|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.30
|
| Rate for Payer: Aetna Government |
$15.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.71
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.30
|
| Rate for Payer: EmblemHealth Commercial |
$15.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.62
|
| Rate for Payer: Group Health Inc Commercial |
$15.30
|
| Rate for Payer: Group Health Inc Medicare |
$15.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.30
|
| Rate for Payer: Healthfirst QHP |
$15.30
|
| Rate for Payer: Humana Medicare |
$15.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
|
|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC ASSAY OF PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
3018018601
|
|
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 PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
3018018601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.76
|
| Rate for Payer: Aetna Government |
$13.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.63
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.76
|
| Rate for Payer: EmblemHealth Commercial |
$13.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.25
|
| Rate for Payer: Group Health Inc Commercial |
$13.76
|
| Rate for Payer: Group Health Inc Medicare |
$13.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.76
|
| Rate for Payer: Healthfirst QHP |
$13.76
|
| Rate for Payer: Humana Medicare |
$14.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.76
|
| Rate for Payer: United Healthcare Commercial |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.38
|
|
|
HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
3018018502
|
|
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 PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
3018018502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$24.75 |
| 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 |
$22.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.98
|
| 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 |
$16.79
|
| 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 PREALBUMIN - PREALBUMIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
3018413401
|
|
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 PREALBUMIN - PREALBUMIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.59
|
| Rate for Payer: Aetna Government |
$14.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.21
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.59
|
| Rate for Payer: EmblemHealth Commercial |
$14.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.59
|
| Rate for Payer: Group Health Inc Medicare |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.39
|
| Rate for Payer: Healthfirst Essential Plan |
$16.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.59
|
| Rate for Payer: Healthfirst QHP |
$14.59
|
| Rate for Payer: Humana Medicare |
$14.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.59
|
| Rate for Payer: United Healthcare Commercial |
$18.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.39
|
| Rate for Payer: Wellcare Medicare |
$13.13
|
|
|
HC ASSAY OF PRIMIDONE - PRIMIDONE LEVEL
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
3018018801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.59
|
| Rate for Payer: Aetna Government |
$16.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.61
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.59
|
| Rate for Payer: EmblemHealth Commercial |
$16.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.77
|
| Rate for Payer: Group Health Inc Commercial |
$16.59
|
| Rate for Payer: Group Health Inc Medicare |
$16.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.59
|
| Rate for Payer: Healthfirst QHP |
$16.59
|
| Rate for Payer: Humana Medicare |
$16.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.59
|
| Rate for Payer: United Healthcare Commercial |
$21.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.93
|
|
|
HC ASSAY OF PRIMIDONE - PRIMIDONE LEVEL
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
3018018801
|
|
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 PROCAINAMIDE W METABOLITES - PROCAINAMIDE + NAPA
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
3018019201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.75
|
| Rate for Payer: Aetna Government |
$16.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.72
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.75
|
| Rate for Payer: EmblemHealth Commercial |
$16.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.91
|
| Rate for Payer: Group Health Inc Commercial |
$16.75
|
| Rate for Payer: Group Health Inc Medicare |
$16.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.75
|
| Rate for Payer: Healthfirst QHP |
$16.75
|
| Rate for Payer: Humana Medicare |
$17.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.75
|
| Rate for Payer: United Healthcare Commercial |
$21.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.91
|
| Rate for Payer: Wellcare Medicare |
$15.07
|
|
|
HC ASSAY OF PROCAINAMIDE W METABOLITES - PROCAINAMIDE + NAPA
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
3018019201
|
|
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 PROCALCITONIN - PROCALCITONIN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
|
|
HC ASSAY OF PROCALCITONIN - PROCALCITONIN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.22
|
| Rate for Payer: Aetna Government |
$27.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.05
|
| Rate for Payer: Brighton Health Commercial |
$51.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.22
|
| Rate for Payer: EmblemHealth Commercial |
$27.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.23
|
| Rate for Payer: Group Health Inc Commercial |
$27.22
|
| Rate for Payer: Group Health Inc Medicare |
$27.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.22
|
| Rate for Payer: Healthfirst QHP |
$27.22
|
| Rate for Payer: Humana Medicare |
$27.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.86
|
| Rate for Payer: Wellcare Medicare |
$24.50
|
|
|
HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
3018349801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
|
|
HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
3018349801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.17
|
| Rate for Payer: Aetna Government |
$27.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.02
|
| Rate for Payer: Brighton Health Commercial |
$51.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.17
|
| Rate for Payer: EmblemHealth Commercial |
$27.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.18
|
| Rate for Payer: Group Health Inc Commercial |
$27.17
|
| Rate for Payer: Group Health Inc Medicare |
$27.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.17
|
| Rate for Payer: Healthfirst Essential Plan |
$61.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.17
|
| Rate for Payer: Healthfirst QHP |
$27.17
|
| Rate for Payer: Humana Medicare |
$27.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.17
|
| Rate for Payer: United Healthcare Commercial |
$34.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.17
|
| Rate for Payer: Wellcare Medicare |
$24.45
|
|
|
HC ASSAY OF PROGESTERONE - PROGESTERONE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
3018414401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC ASSAY OF PROGESTERONE - PROGESTERONE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
3018414401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$46.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.86
|
| Rate for Payer: Aetna Government |
$20.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.60
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.86
|
| Rate for Payer: EmblemHealth Commercial |
$20.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.57
|
| Rate for Payer: Group Health Inc Commercial |
$20.86
|
| Rate for Payer: Group Health Inc Medicare |
$20.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Healthfirst Essential Plan |
$46.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.86
|
| Rate for Payer: Healthfirst QHP |
$20.86
|
| Rate for Payer: Humana Medicare |
$21.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.86
|
| Rate for Payer: United Healthcare Commercial |
$26.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$18.77
|
|
|
HC ASSAY OF PROINSULIN - PROINSULIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
3018420601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
|
|
HC ASSAY OF PROINSULIN - PROINSULIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
3018420601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.69
|
| Rate for Payer: Aetna Government |
$26.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.68
|
| Rate for Payer: Brighton Health Commercial |
$49.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.69
|
| Rate for Payer: EmblemHealth Commercial |
$26.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.75
|
| Rate for Payer: Group Health Inc Commercial |
$26.69
|
| Rate for Payer: Group Health Inc Medicare |
$26.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.69
|
| Rate for Payer: Healthfirst QHP |
$26.69
|
| Rate for Payer: Humana Medicare |
$27.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.69
|
| Rate for Payer: United Healthcare Commercial |
$22.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.36
|
| Rate for Payer: Wellcare Medicare |
$24.02
|
|
|
HC ASSAY OF PROLACTIN - PROLACTIN
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
3018414601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$43.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.38
|
| Rate for Payer: Aetna Government |
$19.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.57
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.38
|
| Rate for Payer: EmblemHealth Commercial |
$19.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.25
|
| Rate for Payer: Group Health Inc Commercial |
$19.38
|
| Rate for Payer: Group Health Inc Medicare |
$19.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.38
|
| Rate for Payer: Healthfirst Essential Plan |
$43.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.38
|
| Rate for Payer: Healthfirst QHP |
$19.38
|
| Rate for Payer: Humana Medicare |
$19.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.38
|
| Rate for Payer: United Healthcare Commercial |
$24.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.38
|
| Rate for Payer: Wellcare Medicare |
$17.44
|
|
|
HC ASSAY OF PROLACTIN - PROLACTIN
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
3018414601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC ASSAY OF RENIN - RENIN DIRECT ASSAY
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
3018424401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.99
|
| Rate for Payer: Aetna Government |
$21.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.39
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.99
|
| Rate for Payer: EmblemHealth Commercial |
$21.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.57
|
| Rate for Payer: Group Health Inc Commercial |
$21.99
|
| Rate for Payer: Group Health Inc Medicare |
$21.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.99
|
| Rate for Payer: Healthfirst QHP |
$21.99
|
| Rate for Payer: Humana Medicare |
$22.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.89
|
| Rate for Payer: Wellcare Medicare |
$19.79
|
|
|
HC ASSAY OF RENIN - RENIN DIRECT ASSAY
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
3018424401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.00
|
|
|
HC ASSAY OF SELENIUM - SELENIUM SERUM
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
3018425501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.53
|
| Rate for Payer: Aetna Government |
$25.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.87
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.53
|
| Rate for Payer: EmblemHealth Commercial |
$25.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.72
|
| Rate for Payer: Group Health Inc Commercial |
$25.53
|
| Rate for Payer: Group Health Inc Medicare |
$25.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.53
|
| Rate for Payer: Healthfirst QHP |
$25.53
|
| Rate for Payer: Humana Medicare |
$26.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.53
|
| Rate for Payer: United Healthcare Commercial |
$32.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.25
|
| Rate for Payer: Wellcare Medicare |
$22.98
|
|
