|
HC URETERAL REFLUX STUDY - NM CYSTOGRAM REFLUX
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78740 TC
|
| Hospital Charge Code |
3407874001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.80
|
| Rate for Payer: Aetna Government |
$130.80
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$579.04
|
| Rate for Payer: EmblemHealth Commercial |
$191.92
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.92
|
| Rate for Payer: Healthfirst Essential Plan |
$320.74
|
| Rate for Payer: United Healthcare Commercial |
$257.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$142.55
|
|
|
HC URETERAL REFLUX STUDY - NM CYSTOGRAM REFLUX
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78740 TC
|
| Hospital Charge Code |
3407874001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC URINALYSIS, AUTOMATED W/O SCOPE
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100303
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
HC URINALYSIS, AUTOMATED W/O SCOPE
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100303
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna Government |
$2.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.57
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$2.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.25
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$2.02
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100304
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna Government |
$2.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.57
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$2.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.25
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$2.02
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100304
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - POCT KETONE, URINE
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100302
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna Government |
$2.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.57
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$2.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.25
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$2.02
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - POCT KETONE, URINE
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3078100302
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - BUNDLED CHARGE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.17
|
| Rate for Payer: Aetna Government |
$3.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.22
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.17
|
| Rate for Payer: EmblemHealth Commercial |
$3.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.17
|
| Rate for Payer: Group Health Inc Medicare |
$3.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Healthfirst Essential Plan |
$7.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.17
|
| Rate for Payer: Healthfirst QHP |
$3.17
|
| Rate for Payer: Humana Medicare |
$3.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$2.85
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - BUNDLED CHARGE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.17
|
| Rate for Payer: Aetna Government |
$3.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.22
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.17
|
| Rate for Payer: EmblemHealth Commercial |
$3.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.17
|
| Rate for Payer: Group Health Inc Medicare |
$3.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Healthfirst Essential Plan |
$7.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.17
|
| Rate for Payer: Healthfirst QHP |
$3.17
|
| Rate for Payer: Humana Medicare |
$3.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$2.85
|
|
|
HC URINALYSIS NONAUTOMATED W/O SCOPE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100213
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTOMATED W/O SCOPE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100213
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100214
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100214
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT ASCORBIC ACID, URINE, QUAL, DIP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT ASCORBIC ACID, URINE, QUAL, DIP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT BILIRUBIN, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100202
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT BILIRUBIN, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100202
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT BLOOD, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100203
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT BLOOD, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100203
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT CREATININE, URINE, QUAL, DIP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100204
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT CREATININE, URINE, QUAL, DIP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100204
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$3.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.02
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE - POCT GLUCOSE, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100205
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
|
