|
HC ASSAY OF LACTIC ACID - POCT LACTIC ACID (LACTATE)
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
3018360503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.57
|
| Rate for Payer: Aetna Government |
$11.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.10
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.57
|
| Rate for Payer: EmblemHealth Commercial |
$11.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.57
|
| Rate for Payer: Group Health Inc Medicare |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.39
|
| Rate for Payer: Healthfirst Essential Plan |
$21.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.57
|
| Rate for Payer: Healthfirst QHP |
$11.57
|
| Rate for Payer: Humana Medicare |
$11.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$13.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.39
|
| Rate for Payer: Wellcare Medicare |
$10.41
|
|
|
HC ASSAY OF LACTIC ACID - POCT LACTIC ACID (LACTATE)
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
3018360503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC ASSAY OF LAMOTRIGINE - LAMOTRIGINE, LAMICTAL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
3018017501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC ASSAY OF LAMOTRIGINE - LAMOTRIGINE, LAMICTAL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
3018017501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
|
|
HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
3018362501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.79
|
| Rate for Payer: Aetna Government |
$12.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.95
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.79
|
| Rate for Payer: EmblemHealth Commercial |
$12.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.38
|
| Rate for Payer: Group Health Inc Commercial |
$12.79
|
| Rate for Payer: Group Health Inc Medicare |
$12.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.79
|
| Rate for Payer: Healthfirst QHP |
$12.79
|
| Rate for Payer: Humana Medicare |
$13.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.79
|
| Rate for Payer: United Healthcare Commercial |
$16.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$11.51
|
|
|
HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
3018362501
|
|
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 LEAD - LEAD 24HR URINE
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.11
|
| Rate for Payer: Aetna Government |
$12.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$169.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$12.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.11
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Essential Plan |
$27.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.11
|
| Rate for Payer: Healthfirst QHP |
$12.11
|
| Rate for Payer: Humana Medicare |
$12.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Wellcare Medicare |
$10.90
|
|
|
HC ASSAY OF LEAD - LEAD 24HR URINE
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
|
|
HC ASSAY OF LEAD - LEAD BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.11
|
| Rate for Payer: Aetna Government |
$12.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$12.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.11
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Essential Plan |
$27.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.11
|
| Rate for Payer: Healthfirst QHP |
$12.11
|
| Rate for Payer: Humana Medicare |
$12.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Wellcare Medicare |
$10.90
|
|
|
HC ASSAY OF LEAD - LEAD BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365503
|
|
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 OF LEAD - LEAD BLOOD, PEDIATRIC
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365502
|
|
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 OF LEAD - LEAD BLOOD, PEDIATRIC
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3018365502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.11
|
| Rate for Payer: Aetna Government |
$12.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$12.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.11
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Essential Plan |
$27.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.11
|
| Rate for Payer: Healthfirst QHP |
$12.11
|
| Rate for Payer: Humana Medicare |
$12.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Wellcare Medicare |
$10.90
|
|
|
HC ASSAY OFLEVETIRACETAM - LEVETIRACETAM, KEPPRA
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC ASSAY OFLEVETIRACETAM - LEVETIRACETAM, KEPPRA
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
|
|
HC ASSAY OF LIDOCAINE - LIDOCAINE LEVEL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
3018017601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.69
|
| Rate for Payer: Aetna Government |
$14.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.28
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.69
|
| Rate for Payer: EmblemHealth Commercial |
$14.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.07
|
| Rate for Payer: Group Health Inc Commercial |
$14.69
|
| Rate for Payer: Group Health Inc Medicare |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.69
|
| Rate for Payer: Healthfirst QHP |
$14.69
|
| Rate for Payer: Humana Medicare |
$14.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$18.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.96
|
| Rate for Payer: Wellcare Medicare |
$13.22
|
|
|
HC ASSAY OF LIDOCAINE - LIDOCAINE LEVEL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
3018017601
|
|
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 OF LIPASE - LIPASE
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC ASSAY OF LIPASE - LIPASE
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.89
|
| Rate for Payer: Aetna Government |
$6.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.82
|
| Rate for Payer: Brighton Health Commercial |
$12.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.89
|
| Rate for Payer: EmblemHealth Commercial |
$6.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.13
|
| Rate for Payer: Group Health Inc Commercial |
$6.89
|
| Rate for Payer: Group Health Inc Medicare |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.81
|
| Rate for Payer: Healthfirst Essential Plan |
$13.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.89
|
| Rate for Payer: Healthfirst QHP |
$6.89
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.81
|
| Rate for Payer: Wellcare Medicare |
$6.20
|
|
|
HC ASSAY OF LIPASE - LIPASE BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3018369002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.89
|
| Rate for Payer: Aetna Government |
$6.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.82
|
| Rate for Payer: Brighton Health Commercial |
$12.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.89
|
| Rate for Payer: EmblemHealth Commercial |
$6.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.13
|
| Rate for Payer: Group Health Inc Commercial |
$6.89
|
| Rate for Payer: Group Health Inc Medicare |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.81
|
| Rate for Payer: Healthfirst Essential Plan |
$13.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.89
|
| Rate for Payer: Healthfirst QHP |
$6.89
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.81
|
| Rate for Payer: Wellcare Medicare |
$6.20
|
|
|
HC ASSAY OF LIPASE - LIPASE BODY FLUID
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3018369002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC ASSAY OF LITHIUM - LITHIUM
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
3018017801
|
|
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 LITHIUM - LITHIUM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
3018017801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.61
|
| Rate for Payer: Aetna Government |
$6.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.63
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.61
|
| Rate for Payer: EmblemHealth Commercial |
$6.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.61
|
| Rate for Payer: Group Health Inc Medicare |
$6.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.61
|
| Rate for Payer: Healthfirst Essential Plan |
$14.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.61
|
| Rate for Payer: Healthfirst QHP |
$6.61
|
| Rate for Payer: Humana Medicare |
$6.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.61
|
| Rate for Payer: United Healthcare Commercial |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.61
|
| Rate for Payer: Wellcare Medicare |
$5.95
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3018373501
|
|
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 MAGNESIUM - MAGNESIUM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3018373501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.70
|
| Rate for Payer: Aetna Government |
$6.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.69
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.70
|
| Rate for Payer: EmblemHealth Commercial |
$6.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.96
|
| Rate for Payer: Group Health Inc Commercial |
$6.70
|
| Rate for Payer: Group Health Inc Medicare |
$6.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.70
|
| Rate for Payer: Healthfirst QHP |
$6.70
|
| Rate for Payer: Humana Medicare |
$6.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare Commercial |
$8.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM 24HR URINE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3018373503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
