|
NM THYROID SINGLE W/UPTAKE
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78014 TC
|
| Hospital Charge Code |
41509981
|
|
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
|
|
|
NM THYROID SINGLE W/UPTAKE
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78014 TC
|
| Hospital Charge Code |
41509981
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM TOTAL BODY THYROID
|
Facility
|
IP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78018 TC
|
| Hospital Charge Code |
41509996
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM TOTAL BODY THYROID
|
Facility
|
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78018 TC
|
| Hospital Charge Code |
41509996
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$232.09 |
| 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 |
$580.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.32
|
| 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 |
$232.09
|
| 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 TOTAL BODY THYROID FOLLOW UP
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78099 TC
|
| Hospital Charge Code |
41505007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$106.23 |
| 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 |
$265.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.88
|
| 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 |
$106.23
|
| 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 TOTAL BODY THYROID FOLLOW UP
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78099 TC
|
| Hospital Charge Code |
41505007
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM TUMOR/ABSCESS LIMITED
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78800 TC
|
| Hospital Charge Code |
41505172
|
|
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 TUMOR/ABSCESS LIMITED
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78800 TC
|
| Hospital Charge Code |
41505172
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM TUMOR/ABSCESS WHOLE
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78802 TC
|
| Hospital Charge Code |
41505176
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM TUMOR/ABSCESS WHOLE
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78802 TC
|
| Hospital Charge Code |
41505176
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.98 |
| 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 |
$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 |
$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 |
$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 TUMOR (SPECT)
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505178
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM TUMOR (SPECT)
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Hospital Charge Code |
41505178
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.98 |
| 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 |
$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 |
$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 |
$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 TUMOR WB (2+DAYS)
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78804 TC
|
| Hospital Charge Code |
41509992
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$660.22 |
| 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 |
$1,651.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,397.63
|
| 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 |
$660.22
|
| 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 TUMOR WB (2+DAYS)
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78804 TC
|
| Hospital Charge Code |
41509992
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,642.08
|
|
|
NM URETERAL REFLUX
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78740 TC
|
| Hospital Charge Code |
41505164
|
|
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 URETERAL REFLUX
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78740 TC
|
| Hospital Charge Code |
41505164
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM URINARY BLADDER RESIDUAL
|
Facility
|
OP
|
$573.86
|
|
|
Service Code
|
HCPCS 78730 TC
|
| Hospital Charge Code |
41505162
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$430.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$315.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.96
|
| Rate for Payer: Aetna Government |
$46.96
|
| Rate for Payer: Brighton Health Commercial |
$430.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$201.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.65
|
| Rate for Payer: Group Health Inc Commercial |
$286.93
|
| Rate for Payer: Group Health Inc Medicare |
$200.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.93
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
|
|
NM VENOGRAM BILATERAL
|
Facility
|
OP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78458 TC
|
| Hospital Charge Code |
41505086
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.28 |
| 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 |
$400.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$339.30
|
| 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 |
$160.28
|
| 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 VENOGRAM BILATERAL
|
Facility
|
IP
|
$1,114.98
|
|
|
Service Code
|
HCPCS 78458 TC
|
| Hospital Charge Code |
41505086
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
NM VENOGRAM UNILATERAL
|
Facility
|
IP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78457 TC
|
| Hospital Charge Code |
41505084
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$625.05
|
|
|
NM VENOGRAM UNILATERAL
|
Facility
|
OP
|
$3,853.15
|
|
|
Service Code
|
HCPCS 78457 TC
|
| Hospital Charge Code |
41505084
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.28 |
| 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 |
$400.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$339.30
|
| 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 |
$160.28
|
| 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
|
|
|
NOBELZYGOMA 45D 40MM
|
Facility
|
OP
|
$823.50
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
64907366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.22 |
| Max. Negotiated Rate |
$864.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$452.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$411.75
|
| Rate for Payer: Aetna Government |
$411.75
|
| Rate for Payer: Brighton Health Commercial |
$494.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$411.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$473.51
|
| Rate for Payer: EmblemHealth Commercial |
$411.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$864.68
|
| Rate for Payer: Group Health Inc Commercial |
$411.75
|
| Rate for Payer: Group Health Inc Medicare |
$288.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$535.28
|
|
|
NOBELZYGOMA 45D 40MM
|
Facility
|
IP
|
$823.50
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
64907366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.75 |
| Max. Negotiated Rate |
$411.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.75
|
|
|
NOBELZYGOMA 45D 42.5MM
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
64907367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.45 |
| Max. Negotiated Rate |
$1,729.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$905.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$823.50
|
| Rate for Payer: Aetna Government |
$823.50
|
| Rate for Payer: Brighton Health Commercial |
$988.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$823.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$947.02
|
| Rate for Payer: EmblemHealth Commercial |
$823.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,729.35
|
| Rate for Payer: Group Health Inc Commercial |
$823.50
|
| Rate for Payer: Group Health Inc Medicare |
$576.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$823.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$823.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,070.55
|
|
|
NOBELZYGOMA 45D 42.5MM
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
64907367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$823.50 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$823.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$823.50
|
|
