|
HC DRUG TEST PRSMV CHEM ANLYZR - BENZODIAZEPINE URINE QUAL
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - CANNABINOID SCREEN, URINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - CANNABINOID SCREEN, URINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - COCAINE URINE QUAL
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - COCAINE URINE QUAL
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR- DRUG SCREEN 10 W/CONF, SERUM
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR- DRUG SCREEN 10 W/CONF, SERUM
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - FLUNITRAZEPAM SCREEN URINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - FLUNITRAZEPAM SCREEN URINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - METHADONE SCREEN, URINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - METHADONE SCREEN, URINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - OPIATE QUALITATIVE URINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - OPIATE QUALITATIVE URINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - OXYCODONE SCREEN URINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - OXYCODONE SCREEN URINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - PHENCYCLIDINE (PCP) SCREEN UR
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - PHENCYCLIDINE (PCP) SCREEN UR
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - POCT AMPHETAMINES
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - POCT AMPHETAMINES
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - POCT BARBITURATES
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.14
|
| Rate for Payer: Aetna Government |
$62.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$62.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.63
|
| Rate for Payer: Amida Care Medicaid |
$27.63
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.14
|
| Rate for Payer: EmblemHealth Commercial |
$62.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.01
|
| Rate for Payer: Group Health Inc Commercial |
$62.14
|
| Rate for Payer: Group Health Inc Medicare |
$62.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Healthfirst Essential Plan |
$62.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.14
|
| Rate for Payer: Healthfirst QHP |
$45.04
|
| Rate for Payer: Humana Medicare |
$63.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.63
|
| Rate for Payer: SOMOS Essential |
$62.17
|
| Rate for Payer: United Healthcare Commercial |
$71.83
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$30.40
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.63
|
| Rate for Payer: Wellcare Medicare |
$55.93
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - POCT BARBITURATES
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
3018030709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC DRUG TEST PRSMV DIR OPT OBS - RAPID DRUG SCREEN, URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
3018030502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.60
|
| Rate for Payer: Aetna Government |
$12.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$34.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$34.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.55
|
| Rate for Payer: Amida Care Medicaid |
$15.55
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.60
|
| Rate for Payer: EmblemHealth Commercial |
$12.60
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$34.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$15.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.33
|
| Rate for Payer: Group Health Inc Commercial |
$12.60
|
| Rate for Payer: Group Health Inc Medicare |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.55
|
| Rate for Payer: Healthfirst Essential Plan |
$34.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.60
|
| Rate for Payer: Healthfirst QHP |
$25.35
|
| Rate for Payer: Humana Medicare |
$12.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.55
|
| Rate for Payer: SOMOS Essential |
$34.99
|
| Rate for Payer: United Healthcare Commercial |
$13.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$34.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.11
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.55
|
| Rate for Payer: Wellcare Medicare |
$11.34
|
|
|
HC DRUG TEST PRSMV DIR OPT OBS - RAPID DRUG SCREEN, URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
3018030502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.00
|
|
|
HC DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$310.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$262.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.35
|
| Rate for Payer: Aetna Government |
$93.35
|
| Rate for Payer: Brighton Health Commercial |
$286.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$239.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$274.85
|
| Rate for Payer: EmblemHealth Commercial |
$239.00
|
| Rate for Payer: Group Health Inc Commercial |
$239.00
|
| Rate for Payer: Group Health Inc Medicare |
$167.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.70
|
|
