|
HC INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 32561 TC
|
| Hospital Charge Code |
3613256101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, SUBSEQUENT
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 32562 TC
|
| Hospital Charge Code |
3613256201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.60
|
| Rate for Payer: Aetna Government |
$87.60
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| 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 |
$954.50
|
| Rate for Payer: Group Health Inc Commercial |
$954.50
|
| Rate for Payer: Group Health Inc Medicare |
$668.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.50
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, SUBSEQUENT
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 32562 TC
|
| Hospital Charge Code |
3613256201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.41
|
| Rate for Payer: Aetna Government |
$21.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.99
|
| Rate for Payer: Brighton Health Commercial |
$39.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.41
|
| Rate for Payer: EmblemHealth Commercial |
$21.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.05
|
| Rate for Payer: Group Health Inc Commercial |
$21.41
|
| Rate for Payer: Group Health Inc Medicare |
$21.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.41
|
| Rate for Payer: Healthfirst QHP |
$21.41
|
| Rate for Payer: Humana Medicare |
$21.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.41
|
| Rate for Payer: United Healthcare Commercial |
$27.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$19.27
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.50
|
|
|
HC INTEGRA WOUND MATRIX PER SQ CM
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT Q4108
|
| Hospital Charge Code |
636Q410801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
|
|
HC INTEGRA WOUND MATRIX PER SQ CM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT Q4108
|
| Hospital Charge Code |
636Q410801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.75
|
| Rate for Payer: Aetna Government |
$36.75
|
| Rate for Payer: Brighton Health Commercial |
$42.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.83
|
| Rate for Payer: EmblemHealth Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.15
|
|
|
HC INTENSIVE OP PSYCHIATRIC SERVICES, PER DIEM
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT S9480
|
| Hospital Charge Code |
905S948001
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$551.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.28
|
| Rate for Payer: Aetna Government |
$63.28
|
| Rate for Payer: Brighton Health Commercial |
$751.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$801.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$681.36
|
| Rate for Payer: EmblemHealth Commercial |
$501.00
|
| Rate for Payer: Group Health Inc Commercial |
$501.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$501.00
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
|
|
HC INTENSIVE OP PSYCHIATRIC SERVICES, PER DIEM
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT S9480
|
| Hospital Charge Code |
905S948001
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$501.00 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.00
|
|
|
HC INTERDENTAL WIRING, OTHER THAN FRAC
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
3612149701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC INTERDENTAL WIRING, OTHER THAN FRAC
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
3612149701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$3,064.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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 |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$678.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC INTERNAL ANASTOMOSIS OF PANC CYST TO GI TRACT, DIRECT
|
Facility
|
IP
|
$5,409.00
|
|
|
Service Code
|
CPT 48520 TC
|
| Hospital Charge Code |
3614852001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,704.50 |
| Max. Negotiated Rate |
$2,704.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.50
|
|
|
HC INTERNAL ANASTOMOSIS OF PANC CYST TO GI TRACT, DIRECT
|
Facility
|
OP
|
$5,409.00
|
|
|
Service Code
|
CPT 48520 TC
|
| Hospital Charge Code |
3614852001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,299.10 |
| Max. Negotiated Rate |
$4,056.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,974.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,299.10
|
| Rate for Payer: Aetna Government |
$1,299.10
|
| Rate for Payer: Brighton Health Commercial |
$4,056.75
|
| 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 |
$2,704.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,704.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,893.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,704.50
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OD - RIGHT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228607
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OD - RIGHT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228607
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OS - LEFT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228609
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OS - LEFT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228609
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OU - BOTH EYES
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - CONFOCAL MICROSCOPY - OU - BOTH EYES
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OD RIGHT
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228608
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OD RIGHT
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228608
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OS LEFT
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OS LEFT
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OU BOTH
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228606
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTO AND CELL COUNT OU BOTH
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92286
|
| Hospital Charge Code |
9209228606
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
