|
HC PROLONGED OUTPATIENT EVAL AND MGMNT SERVICE EACH 15 MINS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
5109941701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.69
|
| Rate for Payer: Aetna Government |
$24.69
|
| 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 |
$25.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PROLONGED SERV,NO CONTACT,1ST HR
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
5109935801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.51
|
| Rate for Payer: Aetna Government |
$80.51
|
| 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 |
$162.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PROLONGED SERV,NO CONTACT,1ST HR
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
5109935801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
|
|
HC PROPHYLAXIS RETINA DETACH,CRYO/DIATH
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
3616714101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$728.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$365.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| Rate for Payer: Group Health Inc Commercial |
$365.24
|
| Rate for Payer: Group Health Inc Medicare |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC PROPHYLAXIS RETINA DETACH,CRYO/DIATH
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
3616714101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.50 |
| Max. Negotiated Rate |
$485.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.50
|
|
|
HC PROPHYLAXIS RETINA DETACH,PHOTOCOAG
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
5106714501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$469.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$469.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$469.20
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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 |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$603.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.56
|
| 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 |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$670.29
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.78
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC PROPHYLAXIS RETINA DETACH,PHOTOCOAG
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
5106714501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
|
HC PRO SERVIC ALLER IMMUNOTH, INCLUD
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 95120
|
| Hospital Charge Code |
9409512001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
|
|
HC PRO SERVIC ALLER IMMUNOTH, INCLUD
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 95120
|
| Hospital Charge Code |
9409512001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.10
|
| Rate for Payer: Aetna Government |
$9.10
|
| Rate for Payer: Brighton Health Commercial |
$29.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.52
|
| Rate for Payer: EmblemHealth Commercial |
$19.50
|
| Rate for Payer: Group Health Inc Commercial |
$19.50
|
| Rate for Payer: Group Health Inc Medicare |
$13.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.50
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
|
|
HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3018415301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3018415301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.39
|
| Rate for Payer: Aetna Government |
$18.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.87
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.39
|
| Rate for Payer: EmblemHealth Commercial |
$18.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$18.39
|
| Rate for Payer: Group Health Inc Medicare |
$18.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.39
|
| Rate for Payer: Healthfirst Essential Plan |
$41.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.39
|
| Rate for Payer: Healthfirst QHP |
$18.39
|
| Rate for Payer: Humana Medicare |
$18.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.39
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
|
|
HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3018415302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3018415302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.39
|
| Rate for Payer: Aetna Government |
$18.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.87
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.39
|
| Rate for Payer: EmblemHealth Commercial |
$18.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$18.39
|
| Rate for Payer: Group Health Inc Medicare |
$18.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.39
|
| Rate for Payer: Healthfirst Essential Plan |
$41.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.39
|
| Rate for Payer: Healthfirst QHP |
$18.39
|
| Rate for Payer: Humana Medicare |
$18.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.39
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.74
|
| Rate for Payer: Aetna Government |
$10.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.52
|
| Rate for Payer: Brighton Health Commercial |
$19.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.74
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.56
|
| Rate for Payer: Group Health Inc Commercial |
$10.74
|
| Rate for Payer: Group Health Inc Medicare |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.08
|
| Rate for Payer: Healthfirst Essential Plan |
$18.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.74
|
| Rate for Payer: Healthfirst QHP |
$10.74
|
| Rate for Payer: Humana Medicare |
$10.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$13.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.08
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
3018416601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
3018416601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.83
|
| Rate for Payer: Aetna Government |
$17.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.48
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.83
|
| Rate for Payer: EmblemHealth Commercial |
$17.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.87
|
| Rate for Payer: Group Health Inc Commercial |
$17.83
|
| Rate for Payer: Group Health Inc Medicare |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.36
|
| Rate for Payer: Healthfirst Essential Plan |
$25.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.83
|
| Rate for Payer: Healthfirst QHP |
$17.83
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$22.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.36
|
| Rate for Payer: Wellcare Medicare |
$16.05
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN BODY FLUID
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3018415702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.80
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.00
|
| Rate for Payer: EmblemHealth Commercial |
$4.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Healthfirst Essential Plan |
$9.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.00
|
| Rate for Payer: Healthfirst QHP |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$3.60
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN BODY FLUID
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3018415702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3018415701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3018415701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.80
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.00
|
| Rate for Payer: EmblemHealth Commercial |
$4.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Healthfirst Essential Plan |
$9.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.00
|
| Rate for Payer: Healthfirst QHP |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$3.60
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - BENCE JONES PROTOCOL
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Essential Plan |
$8.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - BENCE JONES PROTOCOL
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3018415605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
|
