|
URINARY-PHOSPHORUS
|
Facility
OP
|
$14.45
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
40602255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.78
|
| Rate for Payer: Aetna Government |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| 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 |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.78
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.62
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
|
|
URINARY-SODIUM (NA)
|
Facility
OP
|
$12.65
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
40602230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.06
|
| Rate for Payer: Aetna Government |
$5.06
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.06
|
| Rate for Payer: EmblemHealth Commercial |
$5.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.50
|
| Rate for Payer: Group Health Inc Commercial |
$5.06
|
| Rate for Payer: Group Health Inc Medicare |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.06
|
| Rate for Payer: Healthfirst QHP |
$5.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.05
|
| Rate for Payer: Wellcare Medicare |
$4.55
|
|
|
URINARY STONES WITH MCC
|
Facility
IP
|
$27,507.58
|
|
|
Service Code
|
MS-DRG 693
|
| Min. Negotiated Rate |
$12,144.80 |
| Max. Negotiated Rate |
$27,507.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,883.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,968.22
|
| Rate for Payer: Aetna Government |
$26,968.22
|
| Rate for Payer: Brighton Health Commercial |
$20,536.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,507.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,458.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,183.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,619.81
|
| Rate for Payer: EmblemHealth Commercial |
$12,144.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,968.22
|
| Rate for Payer: Group Health Inc Commercial |
$26,968.22
|
| Rate for Payer: Group Health Inc Medicare |
$26,968.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,968.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,540.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,968.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,968.22
|
| Rate for Payer: Wellcare Medicare |
$25,619.81
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
IP
|
$18,545.48
|
|
|
Service Code
|
MS-DRG 694
|
| Min. Negotiated Rate |
$6,711.65 |
| Max. Negotiated Rate |
$18,545.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,540.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,181.84
|
| Rate for Payer: Aetna Government |
$18,181.84
|
| Rate for Payer: Brighton Health Commercial |
$11,349.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,545.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,516.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,154.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,272.75
|
| Rate for Payer: EmblemHealth Commercial |
$6,711.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,181.84
|
| Rate for Payer: Group Health Inc Commercial |
$18,181.84
|
| Rate for Payer: Group Health Inc Medicare |
$18,181.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,181.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,454.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,181.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,181.84
|
| Rate for Payer: Wellcare Medicare |
$17,272.75
|
|
|
URINARY URIC ACID
|
Facility
OP
|
$12.70
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
40602275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.08
|
| Rate for Payer: Aetna Government |
$5.08
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.08
|
| Rate for Payer: EmblemHealth Commercial |
$5.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.52
|
| Rate for Payer: Group Health Inc Commercial |
$5.08
|
| Rate for Payer: Group Health Inc Medicare |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.08
|
| Rate for Payer: Healthfirst QHP |
$5.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.06
|
| Rate for Payer: Wellcare Medicare |
$4.57
|
|
|
URINE 5 DRUG SCREEN
|
Facility
OP
|
$155.35
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
40602470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$124.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.64
|
| Rate for Payer: Group Health Inc Commercial |
$77.68
|
| Rate for Payer: Group Health Inc Medicare |
$54.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.68
|
|
|
URINE ACTH
|
Facility
OP
|
$96.55
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
40607117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.62
|
| Rate for Payer: Aetna Government |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.62
|
| Rate for Payer: EmblemHealth Commercial |
$38.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.37
|
| Rate for Payer: Group Health Inc Commercial |
$38.62
|
| Rate for Payer: Group Health Inc Medicare |
$38.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.62
|
| Rate for Payer: Healthfirst QHP |
$38.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.90
|
| Rate for Payer: Wellcare Medicare |
$34.76
|
|
|
URINE AMYLASE/DAY
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
40602290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.48
|
| Rate for Payer: EmblemHealth Commercial |
$6.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.77
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.48
|
| Rate for Payer: Healthfirst QHP |
$6.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.83
|
|
|
URINE AMYLASE RANDOM
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
40602285
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.48
|
| Rate for Payer: EmblemHealth Commercial |
$6.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.77
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.48
|
| Rate for Payer: Healthfirst QHP |
$6.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.83
|
|
|
URINE BACTERIA CULTURE
|
Facility
OP
|
$20.23
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
40614338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.09
|
| Rate for Payer: Aetna Government |
$8.09
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.09
|
| Rate for Payer: EmblemHealth Commercial |
$8.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.20
|
| Rate for Payer: Group Health Inc Commercial |
$8.09
|
| Rate for Payer: Group Health Inc Medicare |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.09
|
| Rate for Payer: Healthfirst QHP |
$8.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.47
|
| Rate for Payer: Wellcare Medicare |
$7.28
|
|
|
URINE CHLORIDE DAY
|
Facility
OP
|
$14.38
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
40602245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.75
|
| Rate for Payer: Aetna Government |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.75
|
| Rate for Payer: EmblemHealth Commercial |
$5.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.12
|
| Rate for Payer: Group Health Inc Commercial |
$5.75
|
| Rate for Payer: Group Health Inc Medicare |
$5.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.75
|
| Rate for Payer: Healthfirst QHP |
$5.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.60
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
|
|
URINE CHLORIDE RANDOM
|
Facility
OP
|
$14.38
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
40602240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.75
|
| Rate for Payer: Aetna Government |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.75
|
| Rate for Payer: EmblemHealth Commercial |
$5.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.12
|
| Rate for Payer: Group Health Inc Commercial |
$5.75
|
| Rate for Payer: Group Health Inc Medicare |
$5.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.75
|
| Rate for Payer: Healthfirst QHP |
$5.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.60
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
|
|
URINE_CULTURE, ROUTINE
|
Facility
OP
|
$20.18
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
40628847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$12.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.07
|
| Rate for Payer: Aetna Government |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.07
|
| Rate for Payer: EmblemHealth Commercial |
$8.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.18
|
| Rate for Payer: Group Health Inc Commercial |
$8.07
|
| Rate for Payer: Group Health Inc Medicare |
$8.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.07
|
| Rate for Payer: Healthfirst QHP |
$8.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.46
|
| Rate for Payer: Wellcare Medicare |
$7.26
|
|
|
URINE ELECTROLYTES /24 HR
|
Facility
OP
|
$17.53
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
40602330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.01
|
| Rate for Payer: Aetna Government |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.01
|
| Rate for Payer: EmblemHealth Commercial |
$7.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.24
|
| Rate for Payer: Group Health Inc Commercial |
$7.01
|
| Rate for Payer: Group Health Inc Medicare |
$7.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.01
|
| Rate for Payer: Healthfirst QHP |
$7.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.61
|
| Rate for Payer: Wellcare Medicare |
$6.31
|
|
|
URINE ELECTROLYTES SPOT
|
Facility
OP
|
$17.53
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
40602325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.01
|
| Rate for Payer: Aetna Government |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.01
|
| Rate for Payer: EmblemHealth Commercial |
$7.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.24
|
| Rate for Payer: Group Health Inc Commercial |
$7.01
|
| Rate for Payer: Group Health Inc Medicare |
$7.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.01
|
| Rate for Payer: Healthfirst QHP |
$7.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.61
|
| Rate for Payer: Wellcare Medicare |
$6.31
|
|
|
URINE LOW MEASUREMENT
|
Facility
OP
|
$315.67
|
|
|
Service Code
|
HCPCS 51736 TC
|
| Hospital Charge Code |
30306417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.84
|
| Rate for Payer: Aetna Government |
$157.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| 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: Fidelis CHP/HARP/Medicaid |
$6.25
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.94
|
|
|
URINE PREGNANCY TEST
|
Facility
OP
|
$21.53
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
30301273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.61
|
| Rate for Payer: Aetna Government |
$8.61
|
| Rate for Payer: Amida Care Medicaid |
$3.22
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.61
|
| Rate for Payer: EmblemHealth Commercial |
$8.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$8.61
|
| Rate for Payer: Group Health Inc Medicare |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.61
|
| Rate for Payer: Healthfirst QHP |
$3.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: SOMOS Essential |
$3.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.89
|
| Rate for Payer: Wellcare Medicare |
$7.75
|
|
|
URINE PREGNANCY TEST
|
Facility
OP
|
$21.53
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
30301295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.61
|
| Rate for Payer: Aetna Government |
$8.61
|
| Rate for Payer: Amida Care Medicaid |
$3.22
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.61
|
| Rate for Payer: EmblemHealth Commercial |
$8.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$8.61
|
| Rate for Payer: Group Health Inc Medicare |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.61
|
| Rate for Payer: Healthfirst QHP |
$3.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: SOMOS Essential |
$3.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.89
|
| Rate for Payer: Wellcare Medicare |
$7.75
|
|
|
URINE SPECIMAN
|
Facility
OP
|
$6.94
|
|
| Hospital Charge Code |
64905489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.47
|
| Rate for Payer: Aetna Government |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.72
|
| Rate for Payer: Group Health Inc Commercial |
$3.47
|
| Rate for Payer: Group Health Inc Medicare |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.47
|
|
|
URINE UREA NITROGEN /DAY
|
Facility
OP
|
$13.90
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
40602270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.56
|
| Rate for Payer: Aetna Government |
$5.56
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.56
|
| Rate for Payer: EmblemHealth Commercial |
$5.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.95
|
| Rate for Payer: Group Health Inc Commercial |
$5.56
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.56
|
| Rate for Payer: Healthfirst QHP |
$5.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.45
|
| Rate for Payer: Wellcare Medicare |
$5.00
|
|
|
URINE UREA NITROGEN RANDOM
|
Facility
OP
|
$13.90
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
40602265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.56
|
| Rate for Payer: Aetna Government |
$5.56
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.56
|
| Rate for Payer: EmblemHealth Commercial |
$5.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.95
|
| Rate for Payer: Group Health Inc Commercial |
$5.56
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.56
|
| Rate for Payer: Healthfirst QHP |
$5.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.45
|
| Rate for Payer: Wellcare Medicare |
$5.00
|
|
|
URI NEW RX ANTIBIOTIC 30D
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2174
|
| Hospital Charge Code |
30300302
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
URI W COMORB 12M OTH DX
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2173
|
| Hospital Charge Code |
30300301
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
URO DRN TUBE ADAPTER
|
Facility
OP
|
$19.80
|
|
| Hospital Charge Code |
40005169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.90
|
| Rate for Payer: Aetna Government |
$9.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.46
|
| Rate for Payer: Group Health Inc Commercial |
$9.90
|
| Rate for Payer: Group Health Inc Medicare |
$6.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.90
|
|
|
UROLOGY SURGERY PROCEDURE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
40004141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
