|
TUBE VACUT STRL BLUE 1.8ML
|
Facility
OP
|
$126.23
|
|
| Hospital Charge Code |
64902805
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.12
|
| Rate for Payer: Aetna Government |
$63.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$100.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.84
|
| Rate for Payer: Group Health Inc Commercial |
$63.12
|
| Rate for Payer: Group Health Inc Medicare |
$44.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.12
|
|
|
TUBE VENTD BVL'D GRMMT SZ 1 1.14
|
Facility
OP
|
$28.40
|
|
| Hospital Charge Code |
64906758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.20
|
| Rate for Payer: Aetna Government |
$14.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.31
|
| Rate for Payer: Group Health Inc Commercial |
$14.20
|
| Rate for Payer: Group Health Inc Medicare |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.20
|
|
|
TUBE VENT FLURO WHT BEVEL 1.14MM
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
64906680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.00
|
| Rate for Payer: Aetna Government |
$135.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$216.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$183.60
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
TUBING, ARTHROSCOPY
|
Facility
OP
|
$3,116.00
|
|
| Hospital Charge Code |
40203150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,090.60 |
| Max. Negotiated Rate |
$2,492.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,713.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,558.00
|
| Rate for Payer: Aetna Government |
$1,558.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,492.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,118.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,558.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,090.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,558.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.00
|
|
|
TUBING INFLOW CASSETTE
|
Facility
OP
|
$168.20
|
|
| Hospital Charge Code |
64907375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.10
|
| Rate for Payer: Aetna Government |
$84.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$134.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.38
|
| Rate for Payer: Group Health Inc Commercial |
$84.10
|
| Rate for Payer: Group Health Inc Medicare |
$58.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.10
|
|
|
TUBING INSUFFLATION SET
|
Facility
OP
|
$316.97
|
|
| Hospital Charge Code |
64904268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.94 |
| Max. Negotiated Rate |
$253.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$158.48
|
| Rate for Payer: Aetna Government |
$158.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$253.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.54
|
| Rate for Payer: Group Health Inc Commercial |
$158.48
|
| Rate for Payer: Group Health Inc Medicare |
$110.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.48
|
|
|
TUBING IRRIGATION B/POLAR
|
Facility
OP
|
$106.00
|
|
| Hospital Charge Code |
40205972
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$84.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.00
|
| Rate for Payer: Aetna Government |
$53.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.08
|
| Rate for Payer: Group Health Inc Commercial |
$53.00
|
| Rate for Payer: Group Health Inc Medicare |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.00
|
|
|
TUBING, IRRIGATION SET
|
Facility
OP
|
$2,586.00
|
|
| Hospital Charge Code |
40203156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$905.10 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,422.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,293.00
|
| Rate for Payer: Aetna Government |
$1,293.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,068.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,758.48
|
| Rate for Payer: Group Health Inc Commercial |
$1,293.00
|
| Rate for Payer: Group Health Inc Medicare |
$905.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.00
|
|
|
TUBING IRRIG STRGHT SHOT XPS
|
Facility
OP
|
$74.00
|
|
| Hospital Charge Code |
64906926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.00
|
| Rate for Payer: Aetna Government |
$37.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.32
|
| Rate for Payer: Group Health Inc Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
|
|
TUBING OUTFLOW CASSETTE
|
Facility
OP
|
$155.40
|
|
| Hospital Charge Code |
64907376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.70
|
| Rate for Payer: Aetna Government |
$77.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.67
|
| Rate for Payer: Group Health Inc Commercial |
$77.70
|
| Rate for Payer: Group Health Inc Medicare |
$54.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.70
|
|
|
TUBING SUCTION 3/16 X 12
|
Facility
OP
|
$2.48
|
|
| Hospital Charge Code |
64906822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
|
|
TUBING,SUCTION/IRRIGATION,4
|
Facility
OP
|
$186.26
|
|
| Hospital Charge Code |
64905912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.13
|
| Rate for Payer: Aetna Government |
$93.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$149.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.66
|
| Rate for Payer: Group Health Inc Commercial |
$93.13
|
| Rate for Payer: Group Health Inc Medicare |
$65.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.13
|
|
|
TUBNG FLUD SAFE INTGRA0502200000A
|
Facility
OP
|
$850.00
|
|
| Hospital Charge Code |
64906446
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$467.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$425.00
|
| Rate for Payer: Aetna Government |
$425.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$680.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$578.00
|
| Rate for Payer: Group Health Inc Commercial |
$425.00
|
| Rate for Payer: Group Health Inc Medicare |
$297.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.00
|
|
|
TULANT IMPLANT 9 MM
|
Facility
OP
|
$1,500.00
|
|
| Hospital Charge Code |
40200335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$750.00
|
| Rate for Payer: Aetna Government |
$750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,020.00
|
| Rate for Payer: Group Health Inc Commercial |
$750.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
|
TULIP, RELINE MOD
|
Facility
OP
|
$2,990.63
|
|
| Hospital Charge Code |
64906130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,046.72 |
| Max. Negotiated Rate |
$2,392.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,644.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,495.32
|
| Rate for Payer: Aetna Government |
$1,495.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,392.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,033.63
|
| Rate for Payer: Group Health Inc Commercial |
$1,495.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,046.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.32
|
|
|
TUMOR FINGER
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
40021745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$419.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Hospital Charge Code |
30305429
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.32
|
| Rate for Payer: Aetna Government |
$217.32
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$347.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$295.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.72
|
| Rate for Payer: Group Health Inc Commercial |
$217.32
|
| Rate for Payer: Group Health Inc Medicare |
$152.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.25
|
|
|
TUNNELERS,A/V ACCESS 12/30.5CM
|
Facility
OP
|
$1,295.00
|
|
| Hospital Charge Code |
64905734
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$712.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$647.50
|
| Rate for Payer: Aetna Government |
$647.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,036.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$880.60
|
| Rate for Payer: Group Health Inc Commercial |
$647.50
|
| Rate for Payer: Group Health Inc Medicare |
$453.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$647.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$647.50
|
|
|
TURB BLADDER TUMOR
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
40123045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.87 |
| Max. Negotiated Rate |
$6,408.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
TURB MEDIUM TUMOR 0.5-2.0 CM
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
40129679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.79 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
TURB MEDIUM TUMOR 2.0-5.0CM
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
40129813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.06 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$341.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
TURBOVAC SUPER
|
Facility
OP
|
$412.50
|
|
| Hospital Charge Code |
64904554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
TUR PROSTATE
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
40123050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$6,408.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
TUR SET
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40206050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
TUR SET-2C4002
|
Facility
OP
|
$7.80
|
|
| Hospital Charge Code |
40000410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.90
|
| Rate for Payer: Aetna Government |
$3.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$3.90
|
| Rate for Payer: Group Health Inc Medicare |
$2.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.90
|
|
