|
NM MYOCARDIAC (REST) SPECT.
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78469 TC
|
| Hospital Charge Code |
41509994
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$233.11 |
| Max. Negotiated Rate |
$2,119.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.23
|
| 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 |
$583.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$493.48
|
| 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 |
$1,926.58
|
| 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 |
$233.11
|
| 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 MYOCARDIAL INFARCT
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78466 TC
|
| Hospital Charge Code |
41505096
|
|
Hospital Revenue Code
|
341
|
| 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 MYOCARDIAL INFARCT
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78466 TC
|
| Hospital Charge Code |
41505096
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM MYOCARDIAL (SPECT)
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Hospital Charge Code |
41505092
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$607.92 |
| Max. Negotiated Rate |
$2,119.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.23
|
| 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 |
$1,520.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.91
|
| 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 |
$1,926.58
|
| 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 |
$607.92
|
| 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 MYOCARDIAL (SPECT)
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Hospital Charge Code |
41505092
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM MYOCARDIC (STRESS) SPECT.
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
41509995
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM MYOCARDIC (STRESS) SPECT.
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
41509995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$607.92 |
| Max. Negotiated Rate |
$2,119.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.23
|
| 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 |
$1,520.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.91
|
| 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 |
$1,926.58
|
| 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 |
$607.92
|
| 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 MYO. PER.WALL MOT. QUALI/QUAN
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Hospital Charge Code |
41501407
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM MYO. PER.WALL MOT. QUALI/QUAN
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Hospital Charge Code |
41501407
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$607.92 |
| Max. Negotiated Rate |
$2,119.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.23
|
| 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 |
$1,520.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.91
|
| 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 |
$1,926.58
|
| 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 |
$607.92
|
| 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
|
|
|
NMO IGG AUTOANTIBODIES
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
NMO IGG AUTOANTIBODIES
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609702
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
NM PARATHYROID SCAN
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78070 TC
|
| Hospital Charge Code |
41505014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$175.59 |
| 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 |
$439.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$371.71
|
| 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 |
$175.59
|
| 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 PARATHYROID SCAN
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78070 TC
|
| Hospital Charge Code |
41505014
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM PERITONEAL SHUNT PATENCY
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78291 TC
|
| Hospital Charge Code |
41505054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.44 |
| 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 |
$478.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$405.26
|
| 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 |
$191.44
|
| 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 PERITONEAL SHUNT PATENCY
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78291 TC
|
| Hospital Charge Code |
41505054
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM PULMONARY PERFUSION
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78580 TC
|
| Hospital Charge Code |
41505108
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM PULMONARY PERFUSION
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 78580 TC
|
| Hospital Charge Code |
41505108
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$157.46 |
| 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 |
$393.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.34
|
| 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 |
$157.46
|
| 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 PULMONARY VENT/MULTIPLE
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78579 TC
|
| Hospital Charge Code |
41505116
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM PULMONARY VENT/MULTIPLE
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78579 TC
|
| Hospital Charge Code |
41505116
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$161.96 |
| Max. Negotiated Rate |
$891.98 |
| 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 |
$891.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$758.19
|
| 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 |
$161.96
|
| 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 PULMONARY (VQ)
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78582 TC
|
| Hospital Charge Code |
41509991
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.14 |
| Max. Negotiated Rate |
$1,144.80 |
| 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 |
$1,144.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$973.08
|
| 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 |
$253.14
|
| 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 PULMONARY (VQ)
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78582 TC
|
| Hospital Charge Code |
41509991
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM RADIO PHARM - ABLATION
|
Facility
|
IP
|
$719.03
|
|
|
Service Code
|
HCPCS 79005 TC
|
| Hospital Charge Code |
41507498
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$287.70
|
|
|
NM RADIO PHARM - ABLATION
|
Facility
|
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79005 TC
|
| Hospital Charge Code |
41507498
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$448.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$287.70
|
| Rate for Payer: Aetna Government |
$287.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$201.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$201.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$201.39
|
| Rate for Payer: Brighton Health Commercial |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$448.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$287.70
|
| Rate for Payer: EmblemHealth Commercial |
$201.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.05
|
| Rate for Payer: Group Health Inc Commercial |
$258.93
|
| Rate for Payer: Group Health Inc Medicare |
$258.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.70
|
| Rate for Payer: Healthfirst QHP |
$287.70
|
| Rate for Payer: Humana Medicare |
$293.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.70
|
| Rate for Payer: United Healthcare Commercial |
$179.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.16
|
| Rate for Payer: Wellcare Medicare |
$273.32
|
|
|
NM RADIO PHARMACEUTICALS
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS A4641
|
| Hospital Charge Code |
41507496
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$129.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$117.50
|
| Rate for Payer: Aetna Government |
$117.50
|
| Rate for Payer: Brighton Health Commercial |
$176.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$188.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.80
|
| Rate for Payer: Group Health Inc Commercial |
$117.50
|
| Rate for Payer: Group Health Inc Medicare |
$82.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.50
|
|
|
NM REDISTRIBUTION STUDY
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78469 TC
|
| Hospital Charge Code |
41509993
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$233.11 |
| Max. Negotiated Rate |
$2,119.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.23
|
| 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 |
$583.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$493.48
|
| 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 |
$1,926.58
|
| 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 |
$233.11
|
| 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
|
|
