|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3018020201
|
|
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 VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.94
|
| Rate for Payer: Aetna Government |
$33.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.76
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.94
|
| Rate for Payer: EmblemHealth Commercial |
$33.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.21
|
| Rate for Payer: Group Health Inc Commercial |
$33.94
|
| Rate for Payer: Group Health Inc Medicare |
$33.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.94
|
| Rate for Payer: Healthfirst Essential Plan |
$76.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.94
|
| Rate for Payer: Healthfirst QHP |
$33.94
|
| Rate for Payer: Humana Medicare |
$34.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.94
|
| Rate for Payer: United Healthcare Commercial |
$42.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.94
|
| Rate for Payer: Wellcare Medicare |
$30.55
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.00
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.33
|
| Rate for Payer: Aetna Government |
$35.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.73
|
| Rate for Payer: Brighton Health Commercial |
$66.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.33
|
| Rate for Payer: EmblemHealth Commercial |
$35.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.44
|
| Rate for Payer: Group Health Inc Commercial |
$35.33
|
| Rate for Payer: Group Health Inc Medicare |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.33
|
| Rate for Payer: Healthfirst QHP |
$35.33
|
| Rate for Payer: Humana Medicare |
$36.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$44.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.56
|
| Rate for Payer: Wellcare Medicare |
$31.80
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
3018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.61
|
| Rate for Payer: Aetna Government |
$11.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.13
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.61
|
| Rate for Payer: EmblemHealth Commercial |
$11.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.33
|
| Rate for Payer: Group Health Inc Commercial |
$11.61
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Healthfirst Essential Plan |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.61
|
| Rate for Payer: Healthfirst QHP |
$11.61
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Wellcare Medicare |
$10.45
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
3018459001
|
|
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 VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.23
|
| Rate for Payer: Aetna Government |
$21.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.86
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.23
|
| Rate for Payer: EmblemHealth Commercial |
$21.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.89
|
| Rate for Payer: Group Health Inc Commercial |
$21.23
|
| Rate for Payer: Group Health Inc Medicare |
$21.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.15
|
| Rate for Payer: Healthfirst Essential Plan |
$34.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.23
|
| Rate for Payer: Healthfirst QHP |
$21.23
|
| Rate for Payer: Humana Medicare |
$21.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare Commercial |
$26.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.15
|
| Rate for Payer: Wellcare Medicare |
$19.11
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC ASSAY OF VITAMIN B-6 - VITAMIN B6
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
3018420701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.10
|
| Rate for Payer: Aetna Government |
$28.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.67
|
| Rate for Payer: Brighton Health Commercial |
$58.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$28.10
|
| Rate for Payer: EmblemHealth Commercial |
$28.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.01
|
| Rate for Payer: Group Health Inc Commercial |
$28.10
|
| Rate for Payer: Group Health Inc Medicare |
$28.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.10
|
| Rate for Payer: Healthfirst Essential Plan |
$63.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.10
|
| Rate for Payer: Healthfirst QHP |
$28.10
|
| Rate for Payer: Humana Medicare |
$28.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.10
|
| Rate for Payer: United Healthcare Commercial |
$35.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.10
|
| Rate for Payer: Wellcare Medicare |
$25.29
|
|
|
HC ASSAY OF VITAMIN B-6 - VITAMIN B6
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
3018420701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
|
|
HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
3018444601
|
|
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 VITAMIN E - VITAMIN E (TOCOPHEROL)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
3018444601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$31.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.93
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.18
|
| Rate for Payer: EmblemHealth Commercial |
$14.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.62
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.18
|
| Rate for Payer: Healthfirst Essential Plan |
$31.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.18
|
| Rate for Payer: Healthfirst QHP |
$14.18
|
| Rate for Payer: Humana Medicare |
$14.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$17.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.18
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.60
|
| Rate for Payer: Aetna Government |
$29.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.72
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.60
|
| Rate for Payer: EmblemHealth Commercial |
$29.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.34
|
| Rate for Payer: Group Health Inc Commercial |
$29.60
|
| Rate for Payer: Group Health Inc Medicare |
$29.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.60
|
| Rate for Payer: Healthfirst Essential Plan |
$66.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.60
|
| Rate for Payer: Healthfirst QHP |
$29.60
|
| Rate for Payer: Humana Medicare |
$30.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$37.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.60
|
| Rate for Payer: Wellcare Medicare |
$26.64
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
|
|
HC ASSAY OF VOLATILES - VOLATILE COMPOUNDS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84600
|
| Hospital Charge Code |
3018460001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.11
|
| Rate for Payer: Aetna Government |
$17.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.98
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.11
|
| 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 |
$17.11
|
| Rate for Payer: EmblemHealth Commercial |
$17.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.23
|
| Rate for Payer: Group Health Inc Commercial |
$17.11
|
| Rate for Payer: Group Health Inc Medicare |
$17.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.11
|
| Rate for Payer: Healthfirst QHP |
$17.11
|
| Rate for Payer: Humana Medicare |
$17.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.11
|
| Rate for Payer: United Healthcare Commercial |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.25
|
| Rate for Payer: Wellcare Medicare |
$15.40
|
|
|
HC ASSAY OF VOLATILES - VOLATILE COMPOUNDS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84600
|
| Hospital Charge Code |
3018460001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ASSAY OF ZINC - ZINC
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3018463001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.97
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.39
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.14
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.98
|
| Rate for Payer: Healthfirst Essential Plan |
$17.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.39
|
| Rate for Payer: Healthfirst QHP |
$11.39
|
| Rate for Payer: Humana Medicare |
$11.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.98
|
| Rate for Payer: Wellcare Medicare |
$10.25
|
|
|
HC ASSAY OF ZINC - ZINC
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3018463001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC ASSAY OF ZINC - ZINC, WHOLE BLOOD
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3018463002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.97
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.39
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.14
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.98
|
| Rate for Payer: Healthfirst Essential Plan |
$17.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.39
|
| Rate for Payer: Healthfirst QHP |
$11.39
|
| Rate for Payer: Humana Medicare |
$11.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.98
|
| Rate for Payer: Wellcare Medicare |
$10.25
|
|
|
HC ASSAY OF ZINC - ZINC, WHOLE BLOOD
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3018463002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC ASSAY ORGANIC ACIDS QUALITATIVE - ORGANIC ACID ANALYSIS
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
3018391901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.45
|
| Rate for Payer: Aetna Government |
$16.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.45
|
| Rate for Payer: EmblemHealth Commercial |
$16.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.64
|
| Rate for Payer: Group Health Inc Commercial |
$16.45
|
| Rate for Payer: Group Health Inc Medicare |
$16.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.45
|
| Rate for Payer: Healthfirst Essential Plan |
$37.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.45
|
| Rate for Payer: Healthfirst QHP |
$16.45
|
| Rate for Payer: Humana Medicare |
$16.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.45
|
| Rate for Payer: United Healthcare Commercial |
$20.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.45
|
| Rate for Payer: Wellcare Medicare |
$14.80
|
|
|
HC ASSAY ORGANIC ACIDS QUALITATIVE - ORGANIC ACID ANALYSIS
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
3018391901
|
|
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 OTHER FLUID CHLORIDES - ADDITIONAL CHARGE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
3018243804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.00
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.45
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.00
|
| Rate for Payer: Healthfirst Essential Plan |
$11.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.00
|
| Rate for Payer: Healthfirst QHP |
$5.00
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.00
|
| Rate for Payer: Wellcare Medicare |
$4.50
|
|
|
HC ASSAY OTHER FLUID CHLORIDES - ADDITIONAL CHARGE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
3018243804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
