|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
3611002101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
3611002101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| 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: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$488.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| Rate for Payer: Group Health Inc Commercial |
$488.15
|
| Rate for Payer: Group Health Inc Medicare |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC FITTING & INSERT PESSARY/OTHER SUPPORT DEVICE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
3615716001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC FITTING & INSERT PESSARY/OTHER SUPPORT DEVICE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
3615716001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$376.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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: Elderplan Medicare Advantage |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$245.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| Rate for Payer: Group Health Inc Commercial |
$245.79
|
| Rate for Payer: Group Health Inc Medicare |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SURFACE DISEASE
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 92071
|
| Hospital Charge Code |
5109207101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.00
|
|
|
HC FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SURFACE DISEASE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 92071
|
| Hospital Charge Code |
5109207101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.59
|
| Rate for Payer: Aetna Government |
$28.59
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC FLOW CYTOMETRY, CELL CYCLE OR DNA ANALYSIS
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 88182 TC
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
|
|
HC FLOW CYTOMETRY, CELL CYCLE OR DNA ANALYSIS
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88182 TC
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$144.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.44
|
| Rate for Payer: Aetna Government |
$48.44
|
| Rate for Payer: Brighton Health Commercial |
$111.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.46
|
| Rate for Payer: EmblemHealth Commercial |
$144.93
|
| Rate for Payer: Group Health Inc Commercial |
$74.50
|
| Rate for Payer: Group Health Inc Medicare |
$52.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.93
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88184 TC
|
| Hospital Charge Code |
3118818404
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88184 TC
|
| Hospital Charge Code |
3118818404
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.66
|
| Rate for Payer: Aetna Government |
$48.66
|
| Rate for Payer: Brighton Health Commercial |
$114.00
|
| 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 |
$76.00
|
| Rate for Payer: Group Health Inc Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Healthfirst Essential Plan |
$52.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.40
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LYMPHOCYTE T-CELL,% & ABS
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818403
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LYMPHOCYTE T-CELL,% & ABS
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818403
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$448.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$439.51
|
| Rate for Payer: Aetna Government |
$439.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$307.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$307.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.66
|
| Rate for Payer: Brighton Health Commercial |
$439.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$439.51
|
| Rate for Payer: EmblemHealth Commercial |
$91.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.16
|
| Rate for Payer: Group Health Inc Commercial |
$439.51
|
| Rate for Payer: Group Health Inc Medicare |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Healthfirst Essential Plan |
$52.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.51
|
| Rate for Payer: Healthfirst QHP |
$439.51
|
| Rate for Payer: Humana Medicare |
$448.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Wellcare Medicare |
$395.56
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LYMPHOCYTE TRANSPLANTATION
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LYMPHOCYTE TRANSPLANTATION
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$448.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$439.51
|
| Rate for Payer: Aetna Government |
$439.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$307.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$307.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.66
|
| Rate for Payer: Brighton Health Commercial |
$439.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$439.51
|
| Rate for Payer: EmblemHealth Commercial |
$91.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.16
|
| Rate for Payer: Group Health Inc Commercial |
$439.51
|
| Rate for Payer: Group Health Inc Medicare |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Healthfirst Essential Plan |
$52.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.51
|
| Rate for Payer: Healthfirst QHP |
$439.51
|
| Rate for Payer: Humana Medicare |
$448.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Wellcare Medicare |
$395.56
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - PNH PROFILE, WBC
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - PNH PROFILE, WBC
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3118818402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$448.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$439.51
|
| Rate for Payer: Aetna Government |
$439.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$307.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$307.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.66
|
| Rate for Payer: Brighton Health Commercial |
$439.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$439.51
|
| Rate for Payer: EmblemHealth Commercial |
$91.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.16
|
| Rate for Payer: Group Health Inc Commercial |
$439.51
|
| Rate for Payer: Group Health Inc Medicare |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Healthfirst Essential Plan |
$52.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.51
|
| Rate for Payer: Healthfirst QHP |
$439.51
|
| Rate for Payer: Humana Medicare |
$448.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.40
|
| Rate for Payer: Wellcare Medicare |
$395.56
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - BUNDLED CHARGE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3118818502
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - BUNDLED CHARGE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3118818502
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.63
|
| Rate for Payer: Aetna Government |
$29.63
|
| Rate for Payer: Brighton Health Commercial |
$114.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.13
|
| Rate for Payer: EmblemHealth Commercial |
$26.39
|
| Rate for Payer: Group Health Inc Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.60
|
| Rate for Payer: Healthfirst Essential Plan |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.60
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88185 TC
|
| Hospital Charge Code |
3118818501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88185 TC
|
| Hospital Charge Code |
3118818501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.63
|
| Rate for Payer: Aetna Government |
$29.63
|
| Rate for Payer: Brighton Health Commercial |
$114.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.13
|
| Rate for Payer: EmblemHealth Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.60
|
| Rate for Payer: Healthfirst Essential Plan |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.60
|
|
|
HC FLUORESCEIN ANGIOGRAPHY - FLUORESCEIN ANGIOGRAPHY - MULTIFRAME
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
9209223501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC FLUORESCEIN ANGIOGRAPHY - FLUORESCEIN ANGIOGRAPHY - MULTIFRAME
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
9209223501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC FLUORESCEIN ANGIOGRAPHY - FLUORESCEIN ANGIOGRAPHY - OU
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
9209223502
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC FLUORESCEIN ANGIOGRAPHY - FLUORESCEIN ANGIOGRAPHY - OU
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
9209223502
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC FLUORESCENT ANTIBODY; SCREEN - ANTI-MYELIN ASSOC GLYCOP
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
3028625504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$10.85
|
|
