|
HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION-CYTOMEGALOVIRUS (CMV) CULTURE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
3068725202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
|
|
HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION-CYTOMEGALOVIRUS (CMV) CULTURE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
3068725202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Essential Plan |
$58.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$33.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION-VARICELLA ZOSTER VIRUS CULTURE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
3068725203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
|
|
HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION-VARICELLA ZOSTER VIRUS CULTURE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
3068725203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Essential Plan |
$58.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$33.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
HC VISUAL AUDIOMETRY (VRA)
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
4719257901
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$40.10 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC VISUAL AUDIOMETRY (VRA)
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
4719257901
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD BOTH EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208305
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD BOTH EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208305
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD LT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208304
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD LT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208304
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD RT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208303
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - AUTO VISUAL FIELD, EXTENDED OD RT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208303
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OD - RIGHT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208311
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OD - RIGHT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208311
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OS - LEFT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OS - LEFT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OU - BOTH EYES
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208310
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - GOLDMANN PERIMETRY - OU - BOTH EYES
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208310
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OD - RIGHT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208312
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OD - RIGHT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208312
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OS - LEFT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208302
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OS - LEFT EYE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208302
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OU - BOTH EYES
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208309
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - HUMPHREY VISUAL FIELD - OU - BOTH EYES
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208309
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HC VISUAL FIELD EXAM,EXTENDED - MATRIX VISUAL FIELD - OD - RIGHT EYE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92083 TC
|
| Hospital Charge Code |
9209208306
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
