|
HC PURE TONE AUDIOMETRY, AIR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
4719255201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC PURE TONE AUDIOMETRY, AIR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
4719255201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC PURE TONE HEARING TEST, AIR
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
4719255101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC PURE TONE HEARING TEST, AIR
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
4719255101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.97
|
| Rate for Payer: Aetna Government |
$10.97
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
|
|
HC Q FEVER ANTIBODY - Q FEVER ANTIBODY
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
3028663801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC Q FEVER ANTIBODY - Q FEVER ANTIBODY
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
3028663801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.12
|
| Rate for Payer: Aetna Government |
$12.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.12
|
| Rate for Payer: EmblemHealth Commercial |
$12.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.79
|
| Rate for Payer: Group Health Inc Commercial |
$12.12
|
| Rate for Payer: Group Health Inc Medicare |
$12.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.12
|
| Rate for Payer: Healthfirst QHP |
$12.12
|
| Rate for Payer: Humana Medicare |
$12.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare Commercial |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$10.91
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - AMIODARONE LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - AMIODARONE LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - ARGATROBAN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - ARGATROBAN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - CAFFEINE LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - CAFFEINE LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DABIGATRAN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DABIGATRAN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DIGITOXIN LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DIGITOXIN LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DIGITOXIN LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DIGITOXIN LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DISOPYRAMIDE LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - DISOPYRAMIDE LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - FELBAMATE LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029914
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - FELBAMATE LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029914
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - FLECAINIDE LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - FLECAINIDE LEVEL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - KANAMYCIN LEVEL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
