|
HC GLUCOSE BLOOD TEST WITH DEVICE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
3018296201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC GLUCOSE BLOOD TEST WITH DEVICE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
3018296201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.28
|
| Rate for Payer: Aetna Government |
$3.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.30
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.92
|
| Rate for Payer: Group Health Inc Commercial |
$3.28
|
| Rate for Payer: Group Health Inc Medicare |
$3.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.28
|
| Rate for Payer: Healthfirst QHP |
$3.28
|
| Rate for Payer: Humana Medicare |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.28
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.12
|
| Rate for Payer: Wellcare Medicare |
$2.95
|
|
|
HC GLUCOSE TEST - GTT 1 HOUR
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
3018295001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC GLUCOSE TEST - GTT 1 HOUR
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
3018295001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.75
|
| Rate for Payer: Aetna Government |
$4.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.33
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$4.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.23
|
| Rate for Payer: Group Health Inc Commercial |
$4.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.75
|
| Rate for Payer: Healthfirst Essential Plan |
$10.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.75
|
| Rate for Payer: Healthfirst QHP |
$4.75
|
| Rate for Payer: Humana Medicare |
$4.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare Commercial |
$6.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.75
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
|
|
HC GLUCOSE TEST - LTT 2 HR
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
3018295004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.75
|
| Rate for Payer: Aetna Government |
$4.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.33
|
| Rate for Payer: Brighton Health Commercial |
$8.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$4.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.23
|
| Rate for Payer: Group Health Inc Commercial |
$4.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.75
|
| Rate for Payer: Healthfirst Essential Plan |
$10.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.75
|
| Rate for Payer: Healthfirst QHP |
$4.75
|
| Rate for Payer: Humana Medicare |
$4.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare Commercial |
$6.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.75
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
|
|
HC GLUCOSE TEST - LTT 2 HR
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
3018295004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - BUNDLED CHARGE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
3018295102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - BUNDLED CHARGE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
3018295102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.91
|
| Rate for Payer: Healthfirst Essential Plan |
$15.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.91
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
3018295101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.91
|
| Rate for Payer: Healthfirst Essential Plan |
$15.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.91
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
3018295101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC GLYCATED PROTEIN - ALBUMIN, GLYCATED
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC GLYCATED PROTEIN - ALBUMIN, GLYCATED
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.76
|
| Rate for Payer: Aetna Government |
$16.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.73
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.92
|
| Rate for Payer: Group Health Inc Commercial |
$16.76
|
| Rate for Payer: Group Health Inc Medicare |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Healthfirst Essential Plan |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.76
|
| Rate for Payer: Healthfirst QHP |
$16.76
|
| Rate for Payer: Humana Medicare |
$17.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
HC GLYCATED PROTEIN - ALPHA-1-ACID GLYCOPROTEIN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.76
|
| Rate for Payer: Aetna Government |
$16.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.73
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.92
|
| Rate for Payer: Group Health Inc Commercial |
$16.76
|
| Rate for Payer: Group Health Inc Medicare |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Healthfirst Essential Plan |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.76
|
| Rate for Payer: Healthfirst QHP |
$16.76
|
| Rate for Payer: Humana Medicare |
$17.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
HC GLYCATED PROTEIN - ALPHA-1-ACID GLYCOPROTEIN
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC GLYCATED PROTEIN - FRUCTOSAMINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.76
|
| Rate for Payer: Aetna Government |
$16.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.73
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.92
|
| Rate for Payer: Group Health Inc Commercial |
$16.76
|
| Rate for Payer: Group Health Inc Medicare |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Healthfirst Essential Plan |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.76
|
| Rate for Payer: Healthfirst QHP |
$16.76
|
| Rate for Payer: Humana Medicare |
$17.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
HC GLYCATED PROTEIN - FRUCTOSAMINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC GLYCATED PROTEIN - POCT FRUCTOSAMINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.76
|
| Rate for Payer: Aetna Government |
$16.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.73
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.92
|
| Rate for Payer: Group Health Inc Commercial |
$16.76
|
| Rate for Payer: Group Health Inc Medicare |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Healthfirst Essential Plan |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.76
|
| Rate for Payer: Healthfirst QHP |
$16.76
|
| Rate for Payer: Humana Medicare |
$17.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
HC GLYCATED PROTEIN - POCT FRUCTOSAMINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3018298501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC GLYCOSYLATED HEMOGLOBIN, HOME DEVICE - POCT GLYCOSYLATED HEMOGLOBIN
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83037
|
| Hospital Charge Code |
3018303701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.71
|
| Rate for Payer: Aetna Government |
$9.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.80
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.71
|
| Rate for Payer: EmblemHealth Commercial |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.64
|
| Rate for Payer: Group Health Inc Commercial |
$9.71
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.71
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$8.74
|
|
|
HC GLYCOSYLATED HEMOGLOBIN, HOME DEVICE - POCT GLYCOSYLATED HEMOGLOBIN
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83037
|
| Hospital Charge Code |
3018303701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.71
|
| Rate for Payer: Aetna Government |
$9.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.80
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.71
|
| Rate for Payer: EmblemHealth Commercial |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.64
|
| Rate for Payer: Group Health Inc Commercial |
$9.71
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.71
|
| Rate for Payer: Healthfirst Essential Plan |
$21.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.71
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.71
|
| Rate for Payer: Wellcare Medicare |
$8.74
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - POCT GLYCATED HEMOGLOBIN, TOTAL
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83036 QW
|
| Hospital Charge Code |
3018303602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.71
|
| Rate for Payer: Aetna Government |
$9.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.80
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.71
|
| Rate for Payer: EmblemHealth Commercial |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.64
|
| Rate for Payer: Group Health Inc Commercial |
$9.71
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.71
|
| Rate for Payer: Healthfirst Essential Plan |
$21.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.71
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.71
|
| Rate for Payer: Wellcare Medicare |
$8.74
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - POCT GLYCATED HEMOGLOBIN, TOTAL
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83036 QW
|
| Hospital Charge Code |
3018303602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
|
|
HC GONADOTROPIN (FSH) - FSH
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
3018300101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.58
|
| Rate for Payer: Aetna Government |
$18.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.01
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$18.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.54
|
| Rate for Payer: Group Health Inc Commercial |
$18.58
|
| Rate for Payer: Group Health Inc Medicare |
$18.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Healthfirst Essential Plan |
$41.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.58
|
| Rate for Payer: Healthfirst QHP |
$18.58
|
| Rate for Payer: Humana Medicare |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$23.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Wellcare Medicare |
$16.72
|
|
