|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - CELIAC PANEL RFX
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - CELIAC PANEL RFX
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG 1, 2, 3, AND 4
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG 1, 2, 3, AND 4
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.30
|
| Rate for Payer: Aetna Government |
$9.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.51
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.30
|
| Rate for Payer: EmblemHealth Commercial |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.28
|
| Rate for Payer: Group Health Inc Commercial |
$9.30
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Essential Plan |
$20.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.30
|
| Rate for Payer: Humana Medicare |
$9.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Wellcare Medicare |
$8.37
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3018278501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3018278501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.46
|
| Rate for Payer: Aetna Government |
$16.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.46
|
| Rate for Payer: EmblemHealth Commercial |
$16.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.65
|
| Rate for Payer: Group Health Inc Commercial |
$16.46
|
| Rate for Payer: Group Health Inc Medicare |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.46
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$16.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$20.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$14.81
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE, AREA 1
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3018278502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.46
|
| Rate for Payer: Aetna Government |
$16.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.46
|
| Rate for Payer: EmblemHealth Commercial |
$16.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.65
|
| Rate for Payer: Group Health Inc Commercial |
$16.46
|
| Rate for Payer: Group Health Inc Medicare |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.46
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Humana Medicare |
$16.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$20.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$14.81
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE, AREA 1
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3018278502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC ASSAY OF GASTRIN - GASTRIN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
3018294101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.63
|
| Rate for Payer: Aetna Government |
$17.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.34
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.63
|
| Rate for Payer: EmblemHealth Commercial |
$17.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.69
|
| Rate for Payer: Group Health Inc Commercial |
$17.63
|
| Rate for Payer: Group Health Inc Medicare |
$17.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.63
|
| Rate for Payer: Healthfirst Essential Plan |
$39.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.63
|
| Rate for Payer: Healthfirst QHP |
$17.63
|
| Rate for Payer: Humana Medicare |
$17.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.63
|
| Rate for Payer: United Healthcare Commercial |
$22.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.63
|
| Rate for Payer: Wellcare Medicare |
$15.87
|
|
|
HC ASSAY OF GASTRIN - GASTRIN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
3018294101
|
|
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 GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017003
|
|
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 |
$16.38
|
| Rate for Payer: Aetna Government |
$16.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.47
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.38
|
| Rate for Payer: EmblemHealth Commercial |
$16.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.58
|
| Rate for Payer: Group Health Inc Commercial |
$16.38
|
| Rate for Payer: Group Health Inc Medicare |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.38
|
| Rate for Payer: Healthfirst QHP |
$16.38
|
| Rate for Payer: Humana Medicare |
$16.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$20.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.74
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017003
|
|
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 GENTAMICIN - GENTAMICIN RANDOM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017002
|
|
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 GENTAMICIN - GENTAMICIN RANDOM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017002
|
|
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 |
$16.38
|
| Rate for Payer: Aetna Government |
$16.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.47
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.38
|
| Rate for Payer: EmblemHealth Commercial |
$16.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.58
|
| Rate for Payer: Group Health Inc Commercial |
$16.38
|
| Rate for Payer: Group Health Inc Medicare |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.38
|
| Rate for Payer: Healthfirst QHP |
$16.38
|
| Rate for Payer: Humana Medicare |
$16.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$20.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.74
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017001
|
|
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 GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3018017001
|
|
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 |
$16.38
|
| Rate for Payer: Aetna Government |
$16.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.47
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.38
|
| Rate for Payer: EmblemHealth Commercial |
$16.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.58
|
| Rate for Payer: Group Health Inc Commercial |
$16.38
|
| Rate for Payer: Group Health Inc Medicare |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.38
|
| Rate for Payer: Healthfirst QHP |
$16.38
|
| Rate for Payer: Humana Medicare |
$16.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$20.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.74
|
|
|
HC ASSAY OF GGT - GAMMA GT
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
3018297701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
|
