|
TRIGEMINAL NERVE
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64600
|
| Hospital Charge Code |
30305724
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
TRIGLYCERIDES FLUID
|
Facility
OP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40609738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.74
|
| Rate for Payer: EmblemHealth Commercial |
$5.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.74
|
| Rate for Payer: Healthfirst QHP |
$5.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.59
|
| Rate for Payer: Wellcare Medicare |
$5.17
|
|
|
TRIGLYCERIDES QUANTITATION
|
Facility
OP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40602485
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.74
|
| Rate for Payer: EmblemHealth Commercial |
$5.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.74
|
| Rate for Payer: Healthfirst QHP |
$5.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.59
|
| Rate for Payer: Wellcare Medicare |
$5.17
|
|
|
TRIHEXYPHENIDYL 2 MG/5 ML ELIXIR
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41643617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
TRIHEXYPHENIDYL 2 MG/5 ML ELIXIR
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41653617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
TRIHEXYPHENIDYL 2 MG TAB
|
Facility
OP
|
$0.39
|
|
| Hospital Charge Code |
41653458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TRIHEXYPHENIDYL 2 MG TAB
|
Facility
OP
|
$0.39
|
|
| Hospital Charge Code |
41643458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TRIHEXYPHENIDYL 5 MG TAB
|
Facility
OP
|
$0.97
|
|
| Hospital Charge Code |
41643459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
TRIHEXYPHENIDYL 5 MG TAB
|
Facility
OP
|
$0.97
|
|
| Hospital Charge Code |
41653459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
TRIIODOTHYRONINE,FREE,SERUM
|
Facility
OP
|
$42.35
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
40609126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.94
|
| Rate for Payer: Aetna Government |
$16.94
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$16.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$16.94
|
| Rate for Payer: Group Health Inc Medicare |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.94
|
| Rate for Payer: Healthfirst QHP |
$16.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$15.25
|
|
|
TRIM NAIL(S)
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
30300162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM NAILS
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
42500144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM NAIL(S) DYSTROPHIC
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
30303054
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM SKIN LESION
|
Facility
OP
|
$502.69
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
30301100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TRIM SKIN LESIONS 2-4
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
30305439
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TRIM SKIN LESIONS >4
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
30305440
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TRINICA PLATE 20MM
|
Facility
IP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.00
|
|
|
TRINICA PLATE 20MM
|
Facility
OP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,187.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.00
|
| 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 |
$2,470.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,840.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,187.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,211.00
|
|
|
TRIPLE DYE STICK
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
TRIPLE DYE STICK
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
Triple Lumen Cath.
|
Facility
OP
|
$88.60
|
|
| Hospital Charge Code |
40206025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.30
|
| Rate for Payer: Aetna Government |
$44.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.25
|
| Rate for Payer: Group Health Inc Commercial |
$44.30
|
| Rate for Payer: Group Health Inc Medicare |
$31.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.30
|
|
|
TRISMUS APPLIANCE (NOT FOR TMD TR
|
Facility
OP
|
$362.50
|
|
|
Service Code
|
HCPCS D5937
|
| Hospital Charge Code |
42301320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.43
|
| Rate for Payer: Aetna Government |
$242.43
|
| 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: Group Health Inc Commercial |
$181.25
|
| Rate for Payer: Group Health Inc Medicare |
$126.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.25
|
|
|
TRI-STAPLER 2.0 45 MED THICK
|
Facility
OP
|
$9,278.40
|
|
| Hospital Charge Code |
40008319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,247.44 |
| Max. Negotiated Rate |
$7,422.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,103.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,639.20
|
| Rate for Payer: Aetna Government |
$4,639.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,422.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,309.31
|
| Rate for Payer: Group Health Inc Commercial |
$4,639.20
|
| Rate for Payer: Group Health Inc Medicare |
$3,247.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,639.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,639.20
|
|
|
TRIVANTAGE TUBE
|
Facility
OP
|
$822.50
|
|
| Hospital Charge Code |
64905130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$287.88 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$452.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$411.25
|
| Rate for Payer: Aetna Government |
$411.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$658.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$559.30
|
| Rate for Payer: Group Health Inc Commercial |
$411.25
|
| Rate for Payer: Group Health Inc Medicare |
$287.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.25
|
|
|
TRLUML PERIP ATHRC BRCHIOCPH
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
40034271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| 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 |
$1,505.00
|
| 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 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
|
|
