|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN 24 HOUR URINE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN 24 HOUR URINE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN / CREATININE RATIO, U
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN / CREATININE RATIO, U
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN RANDOM URINE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN RANDOM URINE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TIMED URINE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TIMED URINE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN, WESTERN BLOT TEST, W BAND ID - CYSTICERCOSIS ANTI, IGG WB
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
3018418201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC PROTEIN, WESTERN BLOT TEST, W BAND ID - CYSTICERCOSIS ANTI, IGG WB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
3018418201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.21
|
| Rate for Payer: Aetna Government |
$29.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.45
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.21
|
| Rate for Payer: EmblemHealth Commercial |
$29.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.00
|
| Rate for Payer: Group Health Inc Commercial |
$29.21
|
| Rate for Payer: Group Health Inc Medicare |
$29.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.21
|
| Rate for Payer: Healthfirst QHP |
$29.21
|
| Rate for Payer: Humana Medicare |
$29.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.21
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.75
|
| Rate for Payer: Wellcare Medicare |
$26.29
|
|
|
HC PROTHROMBIN TEST,SUBSTI,FRACTN - EQUAL MIX,PT/INR
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
3058561101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
|
|
HC PROTHROMBIN TEST,SUBSTI,FRACTN - EQUAL MIX,PT/INR
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
3058561101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.94
|
| Rate for Payer: Aetna Government |
$3.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.76
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.94
|
| Rate for Payer: EmblemHealth Commercial |
$3.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.94
|
| Rate for Payer: Group Health Inc Medicare |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.94
|
| Rate for Payer: Healthfirst QHP |
$3.94
|
| Rate for Payer: Humana Medicare |
$4.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.94
|
| Rate for Payer: United Healthcare Commercial |
$4.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.74
|
| Rate for Payer: Wellcare Medicare |
$3.55
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna Government |
$4.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.29
|
| Rate for Payer: Group Health Inc Medicare |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.29
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.86
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PROTHROMBIN TIME - ADDITIONAL CHARGE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561004
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna Government |
$4.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.29
|
| Rate for Payer: Group Health Inc Medicare |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.29
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.86
|
|
|
HC PROTHROMBIN TIME - ADDITIONAL CHARGE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561004
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PROTHROMBIN TIME - POCT INR
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna Government |
$4.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.29
|
| Rate for Payer: Group Health Inc Medicare |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.29
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.86
|
|
|
HC PROTHROMBIN TIME - POCT INR
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna Government |
$4.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.29
|
| Rate for Payer: Group Health Inc Medicare |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.29
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.86
|
|
|
HC PROTHROMBIN TIME - PROTIME-INR, FINGERSTICK
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna Government |
$4.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.29
|
| Rate for Payer: Group Health Inc Medicare |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Essential Plan |
$8.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.29
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Wellcare Medicare |
$3.86
|
|
|
HC PROTHROMBIN TIME - PROTIME-INR, FINGERSTICK
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3058561003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PROTOZOA, NOT ELSEWHERE - AMEBIASIS ANTIBODIES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3028675301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC PROTOZOA, NOT ELSEWHERE - AMEBIASIS ANTIBODIES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3028675301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.39
|
| Rate for Payer: Aetna Government |
$12.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.67
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.39
|
| Rate for Payer: EmblemHealth Commercial |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.03
|
| Rate for Payer: Group Health Inc Commercial |
$12.39
|
| Rate for Payer: Group Health Inc Medicare |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.39
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$15.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.77
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
|
|
HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3028675303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.39
|
| Rate for Payer: Aetna Government |
$12.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.67
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.39
|
| Rate for Payer: EmblemHealth Commercial |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.03
|
| Rate for Payer: Group Health Inc Commercial |
$12.39
|
| Rate for Payer: Group Health Inc Medicare |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.39
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$15.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.77
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
|
