|
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
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM URINE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3018373502
|
|
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 URINE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3018373502
|
|
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 MERCURY - MERCURY 24 HOUR URINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3018382501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.26
|
| Rate for Payer: Aetna Government |
$16.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.38
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$16.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.47
|
| Rate for Payer: Group Health Inc Commercial |
$16.26
|
| Rate for Payer: Group Health Inc Medicare |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.26
|
| Rate for Payer: Healthfirst Essential Plan |
$36.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.26
|
| Rate for Payer: Healthfirst QHP |
$16.26
|
| Rate for Payer: Humana Medicare |
$16.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.26
|
| Rate for Payer: Wellcare Medicare |
$14.63
|
|
|
HC ASSAY OF MERCURY - MERCURY 24 HOUR URINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3018382501
|
|
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 MERCURY - MERCURY, BLOOD
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3018382503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.26
|
| Rate for Payer: Aetna Government |
$16.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.38
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$16.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.47
|
| Rate for Payer: Group Health Inc Commercial |
$16.26
|
| Rate for Payer: Group Health Inc Medicare |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.26
|
| Rate for Payer: Healthfirst Essential Plan |
$36.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.26
|
| Rate for Payer: Healthfirst QHP |
$16.26
|
| Rate for Payer: Humana Medicare |
$16.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.26
|
| Rate for Payer: Wellcare Medicare |
$14.63
|
|
|
HC ASSAY OF MERCURY - MERCURY, BLOOD
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3018382503
|
|
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 METANEPHRINES - METANEPHRINES 24HR URINE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
3018383501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$38.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.94
|
| Rate for Payer: Aetna Government |
$16.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.86
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$16.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$16.94
|
| Rate for Payer: Group Health Inc Medicare |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.94
|
| Rate for Payer: Healthfirst Essential Plan |
$38.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.94
|
| Rate for Payer: Healthfirst QHP |
$16.94
|
| Rate for Payer: Humana Medicare |
$17.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$21.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.94
|
| Rate for Payer: Wellcare Medicare |
$15.25
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
3018383501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ASSAY OF MYCOPHENOLATE - MYCOPHENOLATE, MYCOPHENOLIC ACID
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
3018018001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$99.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
|
|
HC ASSAY OF MYCOPHENOLATE - MYCOPHENOLATE, MYCOPHENOLIC ACID
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
3018018001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.45
|
| 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 |
$149.25
|
| 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 |
$159.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.32
|
| 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 |
$22.17
|
| 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 MYOGLOBIN - MYOGLOBIN SERUM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
3018387401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.92
|
| Rate for Payer: Aetna Government |
$12.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.04
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$12.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.92
|
| Rate for Payer: Group Health Inc Medicare |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.92
|
| Rate for Payer: Healthfirst QHP |
$12.92
|
| Rate for Payer: Humana Medicare |
$13.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.27
|
| Rate for Payer: Wellcare Medicare |
$11.63
|
|
|
HC ASSAY OF MYOGLOBIN - MYOGLOBIN SERUM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
3018387401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
3018387402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.92
|
| Rate for Payer: Aetna Government |
$12.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.04
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$12.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.92
|
| Rate for Payer: Group Health Inc Medicare |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.92
|
| Rate for Payer: Healthfirst QHP |
$12.92
|
| Rate for Payer: Humana Medicare |
$13.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.27
|
| Rate for Payer: Wellcare Medicare |
$11.63
|
|
|
HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
3018387402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ASSAY OF NOS VITAMIN - NIACIN (VITAMIN B3)
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
3018459101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.06
|
| Rate for Payer: Aetna Government |
$17.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.94
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.06
|
| Rate for Payer: EmblemHealth Commercial |
$17.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$17.06
|
| Rate for Payer: Group Health Inc Medicare |
$17.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.06
|
| Rate for Payer: Healthfirst QHP |
$17.06
|
| Rate for Payer: Humana Medicare |
$17.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.06
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Wellcare Medicare |
$15.35
|
|
|
HC ASSAY OF NOS VITAMIN - NIACIN (VITAMIN B3)
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
3018459101
|
|
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 OSTEOCALCIN - OSTEOCALCIN
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
3018393701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
|
|
HC ASSAY OF OSTEOCALCIN - OSTEOCALCIN
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
3018393701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.85
|
| Rate for Payer: Aetna Government |
$29.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.89
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.85
|
| Rate for Payer: EmblemHealth Commercial |
$29.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.57
|
| Rate for Payer: Group Health Inc Commercial |
$29.85
|
| Rate for Payer: Group Health Inc Medicare |
$29.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.85
|
| Rate for Payer: Healthfirst QHP |
$29.85
|
| Rate for Payer: Humana Medicare |
$30.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$37.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.36
|
| Rate for Payer: Wellcare Medicare |
$26.86
|
|
|
HC ASSAY OF OXALATE - OXALATE 24HR URINE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3018394501
|
|
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 OXALATE - OXALATE 24HR URINE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3018394501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$27.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.45
|
| Rate for Payer: Aetna Government |
$14.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.12
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.45
|
| Rate for Payer: EmblemHealth Commercial |
$14.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.86
|
| Rate for Payer: Group Health Inc Commercial |
$14.45
|
| Rate for Payer: Group Health Inc Medicare |
$14.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.02
|
| Rate for Payer: Healthfirst Essential Plan |
$27.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.45
|
| Rate for Payer: Healthfirst QHP |
$14.45
|
| Rate for Payer: Humana Medicare |
$14.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.02
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
|
|
HC ASSAY OF OXCARBAZEPINE - OXCARBAZEPINE, TRILEPTAL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
3018018301
|
|
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 OXCARBAZEPINE - OXCARBAZEPINE, TRILEPTAL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
3018018301
|
|
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 PARATHORMONE - PTH INTACT
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
3018397001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$92.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Government |
$41.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.90
|
| Rate for Payer: Brighton Health Commercial |
$77.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$41.28
|
| Rate for Payer: EmblemHealth Commercial |
$41.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.74
|
| Rate for Payer: Group Health Inc Commercial |
$41.28
|
| Rate for Payer: Group Health Inc Medicare |
$41.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.28
|
| Rate for Payer: Healthfirst Essential Plan |
$92.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.28
|
| Rate for Payer: Healthfirst QHP |
$41.28
|
| Rate for Payer: Humana Medicare |
$42.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.28
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.28
|
| Rate for Payer: Wellcare Medicare |
$37.15
|
|
|
HC ASSAY OF PARATHORMONE - PTH INTACT
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
3018397001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.50
|
|
