|
ZZ NM I-123 CAPSULE
|
Facility
OP
|
$68.48
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
41568593
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$1,497.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,497.44
|
| Rate for Payer: Aetna Government |
$1,497.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.57
|
| Rate for Payer: Group Health Inc Commercial |
$34.24
|
| Rate for Payer: Group Health Inc Medicare |
$23.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.24
|
|
|
ZZ NM I-131 CAPSULE/1-6MCI
|
Facility
OP
|
$241.38
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
41568594
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$193.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.34
|
| Rate for Payer: Aetna Government |
$21.34
|
| Rate for Payer: Brighton Health Commercial |
$21.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.34
|
| Rate for Payer: EmblemHealth Commercial |
$21.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.99
|
| Rate for Payer: Group Health Inc Commercial |
$21.34
|
| Rate for Payer: Group Health Inc Medicare |
$21.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$21.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.07
|
| Rate for Payer: Wellcare Medicare |
$20.27
|
|
|
ZZ NM I-131 CAPSULE ADD'L MCI
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
41568595
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.34
|
| Rate for Payer: Aetna Government |
$21.34
|
| Rate for Payer: Brighton Health Commercial |
$21.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$89.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.34
|
| Rate for Payer: EmblemHealth Commercial |
$21.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.99
|
| Rate for Payer: Group Health Inc Commercial |
$21.34
|
| Rate for Payer: Group Health Inc Medicare |
$21.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$21.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.07
|
| Rate for Payer: Wellcare Medicare |
$20.27
|
|
|
ZZ NM INDIUM IN-111 AUTO WBC
|
Facility
OP
|
$1,472.50
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
41567751
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$515.38 |
| Max. Negotiated Rate |
$2,961.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$809.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,961.14
|
| Rate for Payer: Aetna Government |
$2,961.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,178.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,001.30
|
| Rate for Payer: Group Health Inc Commercial |
$736.25
|
| Rate for Payer: Group Health Inc Medicare |
$515.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$736.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$736.25
|
|
|
ZZ NM INDIUM IN-111 PENTETREOTIDE
|
Facility
OP
|
$1,472.50
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
41567752
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$515.38 |
| Max. Negotiated Rate |
$2,961.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$809.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,961.14
|
| Rate for Payer: Aetna Government |
$2,961.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,178.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,001.30
|
| Rate for Payer: Group Health Inc Commercial |
$736.25
|
| Rate for Payer: Group Health Inc Medicare |
$515.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$736.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$736.25
|
|
|
ZZ NM LEXISCAN (REGADENOSON) INJ
|
Facility
OP
|
$534.30
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
41505953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$347.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$293.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.70
|
| Rate for Payer: Aetna Government |
$59.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$267.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$307.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.05
|
| Rate for Payer: Group Health Inc Commercial |
$267.15
|
| Rate for Payer: Group Health Inc Medicare |
$187.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.47
|
| Rate for Payer: SOMOS Essential |
$7.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.30
|
|
|
ZZ NM LEXISCAN (REGADENOSON) INJ
|
Facility
IP
|
$534.30
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
41505953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.15 |
| Max. Negotiated Rate |
$267.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.15
|
|
|
ZZ NM-MDP-TC04
|
Facility
OP
|
$31.18
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
41568582
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$24.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.76
|
| Rate for Payer: Aetna Government |
$10.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.20
|
| Rate for Payer: Group Health Inc Commercial |
$15.59
|
| Rate for Payer: Group Health Inc Medicare |
$10.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.59
|
|
|
ZZ NM MEBROFENIN VIAL
|
Facility
OP
|
$82.34
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
41568603
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$65.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.80
|
| Rate for Payer: Aetna Government |
$45.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.99
|
| Rate for Payer: Group Health Inc Commercial |
$41.17
|
| Rate for Payer: Group Health Inc Medicare |
$28.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.17
|
|
|
ZZ NM PYP
|
Facility
OP
|
$55.80
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
41568599
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$44.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.40
|
| Rate for Payer: Aetna Government |
$41.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.94
|
| Rate for Payer: Group Health Inc Commercial |
$27.90
|
| Rate for Payer: Group Health Inc Medicare |
$19.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.90
|
|
|
ZZ NM-RBC-TC04
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
41568583
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.34
|
| Rate for Payer: Aetna Government |
$77.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Group Health Inc Commercial |
$87.50
|
| Rate for Payer: Group Health Inc Medicare |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
|
ZZ NM SULFUX COLLOID/FILTERED
|
Facility
OP
|
$95.14
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
41568588
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$221.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$221.38
|
| Rate for Payer: Aetna Government |
$221.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.70
|
| Rate for Payer: Group Health Inc Commercial |
$47.57
|
| Rate for Payer: Group Health Inc Medicare |
$33.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.57
|
|
|
ZZ NM SULFUX COLLOID/NON-FILTERED
|
Facility
OP
|
$31.16
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
41568589
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$221.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$221.38
|
| Rate for Payer: Aetna Government |
$221.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.19
|
| Rate for Payer: Group Health Inc Commercial |
$15.58
|
| Rate for Payer: Group Health Inc Medicare |
$10.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.58
|
|
|
ZZ NM TC-04(TC-99N)
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
41568608
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.34
|
| Rate for Payer: Aetna Government |
$77.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Group Health Inc Commercial |
$87.50
|
| Rate for Payer: Group Health Inc Medicare |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
|
ZZ NM TC-99M BICISATE, A DOSE
|
Facility
OP
|
$867.74
|
|
|
Service Code
|
HCPCS A9557
|
| Hospital Charge Code |
41569586
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$303.71 |
| Max. Negotiated Rate |
$694.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$477.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$308.09
|
| Rate for Payer: Aetna Government |
$308.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$694.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$590.06
|
| Rate for Payer: Group Health Inc Commercial |
$433.87
|
| Rate for Payer: Group Health Inc Medicare |
$303.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$433.87
|
|
|
ZZ NM TC-99M CHOLETEC
|
Facility
OP
|
$54.76
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
41568592
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.96
|
| Rate for Payer: Aetna Government |
$57.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.24
|
| Rate for Payer: Group Health Inc Commercial |
$27.38
|
| Rate for Payer: Group Health Inc Medicare |
$19.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.38
|
|
|
ZZ NM TC-99M DTPA
|
Facility
OP
|
$52.16
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
41568591
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$41.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.84
|
| Rate for Payer: Aetna Government |
$24.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.47
|
| Rate for Payer: Group Health Inc Commercial |
$26.08
|
| Rate for Payer: Group Health Inc Medicare |
$18.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.08
|
|
|
ZZ NM TC-99M MAA
|
Facility
OP
|
$24.94
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
41568590
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.84
|
| Rate for Payer: Aetna Government |
$24.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.96
|
| Rate for Payer: Group Health Inc Commercial |
$12.47
|
| Rate for Payer: Group Health Inc Medicare |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.47
|
|
|
ZZ NM TC -99M MAG3
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
41568606
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$641.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$641.51
|
| Rate for Payer: Aetna Government |
$641.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$259.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$220.32
|
| Rate for Payer: Group Health Inc Commercial |
$162.00
|
| Rate for Payer: Group Health Inc Medicare |
$113.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
|
|
ZZ NM TC-99M SESTAMIBI, A DOSE
|
Facility
OP
|
$250.76
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
41569583
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$200.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.39
|
| Rate for Payer: Aetna Government |
$88.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.52
|
| Rate for Payer: Group Health Inc Commercial |
$125.38
|
| Rate for Payer: Group Health Inc Medicare |
$87.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.38
|
|
|
ZZ NM TL-201, PER MCI
|
Facility
OP
|
$54.72
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
41569584
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$126.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.19
|
| Rate for Payer: Aetna Government |
$126.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.21
|
| Rate for Payer: Group Health Inc Commercial |
$27.36
|
| Rate for Payer: Group Health Inc Medicare |
$19.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.36
|
|
|
ZZ NM ULTRA TAG KIT
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
41568597
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.32
|
| Rate for Payer: Aetna Government |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$115.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.92
|
| Rate for Payer: Group Health Inc Commercial |
$72.00
|
| Rate for Payer: Group Health Inc Medicare |
$50.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
|
|
ZZ NOTCH BIOP NDL 20 3.5
|
Facility
OP
|
$15.59
|
|
| Hospital Charge Code |
41567089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.80
|
| Rate for Payer: Aetna Government |
$7.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$7.80
|
| Rate for Payer: Group Health Inc Medicare |
$5.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.80
|
|
|
ZZ NOTCH BIOP NDL 22 3.5
|
Facility
OP
|
$15.59
|
|
| Hospital Charge Code |
41567090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.80
|
| Rate for Payer: Aetna Government |
$7.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$7.80
|
| Rate for Payer: Group Health Inc Medicare |
$5.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.80
|
|
|
ZZ NOTCH BIOP NDL 22 5.5
|
Facility
OP
|
$30.83
|
|
| Hospital Charge Code |
41567091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.42
|
| Rate for Payer: Aetna Government |
$15.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.96
|
| Rate for Payer: Group Health Inc Commercial |
$15.42
|
| Rate for Payer: Group Health Inc Medicare |
$10.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.42
|
|
