|
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
|
|
|
HC ASSAY OF ESTRIOL - ADDITIONAL CHARGE
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
3018267701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.18
|
| Rate for Payer: Aetna Government |
$24.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.93
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$24.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.52
|
| Rate for Payer: Group Health Inc Commercial |
$24.18
|
| Rate for Payer: Group Health Inc Medicare |
$24.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.68
|
| Rate for Payer: Healthfirst Essential Plan |
$39.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.18
|
| Rate for Payer: Healthfirst QHP |
$24.18
|
| Rate for Payer: Humana Medicare |
$24.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.18
|
| Rate for Payer: United Healthcare Commercial |
$30.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.68
|
| Rate for Payer: Wellcare Medicare |
$21.76
|
|
|
HC ASSAY OF ESTRIOL - ADDITIONAL CHARGE
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
3018267701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
HC ASSAY OF ESTROGEN - ESTROGENS, TOTAL
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
3018267201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.70
|
| Rate for Payer: Aetna Government |
$21.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.19
|
| Rate for Payer: Brighton Health Commercial |
$59.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.70
|
| Rate for Payer: EmblemHealth Commercial |
$21.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.31
|
| Rate for Payer: Group Health Inc Commercial |
$21.70
|
| Rate for Payer: Group Health Inc Medicare |
$21.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.70
|
| Rate for Payer: Healthfirst Essential Plan |
$48.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.70
|
| Rate for Payer: Healthfirst QHP |
$21.70
|
| Rate for Payer: Humana Medicare |
$22.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.70
|
| Rate for Payer: United Healthcare Commercial |
$27.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.70
|
| Rate for Payer: Wellcare Medicare |
$19.53
|
|
|
HC ASSAY OF ESTROGEN - ESTROGENS, TOTAL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
3018267201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.50
|
|
|
HC ASSAY OF ESTRONE - ESTRONE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
3018267902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$56.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.95
|
| Rate for Payer: Aetna Government |
$24.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.46
|
| Rate for Payer: Brighton Health Commercial |
$46.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.95
|
| Rate for Payer: EmblemHealth Commercial |
$24.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.21
|
| Rate for Payer: Group Health Inc Commercial |
$24.95
|
| Rate for Payer: Group Health Inc Medicare |
$24.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.95
|
| Rate for Payer: Healthfirst Essential Plan |
$56.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.95
|
| Rate for Payer: Healthfirst QHP |
$24.95
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.95
|
| Rate for Payer: United Healthcare Commercial |
$31.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.95
|
| Rate for Payer: Wellcare Medicare |
$22.45
|
|
|
HC ASSAY OF ESTRONE - ESTRONE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
3018267902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.00
|
|
|
HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
3018016801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Government |
$16.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.44
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.34
|
| Rate for Payer: EmblemHealth Commercial |
$16.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.54
|
| Rate for Payer: Group Health Inc Commercial |
$16.34
|
| Rate for Payer: Group Health Inc Medicare |
$16.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.34
|
| Rate for Payer: Healthfirst QHP |
$16.34
|
| Rate for Payer: Humana Medicare |
$16.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
|
|
HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
3018016801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
3018269301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.90
|
| Rate for Payer: Aetna Government |
$14.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.43
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.90
|
| Rate for Payer: EmblemHealth Commercial |
$14.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.26
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.90
|
| Rate for Payer: Healthfirst QHP |
$14.90
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.90
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.15
|
| Rate for Payer: Wellcare Medicare |
$13.41
|
|
|
HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
3018269301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC ASSAY OF EVEROLIMUS - EVEROLIMUS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC ASSAY OF EVEROLIMUS - EVEROLIMUS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.73
|
| Rate for Payer: Aetna Government |
$13.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.61
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.73
|
| Rate for Payer: EmblemHealth Commercial |
$13.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.22
|
| Rate for Payer: Group Health Inc Commercial |
$13.73
|
| Rate for Payer: Group Health Inc Medicare |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.73
|
| Rate for Payer: Healthfirst QHP |
$13.73
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare Commercial |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.36
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.63
|
| Rate for Payer: Aetna Government |
$13.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.54
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.63
|
| Rate for Payer: EmblemHealth Commercial |
$13.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.13
|
| Rate for Payer: Group Health Inc Commercial |
$13.63
|
| Rate for Payer: Group Health Inc Medicare |
$13.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.63
|
| Rate for Payer: Healthfirst Essential Plan |
$30.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.63
|
| Rate for Payer: Healthfirst QHP |
$13.63
|
| Rate for Payer: Humana Medicare |
$13.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.63
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.63
|
| Rate for Payer: Wellcare Medicare |
$12.27
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC ASSAY OF FETAL FIBRONECTIN - FETAL FIBRONECTIN
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
3018273101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$144.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.41
|
| Rate for Payer: Aetna Government |
$64.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.09
|
| Rate for Payer: Brighton Health Commercial |
$120.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$64.41
|
| Rate for Payer: EmblemHealth Commercial |
$64.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.32
|
| Rate for Payer: Group Health Inc Commercial |
$64.41
|
| Rate for Payer: Group Health Inc Medicare |
$64.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.41
|
| Rate for Payer: Healthfirst Essential Plan |
$144.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.41
|
| Rate for Payer: Healthfirst QHP |
$64.41
|
| Rate for Payer: Humana Medicare |
$65.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$81.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.41
|
| Rate for Payer: Wellcare Medicare |
$57.97
|
|
|
HC ASSAY OF FETAL FIBRONECTIN - FETAL FIBRONECTIN
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
3018273101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.50
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID URINE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
3018315001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID URINE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
3018315001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.41
|
| Rate for Payer: Aetna Government |
$22.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.69
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.41
|
| Rate for Payer: EmblemHealth Commercial |
$22.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.94
|
| Rate for Payer: Group Health Inc Commercial |
$22.41
|
| Rate for Payer: Group Health Inc Medicare |
$22.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.31
|
| Rate for Payer: Healthfirst Essential Plan |
$14.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.41
|
| Rate for Payer: Healthfirst QHP |
$22.41
|
| Rate for Payer: Humana Medicare |
$22.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.41
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.31
|
| Rate for Payer: Wellcare Medicare |
$20.17
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.02
|
| Rate for Payer: Aetna Government |
$9.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.31
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.02
|
| Rate for Payer: EmblemHealth Commercial |
$9.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.03
|
| Rate for Payer: Group Health Inc Commercial |
$9.02
|
| Rate for Payer: Group Health Inc Medicare |
$9.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.00
|
| Rate for Payer: Healthfirst Essential Plan |
$20.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.02
|
| Rate for Payer: Healthfirst QHP |
$9.02
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$11.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.00
|
| Rate for Payer: Wellcare Medicare |
$8.12
|
|
|
HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
3018295501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$21.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.70
|
| Rate for Payer: Aetna Government |
$9.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.79
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.70
|
| Rate for Payer: EmblemHealth Commercial |
$9.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.63
|
| Rate for Payer: Group Health Inc Commercial |
$9.70
|
| Rate for Payer: Group Health Inc Medicare |
$9.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.70
|
| Rate for Payer: Healthfirst Essential Plan |
$21.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.70
|
| Rate for Payer: Healthfirst QHP |
$9.70
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.70
|
| Rate for Payer: Wellcare Medicare |
$8.73
|
|
|
HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
3018295501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
|
|
HC ASSAY OF GABEPENTIN - GABEPENTIN, NEURONTIN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
3018017101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.67
|
| Rate for Payer: Aetna Government |
$21.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.17
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.67
|
| Rate for Payer: EmblemHealth Commercial |
$21.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.29
|
| Rate for Payer: Group Health Inc Commercial |
$21.67
|
| Rate for Payer: Group Health Inc Medicare |
$21.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.67
|
| Rate for Payer: Healthfirst QHP |
$21.67
|
| Rate for Payer: Humana Medicare |
$22.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.67
|
| Rate for Payer: United Healthcare Commercial |
$16.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$19.50
|
|
|
HC ASSAY OF GABEPENTIN - GABEPENTIN, NEURONTIN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
3018017101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.00
|
|
