|
HC OPEN TX, FINGER FRAC W/MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
3612675501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC OPEN TX, FINGER FRAC W/O MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
3612675001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC OPEN TX, FINGER FRAC W/O MANIP
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
3612675001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$489.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC OPEN TX INTERPHALANGEAL JT DISLOCN
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
3612678501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC OPEN TX INTERPHALANGEAL JT DISLOCN
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
3612678501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$6,218.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,218.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| 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 |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC OPEN TX OF TIBIAL SHAFT FRAC, W/PLATES/SCREWS
|
Facility
|
OP
|
$36,044.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
3612775801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,065.74 |
| Max. Negotiated Rate |
$27,033.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,720.94
|
| Rate for Payer: Aetna Government |
$15,720.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11,004.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11,004.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11,004.66
|
| Rate for Payer: Brighton Health Commercial |
$27,033.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,720.94
|
| 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 |
$15,720.94
|
| Rate for Payer: EmblemHealth Commercial |
$15,720.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14,148.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13,362.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,991.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,720.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,991.64
|
| Rate for Payer: Group Health Inc Commercial |
$15,720.94
|
| Rate for Payer: Group Health Inc Medicare |
$15,720.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,720.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,900.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,065.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,362.80
|
| Rate for Payer: Healthfirst QHP |
$15,720.94
|
| Rate for Payer: Humana Medicare |
$16,035.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,720.94
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,720.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,720.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14,934.89
|
| Rate for Payer: Wellcare Medicare |
$14,934.89
|
|
|
HC OPEN TX OF TIBIAL SHAFT FRAC, W/PLATES/SCREWS
|
Facility
|
IP
|
$36,044.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
3612775801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,022.00 |
| Max. Negotiated Rate |
$18,022.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,022.00
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, INCL INT FXN, EACH
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 28525
|
| Hospital Charge Code |
3612852501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, INCL INT FXN, EACH
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 28525
|
| Hospital Charge Code |
3612852501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$468.85 |
| Max. Negotiated Rate |
$6,218.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,218.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| 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 |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, W/ MANIPULATION, EACH
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
3612851501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$471.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, W/ MANIPULATION, EACH
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
3612851501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.50
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, W/O MANIPULATION, EACH
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
3612851001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.22 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$489.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC OPEN TX PHALANX/PHALANGE FRACTURE, W/O MANIPULATION, EACH
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
3612851001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC OPHTHALMIC BIOMETRY - IOL BIOMETRY - OD - RIGHT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213603
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC OPHTHALMIC BIOMETRY - IOL BIOMETRY - OD - RIGHT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213603
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$261.00
|
| 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 |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| 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 |
$52.83
|
| 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 OPHTHALMIC BIOMETRY - IOL BIOMETRY - OS - LEFT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$261.00
|
| 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 |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| 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 |
$52.83
|
| 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 OPHTHALMIC BIOMETRY - IOL BIOMETRY - OS - LEFT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
5109213601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC OPHTHALMIC BIOMETRY - IOL BIOMETRY - OS - LEFT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC OPHTHALMIC BIOMETRY - IOL BIOMETRY - OS - LEFT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
5109213601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$52.83
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 OPHTHALMIC BIOMETRY - IOL BIOMETRY - OU - BOTH EYES
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$261.00
|
| 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 |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| 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 |
$52.83
|
| 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 OPHTHALMIC BIOMETRY - IOL BIOMETRY - OU - BOTH EYES
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
9209213602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC OPHTHALMOLOGICAL EXAM AND EVAL W ANESTH
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
3619201801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,930.50 |
| Max. Negotiated Rate |
$2,930.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.50
|
|
|
HC OPHTHALMOLOGICAL EXAM AND EVAL W ANESTH
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
3619201801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$4,688.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,223.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,850.46
|
| Rate for Payer: Aetna Government |
$2,850.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,995.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,995.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.32
|
| Rate for Payer: Brighton Health Commercial |
$4,395.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,688.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,985.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,850.46
|
| Rate for Payer: EmblemHealth Commercial |
$2,850.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,536.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,536.91
|
| Rate for Payer: Group Health Inc Commercial |
$2,850.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,850.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.89
|
| Rate for Payer: Healthfirst QHP |
$2,850.46
|
| Rate for Payer: Humana Medicare |
$2,907.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.46
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,850.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,707.94
|
| Rate for Payer: Wellcare Medicare |
$2,707.94
|
|
|
HC OPHTHALMOLOGICAL SERVICES - COMPREHENSIVE, ESTABLISHED PT
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 92014
|
| Hospital Charge Code |
5109201401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC OPHTHALMOLOGICAL SERVICES - COMPREHENSIVE, ESTABLISHED PT
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 92014
|
| Hospital Charge Code |
5109201401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.46
|
| Rate for Payer: Aetna Government |
$157.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.14
|
| 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 |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.84
|
| Rate for Payer: Healthfirst QHP |
$157.46
|
| Rate for Payer: Humana Medicare |
$160.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Wellcare Medicare |
$149.59
|
|
