|
THROMBIN_TIME
|
Facility
OP
|
$14.43
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
40629225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna Government |
$5.77
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.77
|
| Rate for Payer: EmblemHealth Commercial |
$5.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.77
|
| Rate for Payer: Group Health Inc Medicare |
$5.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.77
|
| Rate for Payer: Healthfirst QHP |
$5.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.62
|
| Rate for Payer: Wellcare Medicare |
$5.19
|
|
|
THROMBIN TOPICAL 5000 UNITS
|
Facility
OP
|
$116.64
|
|
| Hospital Charge Code |
41644943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.32
|
| Rate for Payer: Aetna Government |
$58.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.32
|
| Rate for Payer: Group Health Inc Commercial |
$58.32
|
| Rate for Payer: Group Health Inc Medicare |
$40.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.82
|
|
|
THROMBIN TOPICAL 5000 UNITS
|
Facility
OP
|
$116.64
|
|
| Hospital Charge Code |
41654943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.32
|
| Rate for Payer: Aetna Government |
$58.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.32
|
| Rate for Payer: Group Health Inc Commercial |
$58.32
|
| Rate for Payer: Group Health Inc Medicare |
$40.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.82
|
|
|
THROMBO ART/VEN THERAPY
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
41102811
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.18 |
| Max. Negotiated Rate |
$3,686.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
THROMBOENDARTARECTOMY-BRACHIAL
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 35321
|
| Hospital Charge Code |
40039588
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,023.11 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,023.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,136.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
THROMBOENDARTARECTOMY CAROTID
|
Facility
OP
|
$6,846.53
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
40033203
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,290.82 |
| Max. Negotiated Rate |
$3,765.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,765.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,290.82
|
| Rate for Payer: Aetna Government |
$1,290.82
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,293.51
|
| Rate for Payer: Group Health Inc Commercial |
$3,423.26
|
| Rate for Payer: Group Health Inc Medicare |
$2,396.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,423.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,423.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,437.23
|
|
|
THROMBOENDARTERECTOMY AORTO ILIAC
|
Facility
OP
|
$4,705.60
|
|
|
Service Code
|
HCPCS 35361
|
| Hospital Charge Code |
40039872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,588.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,753.55
|
| Rate for Payer: Aetna Government |
$1,753.55
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,742.09
|
| Rate for Payer: Group Health Inc Commercial |
$2,352.80
|
| Rate for Payer: Group Health Inc Medicare |
$1,646.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,352.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,352.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,935.66
|
|
|
THROMBOENDARTERECTOMY ILIAC
|
Facility
OP
|
$3,838.38
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
40039871
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,343.43 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,111.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,460.16
|
| Rate for Payer: Aetna Government |
$1,460.16
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,466.03
|
| Rate for Payer: Group Health Inc Commercial |
$1,919.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,343.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,919.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,919.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,628.92
|
|
|
THROMBOPLASTIN TIME PARTIAL
|
Facility
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
40629621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
THROMBO VENOUS THERAPY
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
41102606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.69 |
| Max. Negotiated Rate |
$4,196.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
40034519
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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 |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
THROMB+TBA PERIPH DIALYSIS SEG
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
40034507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.43 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
THROMB+TBA PERIPH DIALYSIS SEG
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
66524702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.43 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
THROMB+TBA_PERIPH_DIALYSIS_SEG
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
66574709
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.43 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
THRYOID STIM IMMUNOGLOBULIN
|
Facility
OP
|
$127.15
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
40609124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$80.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.86
|
| Rate for Payer: Aetna Government |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$50.86
|
| Rate for Payer: EmblemHealth Commercial |
$50.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.27
|
| Rate for Payer: Group Health Inc Commercial |
$50.86
|
| Rate for Payer: Group Health Inc Medicare |
$50.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.86
|
| Rate for Payer: Healthfirst QHP |
$50.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.69
|
| Rate for Payer: Wellcare Medicare |
$45.77
|
|
|
THUMB FCPS 6/15.2CM SERRATED
|
Facility
OP
|
$17.38
|
|
| Hospital Charge Code |
64905676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.69
|
| Rate for Payer: Aetna Government |
$8.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.82
|
| Rate for Payer: Group Health Inc Commercial |
$8.69
|
| Rate for Payer: Group Health Inc Medicare |
$6.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.69
|
|
|
THUMBWHEEL MICRO LENGTHENER
|
Facility
OP
|
$368.88
|
|
| Hospital Charge Code |
64904844
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$295.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$202.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.44
|
| Rate for Payer: Aetna Government |
$184.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$295.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$250.84
|
| Rate for Payer: Group Health Inc Commercial |
$184.44
|
| Rate for Payer: Group Health Inc Medicare |
$129.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.44
|
|
|
THUMBWHEEL TELSCPC
|
Facility
OP
|
$354.90
|
|
| Hospital Charge Code |
64907407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$283.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$177.45
|
| Rate for Payer: Aetna Government |
$177.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$283.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$241.33
|
| Rate for Payer: Group Health Inc Commercial |
$177.45
|
| Rate for Payer: Group Health Inc Medicare |
$124.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.45
|
|
|
THYROGLOBULIN
|
Facility
OP
|
$552.45
|
|
| Hospital Charge Code |
64902740
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$441.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$276.22
|
| Rate for Payer: Aetna Government |
$276.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.67
|
| Rate for Payer: Group Health Inc Commercial |
$276.22
|
| Rate for Payer: Group Health Inc Medicare |
$193.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.22
|
|
|
THYROGLOBULIN ANTIBODY
|
Facility
OP
|
$39.78
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
40609150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.91
|
| Rate for Payer: Aetna Government |
$15.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.91
|
| Rate for Payer: EmblemHealth Commercial |
$15.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.16
|
| Rate for Payer: Group Health Inc Commercial |
$15.91
|
| Rate for Payer: Group Health Inc Medicare |
$15.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.91
|
| Rate for Payer: Healthfirst QHP |
$15.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.73
|
| Rate for Payer: Wellcare Medicare |
$14.32
|
|
|
THYROGLOBULIN & ATA
|
Facility
OP
|
$39.78
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
40608039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.91
|
| Rate for Payer: Aetna Government |
$15.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.91
|
| Rate for Payer: EmblemHealth Commercial |
$15.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.16
|
| Rate for Payer: Group Health Inc Commercial |
$15.91
|
| Rate for Payer: Group Health Inc Medicare |
$15.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.91
|
| Rate for Payer: Healthfirst QHP |
$15.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.73
|
| Rate for Payer: Wellcare Medicare |
$14.32
|
|
|
THYROID 15MG TAB
|
Facility
OP
|
$0.19
|
|
| Hospital Charge Code |
41658412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
THYROID 15MG TAB
|
Facility
OP
|
$0.19
|
|
| Hospital Charge Code |
41648412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
THYROID ANTIBODIES
|
Facility
OP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40729346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
THYROID CA/METS WHOLE BODY
|
Facility
OP
|
$1,429.50
|
|
|
Service Code
|
HCPCS 78018 TC
|
| Hospital Charge Code |
41505012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$280.04 |
| Max. Negotiated Rate |
$1,143.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$714.75
|
| Rate for Payer: Aetna Government |
$714.75
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,143.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$972.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.04
|
| Rate for Payer: Group Health Inc Commercial |
$714.75
|
| Rate for Payer: Group Health Inc Medicare |
$500.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.16
|
|
