|
ANTIPARIETAL CELL ANTIBODY
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ANTIPHOSPHATIDYLSERINE IGG/M/A
|
Facility
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
40729451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
ANTI-PR3 ANTIBODIES
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ANTI-PR3 ANTOBODIES
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729920
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ANTIPROTEINASE 3 (PR-3) ABS
|
Facility
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
ANTIPYRINE-OXYQUINOLINE-BENZO OTIC SOLN
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
41645308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
|
ANTIPYRINE-OXYQUINOLINE-BENZO OTIC SOLN
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
41655308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
|
ANTIRIBOSOMAL P ANTIBODIES
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ANTISCLERODERMA-70 ANTIBODIES
|
Facility
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
ANTI-STREPTOLYSIN-O
|
Facility
OP
|
$14.43
|
|
|
Service Code
|
HCPCS 86063
|
| Hospital Charge Code |
40614165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna Government |
$5.77
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.77
|
| Rate for Payer: EmblemHealth Commercial |
$5.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.77
|
| Rate for Payer: Group Health Inc Medicare |
$5.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.77
|
| Rate for Payer: Healthfirst QHP |
$5.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.62
|
| Rate for Payer: Wellcare Medicare |
$5.19
|
|
|
ANTISTREPTOLYSIN O AB
|
Facility
OP
|
$9.47
|
|
| Hospital Charge Code |
40609909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
|
|
ANTITHROMBIN ANTIGEN
|
Facility
OP
|
$27.03
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
40629214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.81
|
| Rate for Payer: Aetna Government |
$10.81
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.81
|
| Rate for Payer: EmblemHealth Commercial |
$10.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.62
|
| Rate for Payer: Group Health Inc Commercial |
$10.81
|
| Rate for Payer: Group Health Inc Medicare |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.81
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$9.73
|
|
|
ANTITHROMBIN III ANTIGEN
|
Facility
OP
|
$27.03
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
30303375
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.81
|
| Rate for Payer: Aetna Government |
$10.81
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.81
|
| Rate for Payer: EmblemHealth Commercial |
$10.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.62
|
| Rate for Payer: Group Health Inc Commercial |
$10.81
|
| Rate for Payer: Group Health Inc Medicare |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.81
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$9.73
|
|
|
ANTRX THRED BIOCMPSE SCREW 9X30MM
|
Facility
IP
|
$422.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.45 |
| Max. Negotiated Rate |
$211.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.45
|
|
|
ANTRX THRED BIOCMPSE SCREW 9X30MM
|
Facility
OP
|
$422.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$444.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.60
|
| 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 |
$211.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$444.04
|
| Rate for Payer: Group Health Inc Commercial |
$211.45
|
| Rate for Payer: Group Health Inc Medicare |
$148.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.88
|
|
|
AOCOHOL AND/OR DRG ASSESS
|
Facility
OP
|
$450.70
|
|
|
Service Code
|
HCPCS H0001
|
| Hospital Charge Code |
30400232
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$18,861.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.45
|
| Rate for Payer: Aetna Government |
$99.45
|
| Rate for Payer: Amida Care Medicaid |
$188.61
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$190.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,861.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.04
|
| Rate for Payer: Group Health Inc Commercial |
$225.35
|
| Rate for Payer: Group Health Inc Medicare |
$157.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.61
|
| Rate for Payer: Healthfirst Essential Plan |
$424.37
|
| Rate for Payer: Healthfirst QHP |
$188.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$428.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.24
|
| Rate for Payer: Optum Medicaid |
$190.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.61
|
| Rate for Payer: SOMOS Essential |
$424.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.61
|
|
|
A-O HIP PINNING
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 20650
|
| Hospital Charge Code |
40021390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.96 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
IP
|
$118,373.81
|
|
|
Service Code
|
MS-DRG 268
|
| Min. Negotiated Rate |
$47,608.84 |
| Max. Negotiated Rate |
$118,373.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101,072.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102,384.60
|
| Rate for Payer: Aetna Government |
$102,384.60
|
| Rate for Payer: Brighton Health Commercial |
$99,393.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104,432.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$118,373.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97,687.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$97,265.37
|
| Rate for Payer: EmblemHealth Commercial |
$58,779.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$102,384.60
|
| Rate for Payer: Group Health Inc Commercial |
$102,384.60
|
| Rate for Payer: Group Health Inc Medicare |
$102,384.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102,384.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47,608.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102,384.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102,384.60
|
| Rate for Payer: Wellcare Medicare |
$97,265.37
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
IP
|
$71,814.86
|
|
|
Service Code
|
MS-DRG 269
|
| Min. Negotiated Rate |
$30,223.48 |
| Max. Negotiated Rate |
$71,814.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61,318.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64,996.74
|
| Rate for Payer: Aetna Government |
$64,996.74
|
| Rate for Payer: Brighton Health Commercial |
$60,299.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66,296.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71,814.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59,264.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$61,746.90
|
| Rate for Payer: EmblemHealth Commercial |
$35,660.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$64,996.74
|
| Rate for Payer: Group Health Inc Commercial |
$64,996.74
|
| Rate for Payer: Group Health Inc Medicare |
$64,996.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64,996.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30,223.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64,996.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64,996.74
|
| Rate for Payer: Wellcare Medicare |
$61,746.90
|
|
|
AORTIC BODY 20MM (TV-AB2080-E)
|
Facility
IP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
64904126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,250.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,250.00
|
|
|
AORTIC BODY 20MM (TV-AB2080-E)
|
Facility
OP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
64904126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$23,625.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,375.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,937.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,625.00
|
| Rate for Payer: Group Health Inc Commercial |
$11,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$7,875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,625.00
|
|
|
AORTIC BODY 29MM
|
Facility
OP
|
$13,750.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
64903891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$14,437.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,562.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,875.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,906.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,437.50
|
| Rate for Payer: Group Health Inc Commercial |
$6,875.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,812.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,875.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,937.50
|
|
|
AORTIC BODY 29MM
|
Facility
IP
|
$13,750.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
64903891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,875.00 |
| Max. Negotiated Rate |
$6,875.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,875.00
|
|
|
AORTIC GRAFT
|
Facility
IP
|
$1,990.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40202224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.00 |
| Max. Negotiated Rate |
$995.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$995.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$995.00
|
|
