|
NM REDISTRIBUTION STUDY
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78469 TC
|
| Hospital Charge Code |
41509993
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM RENAL - DMSA
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78700 TC
|
| Hospital Charge Code |
41509984
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM RENAL - DMSA
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78700 TC
|
| Hospital Charge Code |
41509984
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$643.38 |
| 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 |
$643.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.40
|
| 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 |
$257.17
|
| 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 RENAL SCAN VASC. FLOW/FUNCTION
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78707 TC
|
| Hospital Charge Code |
41505152
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$787.05 |
| 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 |
$643.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.40
|
| 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 |
$257.17
|
| 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 RENAL SCAN VASC. FLOW/FUNCTION
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
HCPCS 78707 TC
|
| Hospital Charge Code |
41505152
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM RENAL W/CAPTOPRIL SCAN
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78709 TC
|
| Hospital Charge Code |
41502891
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.17 |
| 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 |
$643.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.40
|
| 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 |
$257.17
|
| 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 RENAL W/CAPTOPRIL SCAN
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78709 TC
|
| Hospital Charge Code |
41502891
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM RENAL W/LASIX SCAN
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78708 TC
|
| Hospital Charge Code |
41502890
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.17 |
| 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 |
$643.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.40
|
| 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 |
$257.17
|
| 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 RENAL W/LASIX SCAN
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78708 TC
|
| Hospital Charge Code |
41502890
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NMR LIPOPROFILE
|
Facility
|
OP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40609904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.71
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
NMR LIPOPROFILE
|
Facility
|
IP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40609904
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.39
|
|
|
NM SALIVARY GLAND SCAN
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78230 TC
|
| Hospital Charge Code |
41505038
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM SALIVARY GLAND SCAN
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78230 TC
|
| Hospital Charge Code |
41505038
|
|
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 SENTINEL NODE INJ. ONLY
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
41509988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$809.25
|
| Rate for Payer: Cash Price |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| 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 |
$476.96
|
| Rate for Payer: Group Health Inc Medicare |
$476.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.42
|
| 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 |
$1,113.00
|
| 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 SENTINEL NODE INJ. ONLY
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
41509988
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM SHUNT EVALUATION
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78645 TC
|
| Hospital Charge Code |
41505138
|
|
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 SHUNT EVALUATION
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78645 TC
|
| Hospital Charge Code |
41505138
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM TESTICULAR W/VASC. FLOW
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78761 TC
|
| Hospital Charge Code |
41505168
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$643.38 |
| 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 |
$643.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.40
|
| 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 |
$257.17
|
| 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 TESTICULAR W/VASC. FLOW
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78761 TC
|
| Hospital Charge Code |
41505168
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM THYROID IMAGING ONLY
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78013 TC
|
| Hospital Charge Code |
41507493
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM THYROID IMAGING ONLY
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78013 TC
|
| Hospital Charge Code |
41507493
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.03 |
| 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 |
$120.03
|
| 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 THYROID METS (LIMITED)
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78015 TC
|
| Hospital Charge Code |
41509982
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$232.09 |
| 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 |
$580.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.32
|
| 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 |
$232.09
|
| 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 THYROID METS (LIMITED)
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78015 TC
|
| Hospital Charge Code |
41509982
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM THYROID MULTIPLE W/UPTAKE
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78014 TC
|
| Hospital Charge Code |
41505006
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM THYROID MULTIPLE W/UPTAKE
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78014 TC
|
| Hospital Charge Code |
41505006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$186.35 |
| 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 |
$186.35
|
| 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
|
|
