|
XOPENEX NEBULIZER Q8H/PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306337
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
XOPENEX NEBULIZER QID/PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306332
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
XOPENEX NEBULIZER TID
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306338
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
XOPENEX NEBULIZER TID/PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
XPLOR NOT FOL SURG LOWER ART
|
Facility
OP
|
$1,063.50
|
|
|
Service Code
|
HCPCS 35703
|
| Hospital Charge Code |
40039774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$474.07
|
| Rate for Payer: Aetna Government |
$474.07
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.87
|
| Rate for Payer: Group Health Inc Commercial |
$531.75
|
| Rate for Payer: Group Health Inc Medicare |
$372.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.63
|
|
|
XPLOR NOT FOL SURG UPR EXT ART
|
Facility
OP
|
$1,063.50
|
|
|
Service Code
|
HCPCS 35702
|
| Hospital Charge Code |
40039773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$465.63
|
| Rate for Payer: Aetna Government |
$465.63
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.57
|
| Rate for Payer: Group Health Inc Commercial |
$531.75
|
| Rate for Payer: Group Health Inc Medicare |
$372.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.52
|
|
|
XR ABD. FLAT W/ERECT-DECUBE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Hospital Charge Code |
41102130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.75
|
|
|
XR ABDOMEN
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Hospital Charge Code |
41102128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.99
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.66
|
|
|
XR ABSCESSOGRAM (VIA CATHETER)
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.52
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.91
|
|
|
XR ACRO-CLAVICULAR JOINTS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73050 TC
|
| Hospital Charge Code |
41102058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.14
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.60
|
|
|
XR ANKLE 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73600 TC
|
| Hospital Charge Code |
41102860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.68
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.76
|
|
|
XR ANKLE 2 VIEWS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73600 TC
|
| Hospital Charge Code |
41102488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.68
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.76
|
|
|
XR ANKLE COMPLETE
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Hospital Charge Code |
41102672
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.12
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.69
|
|
|
X-RAY IAC'S (INTERNAL AUD CANAL)
|
Facility
OP
|
$5.31
|
|
|
Service Code
|
HCPCS 70134 TC
|
| Hospital Charge Code |
41107522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$55.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.66
|
| Rate for Payer: Aetna Government |
$2.66
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.87
|
| Rate for Payer: Group Health Inc Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.41
|
|
|
X-RAY OF THE NECK MUSCLES
|
Facility
OP
|
$248.98
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
30302050
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$136.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
X-RAY SHOWING AT LEAST 3 VIEWS
|
Facility
OP
|
$248.98
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
30302052
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$136.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
XRAY SM INTEST F-THRU STD
|
Facility
OP
|
$455.50
|
|
|
Service Code
|
HCPCS 74248 TC
|
| Hospital Charge Code |
41103731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$364.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$250.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$227.75
|
| Rate for Payer: Aetna Government |
$227.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$364.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$309.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.52
|
| Rate for Payer: Group Health Inc Commercial |
$227.75
|
| Rate for Payer: Group Health Inc Medicare |
$159.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.80
|
|
|
XRAY UPPER GI DELAY W/O KUB
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74240 TC
|
| Hospital Charge Code |
41102502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.16
|
|
|
XR BASIC DOSIM CALC
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Hospital Charge Code |
66542932
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.70
|
| Rate for Payer: Aetna Government |
$191.70
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$191.70
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.03
|
|
|
XR BILE DUCT ENDOSCOPY
|
Facility
OP
|
$515.90
|
|
|
Service Code
|
HCPCS 74328 TC
|
| Hospital Charge Code |
41108743
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.56 |
| Max. Negotiated Rate |
$412.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$283.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.95
|
| Rate for Payer: Aetna Government |
$257.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$412.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$350.81
|
| Rate for Payer: Group Health Inc Commercial |
$257.95
|
| Rate for Payer: Group Health Inc Medicare |
$180.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.95
|
|
|
XR BONE AGE
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 77072 TC
|
| Hospital Charge Code |
41102314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.50
|
| Rate for Payer: Aetna Government |
$163.50
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$261.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Group Health Inc Commercial |
$163.50
|
| Rate for Payer: Group Health Inc Medicare |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.32
|
|
|
XR BONE LENGTH
|
Facility
OP
|
$335.12
|
|
|
Service Code
|
HCPCS 77073 TC
|
| Hospital Charge Code |
41102650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$268.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$167.56
|
| Rate for Payer: Aetna Government |
$167.56
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$227.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.82
|
| Rate for Payer: Group Health Inc Commercial |
$167.56
|
| Rate for Payer: Group Health Inc Medicare |
$117.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.80
|
|
|
XR BONE SURVEY COMPLETE
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 77075 TC
|
| Hospital Charge Code |
41102202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.50
|
| Rate for Payer: Aetna Government |
$163.50
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$261.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: Group Health Inc Commercial |
$163.50
|
| Rate for Payer: Group Health Inc Medicare |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.51
|
|
|
XR BONE SURVEY (INFANT)
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 77076 TC
|
| Hospital Charge Code |
41102662
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.50
|
| Rate for Payer: Aetna Government |
$163.50
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$261.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.10
|
| Rate for Payer: Group Health Inc Commercial |
$163.50
|
| Rate for Payer: Group Health Inc Medicare |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.33
|
|
|
XR BONE SURVEY LIMITED
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 77074 TC
|
| Hospital Charge Code |
41102088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.50
|
| Rate for Payer: Aetna Government |
$163.50
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$261.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.50
|
| Rate for Payer: Group Health Inc Commercial |
$163.50
|
| Rate for Payer: Group Health Inc Medicare |
$114.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.00
|
|
