|
| Rate for Payer: SOMOS Essential |
$2.60
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,703.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.94
|
| Rate for Payer: Wellcare Medicare |
$2.31
|
|
|
FACTOR VIII/1 - CHARGE ONLY
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
40701076
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR VIII/1 - CHARGE ONLY
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
40701076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR_VIII_ACTIVITY
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
40629210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR_VIII_ACTIVITY
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
40629210
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR V (LEIDEN) MUTATI
|
Facility
|
IP
|
$183.43
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
30305800
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$73.37
|
|
|
FACTOR V (LEIDEN) MUTATI
|
Facility
|
OP
|
$183.43
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
30305800
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$146.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.37
|
| Rate for Payer: Aetna Government |
$73.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.36
|
| Rate for Payer: Brighton Health Commercial |
$73.37
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.37
|
| Rate for Payer: EmblemHealth Commercial |
$73.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.30
|
| Rate for Payer: Group Health Inc Commercial |
$73.37
|
| Rate for Payer: Group Health Inc Medicare |
$73.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.37
|
| Rate for Payer: Healthfirst QHP |
$73.37
|
| Rate for Payer: Humana Medicare |
$74.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.70
|
| Rate for Payer: Wellcare Medicare |
$66.03
|
|
|
FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$183.43
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
40629204
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$73.37
|
|
|
FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$183.43
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
40629204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$146.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.37
|
| Rate for Payer: Aetna Government |
$73.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.36
|
| Rate for Payer: Brighton Health Commercial |
$73.37
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.37
|
| Rate for Payer: EmblemHealth Commercial |
$73.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.30
|
| Rate for Payer: Group Health Inc Commercial |
$73.37
|
| Rate for Payer: Group Health Inc Medicare |
$73.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.37
|
| Rate for Payer: Healthfirst QHP |
$73.37
|
| Rate for Payer: Humana Medicare |
$74.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.70
|
| Rate for Payer: Wellcare Medicare |
$66.03
|
|
|
FACTOR X ACTIVITY
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
40629213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR X ACTIVITY
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
40629213
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR X CHROMOGENIC
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
40629739
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR X CHROMOGENIC
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
40629739
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR_XI_ACTIVITY
|
Facility
|
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
40629734
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
FACTOR_XI_ACTIVITY
|
Facility
|
IP
|
$44.75
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
40629734
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$17.90
|
|
|
FACTOR_XII_ACTIVITY
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
40629735
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
|
|
FACTOR_XII_ACTIVITY
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
40629735
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$19.35
|
|
