|
HC ASSAY OTHER FLUID CHLORIDES - CHLORIDE BODY FLUID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
3018243801
|
|
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 - CHLORIDE BODY FLUID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
3018243801
|
|
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 QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE FASTING
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE FASTING
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3018294705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - POCT GLUCOMETER
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82947 QW
|
| Hospital Charge Code |
3018294701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - POCT GLUCOMETER
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82947 QW
|
| Hospital Charge Code |
3018294701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC ASSAY RBC PROTOPORPHYRIN - ZINC PROTOPORPHYRIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
3018420202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.35
|
| Rate for Payer: Aetna Government |
$14.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.04
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.35
|
| Rate for Payer: EmblemHealth Commercial |
$14.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$14.35
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Essential Plan |
$20.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.35
|
| Rate for Payer: Healthfirst QHP |
$14.35
|
| Rate for Payer: Humana Medicare |
$14.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.35
|
| Rate for Payer: United Healthcare Commercial |
$18.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$12.91
|
|
|
HC ASSAY RBC PROTOPORPHYRIN - ZINC PROTOPORPHYRIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
3018420202
|
|
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 SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
3018392101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$47.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.21
|
| Rate for Payer: Aetna Government |
$21.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.85
|
| Rate for Payer: Brighton Health Commercial |
$39.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.21
|
| 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 |
$21.21
|
| Rate for Payer: EmblemHealth Commercial |
$21.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.88
|
| Rate for Payer: Group Health Inc Commercial |
$21.21
|
| Rate for Payer: Group Health Inc Medicare |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.21
|
| Rate for Payer: Healthfirst Essential Plan |
$47.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$21.21
|
| Rate for Payer: Humana Medicare |
$21.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.21
|
| Rate for Payer: United Healthcare Commercial |
$20.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.21
|
| Rate for Payer: Wellcare Medicare |
$19.09
|
|
|
HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
3018392101
|
|
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, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3018238401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.68
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Healthfirst Essential Plan |
$41.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Humana Medicare |
$25.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$31.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Wellcare Medicare |
$22.73
|
|
|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3018238401
|
|
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, THREE CATECHOLAMINES - CATECHOLAMINE PLASMA
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3018238402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.68
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Healthfirst Essential Plan |
$41.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Humana Medicare |
$25.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$31.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Wellcare Medicare |
$22.73
|
|
|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE PLASMA
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3018238402
|
|
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 THYROID STIM HORMONE - POCT THYROID STIMULATING HORMONE (TSH)
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
3018444302
|
|
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 THYROID STIM HORMONE - POCT THYROID STIMULATING HORMONE (TSH)
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
3018444302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.76
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Essential Plan |
$20.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
3018444301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.76
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Essential Plan |
$20.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
3018444301
|
|
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 UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.95
|
| Rate for Payer: Aetna Government |
$3.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.77
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.95
|
| Rate for Payer: EmblemHealth Commercial |
$3.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.95
|
| Rate for Payer: Group Health Inc Medicare |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.95
|
| Rate for Payer: Healthfirst QHP |
$3.95
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.56
|
|
|
HC ASSAY UREA NITROGEN, QUAN - POST-DIALYSIS BUN (BLOOD UREA NITROGEN)
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3018452002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.95
|
| Rate for Payer: Aetna Government |
$3.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.77
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.95
|
| Rate for Payer: EmblemHealth Commercial |
$3.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.95
|
| Rate for Payer: Group Health Inc Medicare |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.95
|
| Rate for Payer: Healthfirst QHP |
$3.95
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.56
|
|
