|
TROPICAMIDE 1% OPHTHALMIC SOLN 15 ML
|
Facility
OP
|
$10.74
|
|
| Hospital Charge Code |
41641943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Government |
$5.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.30
|
| Rate for Payer: Group Health Inc Commercial |
$5.37
|
| Rate for Payer: Group Health Inc Medicare |
$3.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.98
|
|
|
TROPICAMIDE 1% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41654321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
TROPICAMIDE 1% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41644321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
TROPONIN I (IN-HOUSE)
|
Facility
OP
|
$31.18
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
40602036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.47
|
| Rate for Payer: Aetna Government |
$12.47
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.47
|
| Rate for Payer: EmblemHealth Commercial |
$12.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.10
|
| Rate for Payer: Group Health Inc Commercial |
$12.47
|
| Rate for Payer: Group Health Inc Medicare |
$12.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.47
|
| Rate for Payer: Healthfirst QHP |
$12.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.98
|
| Rate for Payer: Wellcare Medicare |
$11.22
|
|
|
TRTMNT HUMERUS FRACTURE W/O MANIP
|
Facility
OP
|
$917.80
|
|
| Hospital Charge Code |
30103068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$458.90
|
| Rate for Payer: Aetna Government |
$458.90
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$458.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
TRTMNT. OF ROOT CANAL OBSTRUCTION
|
Facility
OP
|
$425.25
|
|
|
Service Code
|
HCPCS D3331
|
| Hospital Charge Code |
42303303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
TRUCLEAR INCIS PLUS BLADE 2.9
|
Facility
OP
|
$1,773.75
|
|
| Hospital Charge Code |
64905902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$620.81 |
| Max. Negotiated Rate |
$1,419.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$975.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$886.88
|
| Rate for Payer: Aetna Government |
$886.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,419.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,206.15
|
| Rate for Payer: Group Health Inc Commercial |
$886.88
|
| Rate for Payer: Group Health Inc Medicare |
$620.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$886.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$886.88
|
|
|
TRUCLEAR ULTRA RECIPROCATING
|
Facility
OP
|
$2,378.75
|
|
| Hospital Charge Code |
64905960
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$832.56 |
| Max. Negotiated Rate |
$1,903.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,308.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,189.38
|
| Rate for Payer: Aetna Government |
$1,189.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,903.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,617.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,189.38
|
| Rate for Payer: Group Health Inc Medicare |
$832.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,189.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,189.38
|
|
|
TRUE CLONE THOR 11 VENT
|
Facility
OP
|
$600.00
|
|
| Hospital Charge Code |
64903535
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
TRUE CLONE THOR 13 VENT
|
Facility
OP
|
$570.00
|
|
| Hospital Charge Code |
64903537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.00
|
| Rate for Payer: Aetna Government |
$285.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$456.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.60
|
| Rate for Payer: Group Health Inc Commercial |
$285.00
|
| Rate for Payer: Group Health Inc Medicare |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.00
|
|
|
TRV CUT BIOPSY NEEDLE
|
Facility
OP
|
$35.08
|
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.54
|
| Rate for Payer: Aetna Government |
$17.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.85
|
| Rate for Payer: Group Health Inc Commercial |
$17.54
|
| Rate for Payer: Group Health Inc Medicare |
$12.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.54
|
|
|
TRYPAN BLUE
|
Facility
OP
|
$69.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$45.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.90
|
| Rate for Payer: Aetna Government |
$34.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.14
|
| Rate for Payer: Group Health Inc Commercial |
$34.90
|
| Rate for Payer: Group Health Inc Medicare |
$24.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.37
|
|
|
TRYPAN BLUE
|
Facility
IP
|
$69.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.90
|
|
|
TRYPAN BLUE
|
Facility
OP
|
$69.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$45.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.90
|
| Rate for Payer: Aetna Government |
$34.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.14
|
| Rate for Payer: Group Health Inc Commercial |
$34.90
|
| Rate for Payer: Group Health Inc Medicare |
$24.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.37
|
|
|
TRYPAN BLUE
|
Facility
IP
|
$69.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.90
|
|
|
TRYPAN BLUE SYRINGE
|
Facility
OP
|
$133.50
|
|
| Hospital Charge Code |
64904352
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$106.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.75
|
| Rate for Payer: Aetna Government |
$66.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.78
|
| Rate for Payer: Group Health Inc Commercial |
$66.75
|
| Rate for Payer: Group Health Inc Medicare |
$46.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.75
|
|
|
TRYPTASE_
|
Facility
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
TSFB-35-260 BENSTON WIRE .035
|
Facility
OP
|
$46.97
|
|
| Hospital Charge Code |
64905028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.48
|
| Rate for Payer: Aetna Government |
$23.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.94
|
| Rate for Payer: Group Health Inc Commercial |
$23.48
|
| Rate for Payer: Group Health Inc Medicare |
$16.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.48
|
|
|
TSH
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
40609123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
TSH RECEPTOR ANTIBODY
|
Facility
OP
|
$35.30
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30303377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.12
|
| Rate for Payer: EmblemHealth Commercial |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.57
|
| Rate for Payer: Group Health Inc Commercial |
$14.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.12
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.30
|
| Rate for Payer: Wellcare Medicare |
$12.71
|
|
|
TSH (THRID STIM HRM)QUAN SERUM
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
40602350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
T-SPLITTER
|
Facility
OP
|
$2,038.75
|
|
| Hospital Charge Code |
64907307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$713.56 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,121.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,019.38
|
| Rate for Payer: Aetna Government |
$1,019.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,631.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,386.35
|
| Rate for Payer: Group Health Inc Commercial |
$1,019.38
|
| Rate for Payer: Group Health Inc Medicare |
$713.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,019.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,019.38
|
|
|
T-TRANSGLUTAMINASE (TTG) IGA
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40609087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
T-TRANSGLUTAMINASE (TTG) IGG
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40609088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
TUBE BLAKEMORE ESOPH/GASTR
|
Facility
OP
|
$758.30
|
|
| Hospital Charge Code |
64901668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.40 |
| Max. Negotiated Rate |
$606.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$417.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$379.15
|
| Rate for Payer: Aetna Government |
$379.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$606.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$515.64
|
| Rate for Payer: Group Health Inc Commercial |
$379.15
|
| Rate for Payer: Group Health Inc Medicare |
$265.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.15
|
|
