|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$143.39 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3319641101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3319641101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3319640901
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3319640901
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$141.13 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$405.27
|
| Rate for Payer: Aetna Government |
$405.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$283.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$283.69
|
| Rate for Payer: Brighton Health Commercial |
$702.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$405.27
|
| Rate for Payer: EmblemHealth Commercial |
$405.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$405.27
|
| Rate for Payer: Group Health Inc Medicare |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.48
|
| Rate for Payer: Healthfirst QHP |
$405.27
|
| Rate for Payer: Humana Medicare |
$413.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$385.01
|
| Rate for Payer: Wellcare Medicare |
$385.01
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$468.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.50
|
|
|
HC CHG FLOW CYTOMETRY INTERPJ 2-8 MARKERS
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
3118818701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.23
|
| Rate for Payer: Aetna Government |
$44.23
|
| Rate for Payer: Brighton Health Commercial |
$133.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.74
|
| Rate for Payer: EmblemHealth Commercial |
$38.60
|
| Rate for Payer: Group Health Inc Commercial |
$89.00
|
| Rate for Payer: Group Health Inc Medicare |
$62.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
HC CHG FLOW CYTOMETRY INTERPJ 2-8 MARKERS
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
3118818701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.00
|
|
|
HC CHG FLOW CYTOMETRY INTERPJ 9-15 MARKERS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
3118818801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
|
|
HC CHG FLOW CYTOMETRY INTERPJ 9-15 MARKERS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
3118818801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.48
|
| Rate for Payer: Aetna Government |
$56.48
|
| Rate for Payer: Brighton Health Commercial |
$132.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.32
|
| Rate for Payer: EmblemHealth Commercial |
$65.78
|
| Rate for Payer: Group Health Inc Commercial |
$88.00
|
| Rate for Payer: Group Health Inc Medicare |
$61.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.25
|
| Rate for Payer: Healthfirst Essential Plan |
$56.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.25
|
|
|
HC CHG OF CYSTOSTOMY TUBE, SIMPLE
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 51705 TC
|
| Hospital Charge Code |
3615170501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC CHG OF CYSTOSTOMY TUBE, SIMPLE
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 51705 TC
|
| Hospital Charge Code |
3615170501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.54
|
| Rate for Payer: Aetna Government |
$110.54
|
| Rate for Payer: Brighton Health Commercial |
$533.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$355.50
|
| Rate for Payer: Group Health Inc Commercial |
$355.50
|
| Rate for Payer: Group Health Inc Medicare |
$248.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OD RT EYE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OD RT EYE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.00
|
| Rate for Payer: Aetna Government |
$47.00
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$44.58
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.58
|
| Rate for Payer: Healthfirst Essential Plan |
$126.90
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.40
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OS LT EYE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651303
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.00
|
| Rate for Payer: Aetna Government |
$47.00
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$44.58
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.58
|
| Rate for Payer: Healthfirst Essential Plan |
$126.90
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.40
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OS LT EYE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651303
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OU BOTH
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC CHG US, EYE,ANTERIOR - B-SCAN ULTRASOUND, HIGH RESOLUTION OU BOTH
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
4027651304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.00
|
| Rate for Payer: Aetna Government |
$47.00
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$44.58
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.58
|
| Rate for Payer: Healthfirst Essential Plan |
$126.90
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.40
|
|
|
HC CHG US, EYE B-SCAN - B-SCAN ULTRASOUND - OD - RIGHT EYE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
4027651202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.38
|
| Rate for Payer: Aetna Government |
$31.38
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$18.72
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.72
|
| Rate for Payer: Healthfirst Essential Plan |
$132.37
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.83
|
|
|
HC CHG US, EYE B-SCAN - B-SCAN ULTRASOUND - OD - RIGHT EYE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
4027651202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
