|
NM BONE SCAN (3 PHASE)
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78315 TC
|
| Hospital Charge Code |
41505068
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BONE SCAN (LIMITED)
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78300 TC
|
| Hospital Charge Code |
41505060
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BONE SCAN (LIMITED)
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78300 TC
|
| Hospital Charge Code |
41505060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.76 |
| Max. Negotiated Rate |
$593.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$489.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$414.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$195.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM BONE SCAN (MULTI BODY)
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78305 TC
|
| Hospital Charge Code |
41505062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.76 |
| Max. Negotiated Rate |
$593.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$489.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$414.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$195.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM BONE SCAN (MULTI BODY)
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78305 TC
|
| Hospital Charge Code |
41505062
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BONE SCAN (WHOLE BODY)
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78306 TC
|
| Hospital Charge Code |
41505064
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BONE SCAN (WHOLE BODY)
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78306 TC
|
| Hospital Charge Code |
41505064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.76 |
| Max. Negotiated Rate |
$593.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$489.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$414.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$195.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM BONE (SPECT)
|
Facility
|
OP
|
$794.33
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.98 |
| Max. Negotiated Rate |
$1,674.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$436.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,642.08
|
| Rate for Payer: Aetna Government |
$1,642.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,149.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,149.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,149.46
|
| Rate for Payer: Brighton Health Commercial |
$1,642.08
|
| Rate for Payer: Cash Price |
$1,642.08
|
| Rate for Payer: Cash Price |
$1,642.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,642.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$950.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$804.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,642.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,149.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,461.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,642.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,461.45
|
| Rate for Payer: Group Health Inc Commercial |
$1,477.87
|
| Rate for Payer: Group Health Inc Medicare |
$1,477.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,642.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,477.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,642.08
|
| Rate for Payer: Healthfirst QHP |
$1,642.08
|
| Rate for Payer: Humana Medicare |
$1,674.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,642.08
|
| Rate for Payer: United Healthcare Commercial |
$379.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,642.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,642.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,313.66
|
| Rate for Payer: Wellcare Medicare |
$1,559.98
|
|
|
NM BONE (SPECT)
|
Facility
|
IP
|
$794.33
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505070
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM BRAIN IMAG CMPLT W/TOMO SPECT
|
Facility
|
OP
|
$1,417.50
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505128
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.98 |
| Max. Negotiated Rate |
$1,674.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$779.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,642.08
|
| Rate for Payer: Aetna Government |
$1,642.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,149.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,149.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,149.46
|
| Rate for Payer: Brighton Health Commercial |
$1,642.08
|
| Rate for Payer: Cash Price |
$1,642.08
|
| Rate for Payer: Cash Price |
$1,642.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,642.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$950.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$804.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,642.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,149.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,461.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,642.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,461.45
|
| Rate for Payer: Group Health Inc Commercial |
$1,477.87
|
| Rate for Payer: Group Health Inc Medicare |
$1,477.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,642.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,477.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,642.08
|
| Rate for Payer: Healthfirst QHP |
$1,642.08
|
| Rate for Payer: Humana Medicare |
$1,674.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,642.08
|
| Rate for Payer: United Healthcare Commercial |
$379.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,642.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,642.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,313.66
|
| Rate for Payer: Wellcare Medicare |
$1,559.98
|
|
|
NM BRAIN IMAG CMPLT W/TOMO SPECT
|
Facility
|
IP
|
$1,417.50
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505128
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM BRAIN IMAG.COMPLT STUDY,STATIC
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78605 TC
|
| Hospital Charge Code |
41509737
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$192.18 |
| Max. Negotiated Rate |
$786.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$625.05
|
| Rate for Payer: Aetna Government |
$625.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$437.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$437.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$437.54
|
| Rate for Payer: Brighton Health Commercial |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$625.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$406.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$625.05
|
| Rate for Payer: EmblemHealth Commercial |
$437.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$625.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.29
|
| Rate for Payer: Group Health Inc Commercial |
$562.54
|
| Rate for Payer: Group Health Inc Medicare |
$562.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$625.05
|
| Rate for Payer: Healthfirst QHP |
$625.05
|
| Rate for Payer: Humana Medicare |
$637.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$625.05
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$500.04
|
| Rate for Payer: Wellcare Medicare |
$593.80
|
|
|
NM BRAIN IMAG.COMPLT STUDY,STATIC
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78605 TC
|
| Hospital Charge Code |
41509737
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM BRAIN IMAG. COMPLT W/VASC FLOW
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78606 TC
|
| Hospital Charge Code |
41509738
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM BRAIN IMAG. COMPLT W/VASC FLOW
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78606 TC
|
| Hospital Charge Code |
41509738
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$437.54 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$787.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$625.05
|
| Rate for Payer: Aetna Government |
$625.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$437.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$437.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$437.54
|
| Rate for Payer: Brighton Health Commercial |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$625.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,193.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,009.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$625.05
|
| Rate for Payer: EmblemHealth Commercial |
$437.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$625.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.29
|
| Rate for Payer: Group Health Inc Commercial |
$562.54
|
| Rate for Payer: Group Health Inc Medicare |
$562.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$625.05
|
| Rate for Payer: Healthfirst QHP |
$625.05
|
| Rate for Payer: Humana Medicare |
$637.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$625.05
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$500.04
|
| Rate for Payer: Wellcare Medicare |
$593.80
|
|
|
NM BRAIN IMAGING,LIMITED,STATIC
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78600 TC
|
| Hospital Charge Code |
41509735
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BRAIN IMAGING,LIMITED,STATIC
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78600 TC
|
| Hospital Charge Code |
41509735
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$192.18 |
| Max. Negotiated Rate |
$613.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$613.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$406.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM BRAIN IMAG. LIMITED W/VASC FLO
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78601 TC
|
| Hospital Charge Code |
41509736
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM BRAIN IMAG. LIMITED W/VASC FLO
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78601 TC
|
| Hospital Charge Code |
41509736
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$593.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,193.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,009.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM BRAIN VASCULAR FLOW
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78610 TC
|
| Hospital Charge Code |
41505130
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$192.18 |
| Max. Negotiated Rate |
$786.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$625.05
|
| Rate for Payer: Aetna Government |
$625.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$437.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$437.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$437.54
|
| Rate for Payer: Brighton Health Commercial |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$625.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$406.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$625.05
|
| Rate for Payer: EmblemHealth Commercial |
$437.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$625.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.29
|
| Rate for Payer: Group Health Inc Commercial |
$562.54
|
| Rate for Payer: Group Health Inc Medicare |
$562.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$625.05
|
| Rate for Payer: Healthfirst QHP |
$625.05
|
| Rate for Payer: Humana Medicare |
$637.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$625.05
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$500.04
|
| Rate for Payer: Wellcare Medicare |
$593.80
|
|
|
NM BRAIN VASCULAR FLOW
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78610 TC
|
| Hospital Charge Code |
41505130
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM CARDIAC BLOOD POOL/MUGA
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78472 TC
|
| Hospital Charge Code |
41505100
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM CARDIAC BLOOD POOL/MUGA
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78472 TC
|
| Hospital Charge Code |
41505100
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$233.11 |
| Max. Negotiated Rate |
$613.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$613.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$583.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$493.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$333.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$429.26
|
| Rate for Payer: Group Health Inc Medicare |
$429.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.96
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$233.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
NM CISTERNOGRAM
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78630 TC
|
| Hospital Charge Code |
41505134
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$437.54 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$625.05
|
| Rate for Payer: Aetna Government |
$625.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$437.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$437.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$437.54
|
| Rate for Payer: Brighton Health Commercial |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$625.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,193.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,009.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$625.05
|
| Rate for Payer: EmblemHealth Commercial |
$437.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$625.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.29
|
| Rate for Payer: Group Health Inc Commercial |
$562.54
|
| Rate for Payer: Group Health Inc Medicare |
$562.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$625.05
|
| Rate for Payer: Healthfirst QHP |
$625.05
|
| Rate for Payer: Humana Medicare |
$637.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$625.05
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$500.04
|
| Rate for Payer: Wellcare Medicare |
$593.80
|
|
|
NM CISTERNOGRAM
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78630 TC
|
| Hospital Charge Code |
41505134
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
