|
HC IMMUNOASSAY NONANTIBODY - SULFATE-3-GLUC.PARAG. AB IGM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAM AB IGA
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.95
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAM AB IGA
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGA
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.95
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGA
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGG
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.95
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGG
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3018351610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTI-HISTONE ANTIBODY
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTI-HISTONE ANTIBODY
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTIMYELOPEROXIDASE (MPO) ABS
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTIMYELOPEROXIDASE (MPO) ABS
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTIPROTEINASE 3 (PR-3) ABS
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - ANTIPROTEINASE 3 (PR-3) ABS
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - GD1B ANTIBODY IGG, IGM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - GD1B ANTIBODY IGG, IGM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - IGF-BP1
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - IGF-BP1
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - IGF-BP3
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - IGF-BP3
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - INHIBIN_B
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - INHIBIN_B
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - INTERLEUKIN-6, SERUM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - INTERLEUKIN-6, SERUM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - NMO IGG AUTOANTIBODIES
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC IMMUNOASSAY QUANT NOS NONAB - NMO IGG AUTOANTIBODIES
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3018352004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
