|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.51
|
| Rate for Payer: Aetna Government |
$6.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.56
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.51
|
| Rate for Payer: EmblemHealth Commercial |
$6.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$6.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.51
|
| Rate for Payer: Healthfirst QHP |
$6.51
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.86
|
|
|
HC ASSAY OF CLOZAPINE - CLOZAPINE, CLOZARIL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.11
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.93
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.15
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Humana Medicare |
$20.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
|
|
HC ASSAY OF CLOZAPINE - CLOZAPINE, CLOZARIL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
|
|
HC ASSAY OF COPPER - COPPER LIVER TISSUE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3018252501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC ASSAY OF COPPER - COPPER LIVER TISSUE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3018252501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.41
|
| Rate for Payer: Aetna Government |
$12.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.69
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.41
|
| Rate for Payer: EmblemHealth Commercial |
$12.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.04
|
| Rate for Payer: Group Health Inc Commercial |
$12.41
|
| Rate for Payer: Group Health Inc Medicare |
$12.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.41
|
| Rate for Payer: Healthfirst Essential Plan |
$27.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.41
|
| Rate for Payer: Healthfirst QHP |
$12.41
|
| Rate for Payer: Humana Medicare |
$12.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.41
|
| Rate for Payer: Wellcare Medicare |
$11.17
|
|
|
HC ASSAY OF COPPER - COPPER, SERUM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3018252504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.41
|
| Rate for Payer: Aetna Government |
$12.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.69
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.41
|
| Rate for Payer: EmblemHealth Commercial |
$12.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.04
|
| Rate for Payer: Group Health Inc Commercial |
$12.41
|
| Rate for Payer: Group Health Inc Medicare |
$12.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.41
|
| Rate for Payer: Healthfirst Essential Plan |
$27.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.41
|
| Rate for Payer: Healthfirst QHP |
$12.41
|
| Rate for Payer: Humana Medicare |
$12.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.41
|
| Rate for Payer: Wellcare Medicare |
$11.17
|
|
|
HC ASSAY OF COPPER - COPPER, SERUM
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3018252504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC ASSAY OF CORTICOSTEROIDS - 17 OH CORTICOSTEROIDS
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83491
|
| Hospital Charge Code |
3018349101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.53
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Humana Medicare |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$22.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.00
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
HC ASSAY OF CORTICOSTEROIDS - 17 OH CORTICOSTEROIDS
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 83491
|
| Hospital Charge Code |
3018349101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC ASSAY OF C-PEPTIDE - C-PEPTIDE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
3018468101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.57
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Essential Plan |
$46.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$26.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
HC ASSAY OF C-PEPTIDE - C-PEPTIDE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
3018468101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC ASSAY OF CREATININE - CREATININE FLUID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3018256502
|
|
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 OF CREATININE - CREATININE FLUID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3018256502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.12
|
| Rate for Payer: Aetna Government |
$5.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.58
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$5.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.56
|
| Rate for Payer: Group Health Inc Commercial |
$5.12
|
| Rate for Payer: Group Health Inc Medicare |
$5.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.12
|
| Rate for Payer: Healthfirst QHP |
$5.12
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$6.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$4.61
|
|
|
HC ASSAY OF CREATININE - CREATININE SERUM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3018256501
|
|
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 OF CREATININE - CREATININE SERUM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3018256501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.12
|
| Rate for Payer: Aetna Government |
$5.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.58
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$5.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.56
|
| Rate for Payer: Group Health Inc Commercial |
$5.12
|
| Rate for Payer: Group Health Inc Medicare |
$5.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.12
|
| Rate for Payer: Healthfirst QHP |
$5.12
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$6.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$4.61
|
|
|
HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3018259501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3018259501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.53
|
| Rate for Payer: Healthfirst Essential Plan |
$12.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.53
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
HC ASSAY OF CYANIDE - CYANIDE LEVEL
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 82600
|
| Hospital Charge Code |
3018260001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.40
|
| Rate for Payer: Aetna Government |
$19.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.58
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.40
|
| Rate for Payer: EmblemHealth Commercial |
$19.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.27
|
| Rate for Payer: Group Health Inc Commercial |
$19.40
|
| Rate for Payer: Group Health Inc Medicare |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.40
|
| Rate for Payer: Healthfirst QHP |
$19.40
|
| Rate for Payer: Humana Medicare |
$19.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.40
|
| Rate for Payer: United Healthcare Commercial |
$24.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.43
|
| Rate for Payer: Wellcare Medicare |
$17.46
|
|
|
HC ASSAY OF CYANIDE - CYANIDE LEVEL
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 82600
|
| Hospital Charge Code |
3018260001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3018015801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3018015801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.05
|
| Rate for Payer: Aetna Government |
$18.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.63
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.05
|
| Rate for Payer: EmblemHealth Commercial |
$18.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.06
|
| Rate for Payer: Group Health Inc Commercial |
$18.05
|
| Rate for Payer: Group Health Inc Medicare |
$18.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.05
|
| Rate for Payer: Healthfirst QHP |
$18.05
|
| Rate for Payer: Humana Medicare |
$18.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare Commercial |
$22.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$16.25
|
|
|
HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
3018266801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$38.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.79
|
| Rate for Payer: Aetna Government |
$18.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.15
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.79
|
| Rate for Payer: EmblemHealth Commercial |
$18.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.72
|
| Rate for Payer: Group Health Inc Commercial |
$18.79
|
| Rate for Payer: Group Health Inc Medicare |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.23
|
| Rate for Payer: Healthfirst Essential Plan |
$38.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.79
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: Humana Medicare |
$19.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.23
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
|
|
HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
3018266801
|
|
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 OF ESTRADIOL - ESTRADIOL
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
3018267001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
