|
HC ASSAY OF SELENIUM - SELENIUM SERUM
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
3018425501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
|
|
HC ASSAY OF SEROTONIN - SEROTONIN SERUM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
3018426001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.98
|
| Rate for Payer: Aetna Government |
$30.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.69
|
| Rate for Payer: Brighton Health Commercial |
$57.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.98
|
| Rate for Payer: EmblemHealth Commercial |
$30.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.57
|
| Rate for Payer: Group Health Inc Commercial |
$30.98
|
| Rate for Payer: Group Health Inc Medicare |
$30.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.98
|
| Rate for Payer: Healthfirst QHP |
$30.98
|
| Rate for Payer: Humana Medicare |
$31.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.98
|
| Rate for Payer: United Healthcare Commercial |
$39.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.43
|
| Rate for Payer: Wellcare Medicare |
$27.88
|
|
|
HC ASSAY OF SEROTONIN - SEROTONIN SERUM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
3018426001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna Government |
$4.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.46
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.95
|
| Rate for Payer: EmblemHealth Commercial |
$4.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.41
|
| Rate for Payer: Group Health Inc Commercial |
$4.95
|
| Rate for Payer: Group Health Inc Medicare |
$4.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.95
|
| Rate for Payer: Healthfirst Essential Plan |
$11.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.95
|
| Rate for Payer: Healthfirst QHP |
$4.95
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.95
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY OF SERUM POTASSIUM - POTASSIUM
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
3018413201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.76
|
| Rate for Payer: Aetna Government |
$4.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.33
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.76
|
| Rate for Payer: EmblemHealth Commercial |
$4.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.24
|
| Rate for Payer: Group Health Inc Commercial |
$4.76
|
| Rate for Payer: Group Health Inc Medicare |
$4.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.76
|
| Rate for Payer: Healthfirst Essential Plan |
$10.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.76
|
| Rate for Payer: Healthfirst QHP |
$4.76
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.76
|
| Rate for Payer: United Healthcare Commercial |
$5.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.76
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
|
|
HC ASSAY OF SERUM POTASSIUM - POTASSIUM
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
3018413201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC ASSAY OF SERUM SODIUM - SODIUM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
3018429501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY OF SERUM SODIUM - SODIUM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
3018429501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$10.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.81
|
| Rate for Payer: Aetna Government |
$4.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.37
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.81
|
| Rate for Payer: EmblemHealth Commercial |
$4.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Group Health Inc Commercial |
$4.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.81
|
| Rate for Payer: Healthfirst Essential Plan |
$10.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.81
|
| Rate for Payer: Healthfirst QHP |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.81
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.81
|
| Rate for Payer: Wellcare Medicare |
$4.33
|
|
|
HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3018427001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.73
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.64
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
|
|
HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3018427001
|
|
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 SEX HORMONE BINDING GLOBULIN - TESTOSTERONE, BIOAVAILABLE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3018427002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.73
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.64
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
|
|
HC ASSAY OF SEX HORMONE BINDING GLOBULIN - TESTOSTERONE, BIOAVAILABLE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3018427002
|
|
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 SIALIC ACID - LIPID ASSOCIATED SIALIC ACID (LASA)
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 84275
|
| Hospital Charge Code |
3018427501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.44
|
| Rate for Payer: Aetna Government |
$13.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.41
|
| Rate for Payer: Brighton Health Commercial |
$50.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.44
|
| Rate for Payer: EmblemHealth Commercial |
$13.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.96
|
| Rate for Payer: Group Health Inc Commercial |
$13.44
|
| Rate for Payer: Group Health Inc Medicare |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Healthfirst Essential Plan |
$30.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.44
|
| Rate for Payer: Healthfirst QHP |
$13.44
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$17.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Wellcare Medicare |
$12.10
|
|
|
HC ASSAY OF SIALIC ACID - LIPID ASSOCIATED SIALIC ACID (LASA)
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 84275
|
| Hospital Charge Code |
3018427501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.50
|
|
|
HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM BODY FLUID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
3018430201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM BODY FLUID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
3018430201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.86
|
| Rate for Payer: Aetna Government |
$4.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$4.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.33
|
| Rate for Payer: Group Health Inc Commercial |
$4.86
|
| Rate for Payer: Group Health Inc Medicare |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.86
|
| Rate for Payer: Healthfirst Essential Plan |
$10.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.86
|
| Rate for Payer: Healthfirst QHP |
$4.86
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.86
|
| Rate for Payer: United Healthcare Commercial |
$6.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.86
|
| Rate for Payer: Wellcare Medicare |
$4.37
|
|
|
HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM STOOL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
3018430202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.86
|
| Rate for Payer: Aetna Government |
$4.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$4.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.33
|
| Rate for Payer: Group Health Inc Commercial |
$4.86
|
| Rate for Payer: Group Health Inc Medicare |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.86
|
| Rate for Payer: Healthfirst Essential Plan |
$10.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.86
|
| Rate for Payer: Healthfirst QHP |
$4.86
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.86
|
| Rate for Payer: United Healthcare Commercial |
$6.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.86
|
| Rate for Payer: Wellcare Medicare |
$4.37
|
|
|
HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM STOOL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
3018430202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
3018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.50
|
|
|
HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
3018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$46.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.26
|
| Rate for Payer: Aetna Government |
$21.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.88
|
| Rate for Payer: Brighton Health Commercial |
$39.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.26
|
| Rate for Payer: EmblemHealth Commercial |
$21.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.92
|
| Rate for Payer: Group Health Inc Commercial |
$21.26
|
| Rate for Payer: Group Health Inc Medicare |
$21.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.71
|
| Rate for Payer: Healthfirst Essential Plan |
$46.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.26
|
| Rate for Payer: Healthfirst QHP |
$21.26
|
| Rate for Payer: Humana Medicare |
$21.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.71
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
|
|
HC ASSAY OF TACROLIMUS - TACROLIMUS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
3018019701
|
|
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 TACROLIMUS - TACROLIMUS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
3018019701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.73
|
| Rate for Payer: Aetna Government |
$13.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.61
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.73
|
| Rate for Payer: EmblemHealth Commercial |
$13.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.22
|
| Rate for Payer: Group Health Inc Commercial |
$13.73
|
| Rate for Payer: Group Health Inc Medicare |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.73
|
| Rate for Payer: Healthfirst QHP |
$13.73
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare Commercial |
$17.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.36
|
|
|
HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
|
|
HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$57.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.47
|
| Rate for Payer: Aetna Government |
$25.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.83
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.83
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.83
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.47
|
| Rate for Payer: EmblemHealth Commercial |
$25.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$25.47
|
| Rate for Payer: Group Health Inc Medicare |
$25.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.47
|
| Rate for Payer: Healthfirst Essential Plan |
$57.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.47
|
| Rate for Payer: Healthfirst QHP |
$25.47
|
| Rate for Payer: Humana Medicare |
$25.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$32.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.47
|
| Rate for Payer: Wellcare Medicare |
$22.92
|
|
