|
11-dehydro TXB2/Creat Ratio
|
Facility
IP
|
$23.58
|
|
| Hospital Charge Code |
501620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$11.79 |
| Rate for Payer: SELF PAY |
$11.79
|
|
|
11-dehydro TXB2/Creat Ratio
|
Facility
OP
|
$23.58
|
|
| Hospital Charge Code |
501620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$11.79 |
| Rate for Payer: SELF PAY |
$11.79
|
|
|
15mmOD x 22mmOD ADAPTER WP
|
Facility
IP
|
$1.26
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: SELF PAY |
$0.63
|
|
|
15mmOD x 22mmOD ADAPTER WP
|
Facility
OP
|
$1.26
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: SELF PAY |
$0.63
|
|
|
17-Alpha-Hydroxyprogesterone
|
Facility
OP
|
$29.82
|
|
| Hospital Charge Code |
500163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: SELF PAY |
$14.91
|
|
|
17-Alpha-Hydroxyprogesterone
|
Facility
IP
|
$29.82
|
|
| Hospital Charge Code |
500163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: SELF PAY |
$14.91
|
|
|
17-Hydroxycorticosteroids
|
Facility
OP
|
$19.23
|
|
| Hospital Charge Code |
806730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: SELF PAY |
$9.62
|
|
|
17-Hydroxycorticosteroids
|
Facility
IP
|
$19.23
|
|
| Hospital Charge Code |
806730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: SELF PAY |
$9.62
|
|
|
17-Hydroxypregnenolone, MS
|
Facility
IP
|
$16.89
|
|
| Hospital Charge Code |
140715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: SELF PAY |
$8.45
|
|
|
17-Hydroxypregnenolone, MS
|
Facility
OP
|
$16.89
|
|
| Hospital Charge Code |
140715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: SELF PAY |
$8.45
|
|
|
17-Ketosteroids, Urine
|
Facility
IP
|
$14.05
|
|
| Hospital Charge Code |
806813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: SELF PAY |
$7.03
|
|
|
17-Ketosteroids, Urine
|
Facility
OP
|
$14.05
|
|
| Hospital Charge Code |
806813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: SELF PAY |
$7.03
|
|
|
17-OH Progesterone LCMS
|
Facility
IP
|
$31.30
|
|
| Hospital Charge Code |
70085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: SELF PAY |
$15.65
|
|
|
17-OH Progesterone LCMS
|
Facility
IP
|
$29.82
|
|
| Hospital Charge Code |
70085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: SELF PAY |
$14.91
|
|
|
17-OH Progesterone LCMS
|
Facility
OP
|
$31.30
|
|
| Hospital Charge Code |
70085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: SELF PAY |
$15.65
|
|
|
17-OH Progesterone LCMS
|
Facility
OP
|
$29.82
|
|
| Hospital Charge Code |
70085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: SELF PAY |
$14.91
|
|
|
18-Hydroxycorticosterone, S
|
Facility
OP
|
$19.82
|
|
| Hospital Charge Code |
500778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$9.91 |
| Rate for Payer: SELF PAY |
$9.91
|
|
|
18-Hydroxycorticosterone, S
|
Facility
IP
|
$19.82
|
|
| Hospital Charge Code |
500778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$9.91 |
| Rate for Payer: SELF PAY |
$9.91
|
|
|
1 Floor Mat
|
Facility
IP
|
$133.00
|
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: SELF PAY |
$66.50
|
|
|
1 Floor Mat
|
Facility
OP
|
$133.00
|
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: SELF PAY |
$66.50
|
|
|
21-Hydroxylase Antibodies
|
Facility
OP
|
$14.82
|
|
| Hospital Charge Code |
504805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: SELF PAY |
$7.41
|
|
|
21-Hydroxylase Antibodies
|
Facility
OP
|
$14.82
|
|
| Hospital Charge Code |
504805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: SELF PAY |
$7.41
|
|
|
21-Hydroxylase Antibodies
|
Facility
IP
|
$14.82
|
|
| Hospital Charge Code |
500092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: SELF PAY |
$7.41
|
|
|
21-Hydroxylase Antibodies
|
Facility
IP
|
$14.82
|
|
| Hospital Charge Code |
504805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: SELF PAY |
$7.41
|
|
|
21-Hydroxylase Antibodies
|
Facility
IP
|
$14.82
|
|
| Hospital Charge Code |
504805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: SELF PAY |
$7.41
|
|
