|
TRACHEOTOMY TUBE (SHILEY)
|
Facility
OP
|
$90.00
|
|
| Hospital Charge Code |
40206047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.00
|
| Rate for Payer: Aetna Government |
$45.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.20
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
TRACHEOTOMY TUBING #72
|
Facility
OP
|
$126.51
|
|
| Hospital Charge Code |
40206006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$101.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.26
|
| Rate for Payer: Aetna Government |
$63.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.03
|
| Rate for Payer: Group Health Inc Commercial |
$63.26
|
| Rate for Payer: Group Health Inc Medicare |
$44.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.26
|
|
|
TRACHETOMY CLEANING SET
|
Facility
OP
|
$18.78
|
|
| Hospital Charge Code |
40206040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
TRACH PUNCT, PERC W TT ASP OR INJ
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 31612
|
| Hospital Charge Code |
30103313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,723.23
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
TRACH TUBE
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
40306213
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
TRACTION SET UP
|
Facility
OP
|
$25.52
|
|
| Hospital Charge Code |
40207622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
TRAMADOL
|
Facility
OP
|
$49.93
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
40609881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.95
|
| Rate for Payer: Group Health Inc Commercial |
$24.96
|
| Rate for Payer: Group Health Inc Medicare |
$17.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.96
|
|
|
TRAMADOL 50 MG TAB
|
Facility
OP
|
$0.12
|
|
| Hospital Charge Code |
41643851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
TRAMADOL 50 MG TAB
|
Facility
OP
|
$0.12
|
|
| Hospital Charge Code |
41653851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
TRAMADOL + METABOLITES, URINE
|
Facility
OP
|
$49.93
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
40609023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.95
|
| Rate for Payer: Group Health Inc Commercial |
$24.96
|
| Rate for Payer: Group Health Inc Medicare |
$17.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.96
|
|
|
TRAMA RESP W/CRITICAL CARE
|
Facility
OP
|
$2,744.13
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
30102509
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,266.61 |
| Max. Negotiated Rate |
$2,195.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,509.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,583.26
|
| Rate for Payer: Aetna Government |
$1,583.26
|
| Rate for Payer: Cash Price |
$1,583.26
|
| Rate for Payer: Cash Price |
$1,583.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,583.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,195.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,866.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,583.26
|
| Rate for Payer: EmblemHealth Commercial |
$1,583.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,345.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,409.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,409.10
|
| Rate for Payer: Group Health Inc Commercial |
$1,583.26
|
| Rate for Payer: Group Health Inc Medicare |
$1,583.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,372.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,583.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,345.77
|
| Rate for Payer: Healthfirst QHP |
$1,583.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,583.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,583.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,266.61
|
| Rate for Payer: Wellcare Medicare |
$1,504.10
|
|
|
TRANEXAMIC ACID 100 MG/10 ML INJ
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
41646087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.00
|
| Rate for Payer: Aetna Government |
$70.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Group Health Inc Commercial |
$70.00
|
| Rate for Payer: Group Health Inc Medicare |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.00
|
|
|
TRANEXAMIC ACID 100 MG/10ML INJ
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
41656087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.00
|
| Rate for Payer: Aetna Government |
$70.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Group Health Inc Commercial |
$70.00
|
| Rate for Payer: Group Health Inc Medicare |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.00
|
|
|
Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography
|
Facility
OP
|
$3,615.39
|
|
|
Service Code
|
CPT 58345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.91 |
| Max. Negotiated Rate |
$3,615.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
TRANSDUCER BELTS E9005BA
|
Facility
OP
|
$2.46
|
|
| Hospital Charge Code |
64902368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
|
|
TRANSDUCER DOUBLE LUER LOCK505343
|
Facility
OP
|
$0.50
|
|
| Hospital Charge Code |
40209482
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
|
TRANSDUCER FILTER
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
42905080
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
Transection or avulsion of other spinal nerve, extradural
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 64772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$636.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$707.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAM
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
41118923
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.30
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAM
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
40802500
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.30
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
41508705
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.30
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
|
|
TRANSESOPHAGEAL ECHO W/BUB SETTIN
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
40804116
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.30
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
|
|
TRANSESOPHAGEAL ECHO W/BUB SETTIN
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
41506554
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.30
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
|
|
TRANSFERRIN_
|
Facility
OP
|
$31.90
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
40609125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.76
|
| Rate for Payer: EmblemHealth Commercial |
$12.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.36
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.76
|
| Rate for Payer: Healthfirst QHP |
$12.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.21
|
| Rate for Payer: Wellcare Medicare |
$11.48
|
|
|
TRANSFIXING PINS
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$224.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.70
|
| Rate for Payer: Group Health Inc Commercial |
$107.00
|
| Rate for Payer: Group Health Inc Medicare |
$74.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.10
|
|
