|
HC ASSAY OF TESTOSTERONE - TOTAL FREE & WEAKLY BOUND
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3018440202
|
|
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 - TOTAL FREE & WEAKLY BOUND
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3018440202
|
|
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
|
|
|
HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
3018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
3018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.14
|
| Rate for Payer: Aetna Government |
$14.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.90
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.14
|
| Rate for Payer: EmblemHealth Commercial |
$14.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.58
|
| Rate for Payer: Group Health Inc Commercial |
$14.14
|
| Rate for Payer: Group Health Inc Medicare |
$14.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.08
|
| Rate for Payer: Healthfirst Essential Plan |
$18.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.14
|
| Rate for Payer: Healthfirst QHP |
$14.14
|
| Rate for Payer: Humana Medicare |
$14.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare Commercial |
$17.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.08
|
| Rate for Payer: Wellcare Medicare |
$12.73
|
|
|
HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3018443201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.06
|
| Rate for Payer: Aetna Government |
$16.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.24
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.06
|
| Rate for Payer: EmblemHealth Commercial |
$16.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.29
|
| Rate for Payer: Group Health Inc Commercial |
$16.06
|
| Rate for Payer: Group Health Inc Medicare |
$16.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.06
|
| Rate for Payer: Healthfirst QHP |
$16.06
|
| Rate for Payer: Humana Medicare |
$16.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare Commercial |
$20.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.26
|
| Rate for Payer: Wellcare Medicare |
$14.45
|
|
|
HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3018443201
|
|
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 THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
3018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.86
|
| Rate for Payer: Aetna Government |
$50.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.60
|
| Rate for Payer: Brighton Health Commercial |
$95.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$50.86
|
| Rate for Payer: EmblemHealth Commercial |
$50.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.27
|
| Rate for Payer: Group Health Inc Commercial |
$50.86
|
| Rate for Payer: Group Health Inc Medicare |
$50.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.86
|
| Rate for Payer: Healthfirst QHP |
$50.86
|
| Rate for Payer: Humana Medicare |
$51.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.86
|
| Rate for Payer: United Healthcare Commercial |
$64.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.32
|
| Rate for Payer: Wellcare Medicare |
$45.77
|
|
|
HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
3018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.50
|
|
|
HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
3018444201
|
|
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 THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
3018444201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.78
|
| Rate for Payer: Aetna Government |
$14.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.35
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.78
|
| Rate for Payer: EmblemHealth Commercial |
$14.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Group Health Inc Commercial |
$14.78
|
| Rate for Payer: Group Health Inc Medicare |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Essential Plan |
$20.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.78
|
| Rate for Payer: Healthfirst QHP |
$14.78
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
|
|
HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN RANDOM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
3018020002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
| Rate for Payer: Aetna Government |
$16.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.29
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.13
|
| Rate for Payer: EmblemHealth Commercial |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.36
|
| Rate for Payer: Group Health Inc Commercial |
$16.13
|
| Rate for Payer: Group Health Inc Medicare |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.13
|
| Rate for Payer: Healthfirst QHP |
$16.13
|
| Rate for Payer: Humana Medicare |
$16.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.13
|
| Rate for Payer: United Healthcare Commercial |
$20.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.52
|
|
|
HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN RANDOM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
3018020002
|
|
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 TOBRAMYCIN - TOBRAMYCIN TROUGH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
3018020003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
| Rate for Payer: Aetna Government |
$16.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.29
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.13
|
| Rate for Payer: EmblemHealth Commercial |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.36
|
| Rate for Payer: Group Health Inc Commercial |
$16.13
|
| Rate for Payer: Group Health Inc Medicare |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.13
|
| Rate for Payer: Healthfirst QHP |
$16.13
|
| Rate for Payer: Humana Medicare |
$16.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.13
|
| Rate for Payer: United Healthcare Commercial |
$20.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$14.52
|
|
|
HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN TROUGH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
3018020003
|
|
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 TOPIRAMATE - TOPIRAMATE LEVEL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
3018020101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC ASSAY OF TOPIRAMATE - TOPIRAMATE LEVEL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
3018020101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.92
|
| Rate for Payer: Aetna Government |
$11.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.34
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.92
|
| Rate for Payer: EmblemHealth Commercial |
$11.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$11.92
|
| Rate for Payer: Group Health Inc Medicare |
$11.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.92
|
| Rate for Payer: Healthfirst QHP |
$11.92
|
| Rate for Payer: Humana Medicare |
$12.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$15.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.32
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
|
|
HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
3018440301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$58.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.81
|
| Rate for Payer: Aetna Government |
$25.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.07
|
| Rate for Payer: Brighton Health Commercial |
$48.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.81
|
| Rate for Payer: EmblemHealth Commercial |
$25.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.97
|
| Rate for Payer: Group Health Inc Commercial |
$25.81
|
| Rate for Payer: Group Health Inc Medicare |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.81
|
| Rate for Payer: Healthfirst Essential Plan |
$58.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.81
|
| Rate for Payer: Healthfirst QHP |
$25.81
|
| Rate for Payer: Humana Medicare |
$26.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.81
|
| Rate for Payer: Wellcare Medicare |
$23.23
|
|
|
HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
3018440301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.00
|
|
|
HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
3018443601
|
|
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 TOTAL THYROXINE - T4 (THYROID HORMONE)
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
3018443601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.87
|
| Rate for Payer: Aetna Government |
$6.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.81
|
| Rate for Payer: Brighton Health Commercial |
$12.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.87
|
| Rate for Payer: EmblemHealth Commercial |
$6.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.11
|
| Rate for Payer: Group Health Inc Commercial |
$6.87
|
| Rate for Payer: Group Health Inc Medicare |
$6.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Healthfirst Essential Plan |
$12.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.87
|
| Rate for Payer: Healthfirst QHP |
$6.87
|
| Rate for Payer: Humana Medicare |
$7.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$8.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.76
|
| Rate for Payer: Wellcare Medicare |
$6.18
|
|
|
HC ASSAY OF TRANSFERRIN - TRANSFERRIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
3018446601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.93
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.76
|
| Rate for Payer: EmblemHealth Commercial |
$12.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.36
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.76
|
| Rate for Payer: Healthfirst QHP |
$12.76
|
| Rate for Payer: Humana Medicare |
$13.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$16.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$11.48
|
|
|
HC ASSAY OF TRANSFERRIN - TRANSFERRIN
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
3018446601
|
|
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 TRIGLYCERIDES - POCT TRIGLYCERIDE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3018447803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC ASSAY OF TRIGLYCERIDES - POCT TRIGLYCERIDE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3018447803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.02
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.74
|
| Rate for Payer: EmblemHealth Commercial |
$5.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.74
|
| Rate for Payer: Healthfirst QHP |
$5.74
|
| Rate for Payer: Humana Medicare |
$5.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare Commercial |
$7.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.17
|
|
|
HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3018447801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
