|
HC ASSAY OF URINE CREATININE - METANEPHRINES, PHEOCHROMOCYTE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3018257005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
HC ASSAY OF URINE CREATININE - METANEPHRINES, PHEOCHROMOCYTE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3018257005
|
|
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 URINE OSMOLALITY - OSMOLALITY URINE
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
3018393501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$13.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.82
|
| Rate for Payer: Aetna Government |
$6.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.77
|
| Rate for Payer: Brighton Health Commercial |
$12.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.82
|
| Rate for Payer: EmblemHealth Commercial |
$6.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.07
|
| Rate for Payer: Group Health Inc Commercial |
$6.82
|
| Rate for Payer: Group Health Inc Medicare |
$6.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.10
|
| Rate for Payer: Healthfirst Essential Plan |
$13.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.82
|
| Rate for Payer: Healthfirst QHP |
$6.82
|
| Rate for Payer: Humana Medicare |
$6.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.82
|
| Rate for Payer: United Healthcare Commercial |
$8.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.10
|
| Rate for Payer: Wellcare Medicare |
$6.14
|
|
|
HC ASSAY OF URINE OSMOLALITY - OSMOLALITY URINE
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
3018393501
|
|
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 URINE PHOSPHORUS - PHOSPHORUS RANDOM URINE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3018410501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.78
|
| Rate for Payer: Aetna Government |
$5.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.05
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.78
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: Humana Medicare |
$5.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
|
|
HC ASSAY OF URINE PHOSPHORUS - PHOSPHORUS RANDOM URINE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3018410501
|
|
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 URINE PHOSPHORUS - PHOSPHORUS TIMED URINE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3018410503
|
|
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 URINE PHOSPHORUS - PHOSPHORUS TIMED URINE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3018410503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.78
|
| Rate for Payer: Aetna Government |
$5.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.05
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.78
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: Humana Medicare |
$5.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
|
|
HC ASSAY OF URINE POTASSIUM - POTASSIUM 24 HOUR URINE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3018413305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.73
|
| Rate for Payer: Aetna Government |
$4.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.31
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$4.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.21
|
| Rate for Payer: Group Health Inc Commercial |
$4.73
|
| Rate for Payer: Group Health Inc Medicare |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.73
|
| Rate for Payer: Healthfirst Essential Plan |
$10.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.73
|
| Rate for Payer: Healthfirst QHP |
$4.73
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.73
|
| Rate for Payer: Wellcare Medicare |
$4.26
|
|
|
HC ASSAY OF URINE POTASSIUM - POTASSIUM 24 HOUR URINE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3018413305
|
|
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 URINE POTASSIUM - POTASSIUM RANDOM URINE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3018413303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.73
|
| Rate for Payer: Aetna Government |
$4.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.31
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$4.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.21
|
| Rate for Payer: Group Health Inc Commercial |
$4.73
|
| Rate for Payer: Group Health Inc Medicare |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.73
|
| Rate for Payer: Healthfirst Essential Plan |
$10.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.73
|
| Rate for Payer: Healthfirst QHP |
$4.73
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.73
|
| Rate for Payer: Wellcare Medicare |
$4.26
|
|
|
HC ASSAY OF URINE POTASSIUM - POTASSIUM RANDOM URINE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3018413303
|
|
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 URINE SODIUM - SODIUM 24 HOUR URINE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3018430003
|
|
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 URINE SODIUM - SODIUM 24 HOUR URINE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3018430003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.06
|
| Rate for Payer: Aetna Government |
$5.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.06
|
| 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 |
$5.06
|
| Rate for Payer: EmblemHealth Commercial |
$5.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.50
|
| Rate for Payer: Group Health Inc Commercial |
$5.06
|
| Rate for Payer: Group Health Inc Medicare |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.03
|
| Rate for Payer: Healthfirst Essential Plan |
$11.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.06
|
| Rate for Payer: Healthfirst QHP |
$5.06
|
| Rate for Payer: Humana Medicare |
$5.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$6.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.03
|
| Rate for Payer: Wellcare Medicare |
$4.55
|
|
|
HC ASSAY OF URINE SODIUM - SODIUM RANDOM URINE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3018430001
|
|
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 URINE SODIUM - SODIUM RANDOM URINE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3018430001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.06
|
| Rate for Payer: Aetna Government |
$5.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.06
|
| 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 |
$5.06
|
| Rate for Payer: EmblemHealth Commercial |
$5.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.50
|
| Rate for Payer: Group Health Inc Commercial |
$5.06
|
| Rate for Payer: Group Health Inc Medicare |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.03
|
| Rate for Payer: Healthfirst Essential Plan |
$11.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.06
|
| Rate for Payer: Healthfirst QHP |
$5.06
|
| Rate for Payer: Humana Medicare |
$5.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$6.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.03
|
| Rate for Payer: Wellcare Medicare |
$4.55
|
|
|
HC ASSAY OF URINE SULFATE - SULFATE, URINE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
3018439201
|
|
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 URINE SULFATE - SULFATE, URINE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
3018439201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.49
|
| Rate for Payer: Aetna Government |
$5.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$5.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.89
|
| Rate for Payer: Group Health Inc Commercial |
$5.49
|
| Rate for Payer: Group Health Inc Medicare |
$5.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.49
|
| Rate for Payer: Healthfirst QHP |
$5.49
|
| Rate for Payer: Humana Medicare |
$5.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$6.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Wellcare Medicare |
$4.94
|
|
|
HC ASSAY OF URINE VMA - VMA 24 HOUR URINE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
3018458501
|
|
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 URINE VMA - VMA 24 HOUR URINE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
3018458501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.50
|
| Rate for Payer: Aetna Government |
$15.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.85
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.50
|
| Rate for Payer: EmblemHealth Commercial |
$15.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.79
|
| Rate for Payer: Group Health Inc Commercial |
$15.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.50
|
| Rate for Payer: Healthfirst Essential Plan |
$34.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.50
|
| Rate for Payer: Healthfirst QHP |
$15.50
|
| Rate for Payer: Humana Medicare |
$15.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.50
|
| Rate for Payer: United Healthcare Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.50
|
| Rate for Payer: Wellcare Medicare |
$13.95
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020203
|
|
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 VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.54
|
| Rate for Payer: Aetna Government |
$13.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.54
|
| Rate for Payer: EmblemHealth Commercial |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$13.54
|
| Rate for Payer: Group Health Inc Medicare |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.54
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: Humana Medicare |
$13.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$17.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.19
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.54
|
| Rate for Payer: Aetna Government |
$13.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.54
|
| Rate for Payer: EmblemHealth Commercial |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$13.54
|
| Rate for Payer: Group Health Inc Medicare |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.54
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: Humana Medicare |
$13.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$17.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.19
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020202
|
|
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 VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.54
|
| Rate for Payer: Aetna Government |
$13.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.48
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.54
|
| Rate for Payer: EmblemHealth Commercial |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$13.54
|
| Rate for Payer: Group Health Inc Medicare |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.54
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: Humana Medicare |
$13.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$17.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.61
|
| Rate for Payer: Wellcare Medicare |
$12.19
|
|
