|
TBA_EA_ADD_ARTERY_(NOT LE)
|
Facility
OP
|
$487.45
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
66574712
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.71
|
| Rate for Payer: Aetna Government |
$191.71
|
| 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: Fidelis CHP/HARP/Medicaid |
$192.25
|
| Rate for Payer: Group Health Inc Commercial |
$243.72
|
| Rate for Payer: Group Health Inc Medicare |
$170.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.61
|
|
|
TBA EA ADD ART (NOT DIALYSIS)
|
Facility
OP
|
$414.93
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
66524707
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.16
|
| Rate for Payer: Aetna Government |
$163.16
|
| 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: Fidelis CHP/HARP/Medicaid |
$159.26
|
| Rate for Payer: Group Health Inc Commercial |
$207.46
|
| Rate for Payer: Group Health Inc Medicare |
$145.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.96
|
|
|
TBA EA ADD ART (NOT DIALYSIS)
|
Facility
OP
|
$414.93
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
40034513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.16
|
| Rate for Payer: Aetna Government |
$163.16
|
| 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: Fidelis CHP/HARP/Medicaid |
$159.26
|
| Rate for Payer: Group Health Inc Commercial |
$207.46
|
| Rate for Payer: Group Health Inc Medicare |
$145.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.96
|
|
|
TBA_EA_ADD_ART_(NOT DIALYSIS)
|
Facility
OP
|
$414.93
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
66574714
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.16
|
| Rate for Payer: Aetna Government |
$163.16
|
| 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: Fidelis CHP/HARP/Medicaid |
$159.26
|
| Rate for Payer: Group Health Inc Commercial |
$207.46
|
| Rate for Payer: Group Health Inc Medicare |
$145.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.96
|
|
|
TBA PERIPH DIALYSIS SEGMENT
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
40034517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.08 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA PERIPH DIALYSIS SEGMENT
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
66524701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.08 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA_PERIPH_DIALYSIS_SEGMENT
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
66574708
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.08 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
T-BINDERS
|
Facility
OP
|
$2.48
|
|
| Hospital Charge Code |
40000375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
|
|
TB INTRADERMAL TEST
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
30305685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Amida Care Medicaid |
$5.05
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$5.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.05
|
| Rate for Payer: SOMOS Essential |
$5.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
TB INTRADERMAL TEST
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
40618196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Amida Care Medicaid |
$5.05
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$5.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.05
|
| Rate for Payer: SOMOS Essential |
$5.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
TB TINE TEST
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
40618197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Amida Care Medicaid |
$5.05
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: Healthfirst Essential Plan |
$5.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.05
|
| Rate for Payer: SOMOS Essential |
$5.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
TC-99M DMSA
|
Facility
OP
|
$1,279.35
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
41646583
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$447.77 |
| Max. Negotiated Rate |
$1,023.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$703.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$496.32
|
| Rate for Payer: Aetna Government |
$496.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,023.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$869.96
|
| Rate for Payer: Group Health Inc Commercial |
$639.68
|
| Rate for Payer: Group Health Inc Medicare |
$447.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$639.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$639.68
|
|
|
TC-99M DMSA
|
Facility
OP
|
$1,279.35
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
41656583
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$447.77 |
| Max. Negotiated Rate |
$1,023.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$703.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$496.32
|
| Rate for Payer: Aetna Government |
$496.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,023.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$869.96
|
| Rate for Payer: Group Health Inc Commercial |
$639.68
|
| Rate for Payer: Group Health Inc Medicare |
$447.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$639.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$639.68
|
|
|
TC-99M MAA
|
Facility
OP
|
$54.57
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
41646578
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.84
|
| Rate for Payer: Aetna Government |
$24.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.11
|
| Rate for Payer: Group Health Inc Commercial |
$27.28
|
| Rate for Payer: Group Health Inc Medicare |
$19.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.28
|
|
|
TC-99M MAA
|
Facility
OP
|
$54.57
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
41656578
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.84
|
| Rate for Payer: Aetna Government |
$24.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.11
|
| Rate for Payer: Group Health Inc Commercial |
$27.28
|
| Rate for Payer: Group Health Inc Medicare |
$19.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.28
|
|
|
TC-99M PENTETATE
|
Facility
OP
|
$7.35
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
41646576
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Government |
$25.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.68
|
| Rate for Payer: Group Health Inc Medicare |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.68
|
|
|
TC-99M PENTETATE
|
Facility
OP
|
$7.35
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
41656576
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Government |
$25.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.68
|
| Rate for Payer: Group Health Inc Medicare |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.68
|
|
|
TC-99M PENTETATE AEROSOL
|
Facility
OP
|
$6.12
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
41656577
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna Government |
$3.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
TC-99M PENTETATE AEROSOL
|
Facility
OP
|
$6.12
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
41646577
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna Government |
$3.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
TCD EMBOLI DETCT W/INJ
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93893 TC
|
| Hospital Charge Code |
41301523
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$415.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.56
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$415.07
|
|
|
TCD EMBOLI DETECT W/O INJ
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93892 TC
|
| Hospital Charge Code |
41301522
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$322.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.02
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.25
|
|
|
TCD VASOREACTIVITY STUDY
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93890 TC
|
| Hospital Charge Code |
41301521
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$247.04 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.17
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.41
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
OP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
40629622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.98
|
| Rate for Payer: Aetna Government |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.98
|
| Rate for Payer: EmblemHealth Commercial |
$46.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.81
|
| Rate for Payer: Group Health Inc Commercial |
$46.98
|
| Rate for Payer: Group Health Inc Medicare |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.98
|
| Rate for Payer: Healthfirst QHP |
$46.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.58
|
| Rate for Payer: Wellcare Medicare |
$42.28
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
OP
|
$117.45
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
30305610
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.98
|
| Rate for Payer: Aetna Government |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.98
|
| Rate for Payer: EmblemHealth Commercial |
$46.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.81
|
| Rate for Payer: Group Health Inc Commercial |
$46.98
|
| Rate for Payer: Group Health Inc Medicare |
$46.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.98
|
| Rate for Payer: Healthfirst QHP |
$46.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.58
|
| Rate for Payer: Wellcare Medicare |
$42.28
|
|
|
TDAP (VFC) 0.5ML IM SYR
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41659570
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.80
|
| Rate for Payer: Aetna Government |
$35.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: SOMOS Essential |
$41.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
