|
HC URINALYSIS NONAUTO W/O SCOPE - POCT GLUCOSE, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100205
|
|
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 LEUKOCYTES, URINE, QUAL, DIP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100206
|
|
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 LEUKOCYTES, URINE, QUAL, DIP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100206
|
|
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 NITRITE, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100207
|
|
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 NITRITE, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100207
|
|
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 PH, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100208
|
|
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 PH, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100208
|
|
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 PROTEIN, URINE, QUAL, DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100209
|
|
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 PROTEIN, URINE, QUAL, DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100209
|
|
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 SPECIFIC GRAVITY, URINE QUAL DIP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100210
|
|
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 SPECIFIC GRAVITY, URINE QUAL DIP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100210
|
|
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 URINALYSIS DIPSTICK
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100211
|
|
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 URINALYSIS DIPSTICK
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100211
|
|
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 UROBILINOGEN, URINE, QUAL, DIP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100212
|
|
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 UROBILINOGEN, URINE, QUAL, DIP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3078100212
|
|
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, POCT, AUTO, W/O SCOPE
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 81003 QW
|
| Hospital Charge Code |
3078100301
|
|
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, POCT, AUTO, W/O SCOPE
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 81003 QW
|
| Hospital Charge Code |
3078100301
|
|
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 URINARY BLADDER RESIDUAL STUDT
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 78730 TC
|
| Hospital Charge Code |
3417873001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$286.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.50
|
|
|
HC URINARY BLADDER RESIDUAL STUDT
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 78730 TC
|
| Hospital Charge Code |
3417873001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$429.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$315.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.96
|
| Rate for Payer: Aetna Government |
$46.96
|
| Rate for Payer: Brighton Health Commercial |
$429.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$215.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.51
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Commercial |
$286.50
|
| Rate for Payer: Group Health Inc Medicare |
$200.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.70
|
| Rate for Payer: Healthfirst Essential Plan |
$139.39
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$61.95
|
|
|
HC URINE PREGNANCY TEST - POCT PREGNANCY, URINE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3078102502
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.61
|
| Rate for Payer: Aetna Government |
$8.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.22
|
| Rate for Payer: Amida Care Medicaid |
$3.22
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.61
|
| Rate for Payer: EmblemHealth Commercial |
$8.61
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$8.61
|
| Rate for Payer: Group Health Inc Medicare |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.61
|
| Rate for Payer: Healthfirst QHP |
$5.25
|
| Rate for Payer: Humana Medicare |
$8.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: SOMOS Essential |
$7.25
|
| Rate for Payer: United Healthcare Commercial |
$8.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.54
|
| Rate for Payer: United Healthcare Medicaid |
$3.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Wellcare Medicare |
$7.75
|
|
|
HC URINE PREGNANCY TEST - POCT PREGNANCY, URINE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3078102502
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.61
|
| Rate for Payer: Aetna Government |
$8.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.22
|
| Rate for Payer: Amida Care Medicaid |
$3.22
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.61
|
| Rate for Payer: EmblemHealth Commercial |
$8.61
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$8.61
|
| Rate for Payer: Group Health Inc Medicare |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.61
|
| Rate for Payer: Healthfirst QHP |
$5.25
|
| Rate for Payer: Humana Medicare |
$8.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: SOMOS Essential |
$7.25
|
| Rate for Payer: United Healthcare Commercial |
$8.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.54
|
| Rate for Payer: United Healthcare Medicaid |
$3.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Wellcare Medicare |
$7.75
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC UROGRAPHY, INFUSION DRIP &/ BOLUS TECHNIQUE
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74410 TC
|
| Hospital Charge Code |
3207441001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC UROGRAPHY, INFUSION DRIP &/ BOLUS TECHNIQUE
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74410 TC
|
| Hospital Charge Code |
3207441001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.69
|
| Rate for Payer: Aetna Government |
$65.69
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$317.25
|
| Rate for Payer: EmblemHealth Commercial |
$121.99
|
| Rate for Payer: Group Health Inc Commercial |
$275.50
|
| Rate for Payer: Group Health Inc Medicare |
$192.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.99
|
| Rate for Payer: Healthfirst Essential Plan |
$204.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$90.84
|
|
