|
PROTEIN C ANTIGEN
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
40629215
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.01
|
|
|
PROTEIN C ANTIGEN
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
40629215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.01
|
| Rate for Payer: Aetna Government |
$12.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.41
|
| Rate for Payer: Brighton Health Commercial |
$22.52
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.01
|
| Rate for Payer: EmblemHealth Commercial |
$12.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.69
|
| Rate for Payer: Group Health Inc Commercial |
$12.01
|
| Rate for Payer: Group Health Inc Medicare |
$12.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.01
|
| Rate for Payer: Healthfirst QHP |
$12.01
|
| Rate for Payer: Humana Medicare |
$12.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.61
|
| Rate for Payer: Wellcare Medicare |
$10.81
|
|
|
PROTEIN C ANTIGEN
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
30303358
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$12.01
|
|
|
PROTEIN C-FUNCTIONAL
|
Facility
|
OP
|
$34.60
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
40629216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.84
|
| Rate for Payer: Aetna Government |
$13.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.69
|
| Rate for Payer: Brighton Health Commercial |
$25.95
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.84
|
| Rate for Payer: EmblemHealth Commercial |
$13.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.32
|
| Rate for Payer: Group Health Inc Commercial |
$13.84
|
| Rate for Payer: Group Health Inc Medicare |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.84
|
| Rate for Payer: Healthfirst QHP |
$13.84
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.84
|
| Rate for Payer: United Healthcare Commercial |
$17.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.07
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
|
|
PROTEIN C-FUNCTIONAL
|
Facility
|
IP
|
$34.60
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
40629216
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.84
|
|
|
PROTEIN, ELECTRO, 24HR URINE
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
40608088
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
PROTEIN, ELECTRO, 24HR URINE
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
40608088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
PROTEIN ELECTRO, RANDOM
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40608127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
PROTEIN ELECTRO, RANDOM
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40608127
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
PROTEIN ELECTRO., S
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40609112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
PROTEIN ELECTRO., S
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40609112
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
IP
|
$44.58
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
30305600
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.83
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
OP
|
$44.58
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
30305600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.83
|
| Rate for Payer: Aetna Government |
$17.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.48
|
| Rate for Payer: Brighton Health Commercial |
$33.44
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.83
|
| Rate for Payer: EmblemHealth Commercial |
$17.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.87
|
| Rate for Payer: Group Health Inc Commercial |
$17.83
|
| Rate for Payer: Group Health Inc Medicare |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.83
|
| Rate for Payer: Healthfirst QHP |
$17.83
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$22.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.26
|
| Rate for Payer: Wellcare Medicare |
$16.05
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
IP
|
$44.58
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
40609602
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.83
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
OP
|
$44.58
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
40609602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.83
|
| Rate for Payer: Aetna Government |
$17.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.48
|
| Rate for Payer: Brighton Health Commercial |
$33.44
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.83
|
| Rate for Payer: EmblemHealth Commercial |
$17.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.87
|
| Rate for Payer: Group Health Inc Commercial |
$17.83
|
| Rate for Payer: Group Health Inc Medicare |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.83
|
| Rate for Payer: Healthfirst QHP |
$17.83
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$22.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.26
|
| Rate for Payer: Wellcare Medicare |
$16.05
|
|
|
PROTEIN QUANTITATIVE-URINARY
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602235
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
PROTEIN QUANTITATIVE-URINARY
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
PROTEIN S-ANTIGEN
|
Facility
|
OP
|
$29.03
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
40629217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.61
|
| Rate for Payer: Aetna Government |
$11.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.13
|
| Rate for Payer: Brighton Health Commercial |
$21.77
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.61
|
| Rate for Payer: EmblemHealth Commercial |
$11.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.33
|
| Rate for Payer: Group Health Inc Commercial |
$11.61
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.61
|
| Rate for Payer: Healthfirst QHP |
$11.61
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.29
|
| Rate for Payer: Wellcare Medicare |
$10.45
|
|
|
PROTEIN S-ANTIGEN
|
Facility
|
IP
|
$29.03
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
40629217
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.61
|
|
|
PROTEIN S-FUNCTIONAL
|
Facility
|
OP
|
$38.30
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
40629218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$28.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.32
|
| Rate for Payer: Aetna Government |
$15.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.72
|
| Rate for Payer: Brighton Health Commercial |
$28.72
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$15.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.63
|
| Rate for Payer: Group Health Inc Commercial |
$15.32
|
| Rate for Payer: Group Health Inc Medicare |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.32
|
| Rate for Payer: Healthfirst QHP |
$15.32
|
| Rate for Payer: Humana Medicare |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare Commercial |
$19.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
|
|
PROTEIN S-FUNCTIONAL
|
Facility
|
IP
|
$38.30
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
40629218
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.32
|
|
|
PROTEIN TOTAL RANDOM URINE
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
PROTEIN TOTAL RANDOM URINE
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602610
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
PROTEIN TOTAL (SERUM PLASMA)
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602090
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.67
|
|
|
PROTEIN TOTAL (SERUM PLASMA)
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
