|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
3018407501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3018408001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.78
|
| Rate for Payer: Aetna Government |
$14.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.35
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.78
|
| Rate for Payer: EmblemHealth Commercial |
$14.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Group Health Inc Commercial |
$14.78
|
| Rate for Payer: Group Health Inc Medicare |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.01
|
| Rate for Payer: Healthfirst Essential Plan |
$22.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.78
|
| Rate for Payer: Healthfirst QHP |
$14.78
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.01
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3018408001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - ADDITIONAL CHARGE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - ADDITIONAL CHARGE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.35
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Healthfirst Essential Plan |
$9.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.35
|
| Rate for Payer: Healthfirst QHP |
$4.35
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$5.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL FLUID
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL FLUID
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.35
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Healthfirst Essential Plan |
$9.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.35
|
| Rate for Payer: Healthfirst QHP |
$4.35
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$5.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.35
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Healthfirst Essential Plan |
$9.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.35
|
| Rate for Payer: Healthfirst QHP |
$4.35
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$5.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - POCT CHOLESTEROL
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - POCT CHOLESTEROL
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3018246503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.35
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Healthfirst Essential Plan |
$9.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.35
|
| Rate for Payer: Healthfirst QHP |
$4.35
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$5.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
|
|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
3018237401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
3018237401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.88
|
| Rate for Payer: Aetna Government |
$4.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.42
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.88
|
| Rate for Payer: EmblemHealth Commercial |
$4.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$4.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.88
|
| Rate for Payer: Healthfirst Essential Plan |
$10.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.88
|
| Rate for Payer: Healthfirst QHP |
$4.88
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.88
|
| Rate for Payer: Wellcare Medicare |
$4.39
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.32
|
| Rate for Payer: Aetna Government |
$12.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.62
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.32
|
| Rate for Payer: EmblemHealth Commercial |
$12.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.96
|
| Rate for Payer: Group Health Inc Commercial |
$12.32
|
| Rate for Payer: Group Health Inc Medicare |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.11
|
| Rate for Payer: Healthfirst Essential Plan |
$25.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.32
|
| Rate for Payer: Healthfirst QHP |
$12.32
|
| Rate for Payer: Humana Medicare |
$12.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$15.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.11
|
| Rate for Payer: Wellcare Medicare |
$11.09
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.08
|
| Rate for Payer: Aetna Government |
$29.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.36
|
| Rate for Payer: Brighton Health Commercial |
$54.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.08
|
| Rate for Payer: EmblemHealth Commercial |
$29.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.88
|
| Rate for Payer: Group Health Inc Commercial |
$29.08
|
| Rate for Payer: Group Health Inc Medicare |
$29.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Healthfirst Essential Plan |
$41.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.08
|
| Rate for Payer: Healthfirst QHP |
$29.08
|
| Rate for Payer: Humana Medicare |
$29.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.08
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Wellcare Medicare |
$26.17
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.00
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.50
|
| Rate for Payer: Aetna Government |
$38.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.95
|
| Rate for Payer: Brighton Health Commercial |
$72.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.50
|
| Rate for Payer: EmblemHealth Commercial |
$38.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.27
|
| Rate for Payer: Group Health Inc Commercial |
$38.50
|
| Rate for Payer: Group Health Inc Medicare |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.50
|
| Rate for Payer: Healthfirst QHP |
$38.50
|
| Rate for Payer: Humana Medicare |
$39.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$48.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36.58
|
| Rate for Payer: Wellcare Medicare |
$34.65
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, SERUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.68
|
| Rate for Payer: Aetna Government |
$18.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.08
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.68
|
| Rate for Payer: EmblemHealth Commercial |
$18.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.63
|
| Rate for Payer: Group Health Inc Commercial |
$18.68
|
| Rate for Payer: Group Health Inc Medicare |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.68
|
| Rate for Payer: Healthfirst Essential Plan |
$42.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.68
|
| Rate for Payer: Healthfirst QHP |
$18.68
|
| Rate for Payer: Humana Medicare |
$19.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.68
|
| Rate for Payer: United Healthcare Commercial |
$23.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.68
|
| Rate for Payer: Wellcare Medicare |
$16.81
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, SERUM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE CONF URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3018399201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.02
|
| Rate for Payer: EmblemHealth Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$18.61
|
|
|
HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE CONF URINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3018399201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE LEVEL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3018399202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE LEVEL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3018399202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.02
|
| Rate for Payer: EmblemHealth Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$18.61
|
|
