|
XR CERVICAL SPINE AP/LAT/OM
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 72040 TC
|
| Hospital Charge Code |
41102256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.49 |
| 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 |
$32.49
|
| 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 |
$36.10
|
|
|
XR CERVICAL SPINE COMPLETE
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 72050 TC
|
| Hospital Charge Code |
41102220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.06 |
| 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 |
$45.06
|
| 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 |
$50.07
|
|
|
XR CERV. SPINE W/FLEX-EXT
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 72052 TC
|
| Hospital Charge Code |
41102222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| 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 |
$53.56
|
| 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 |
$59.51
|
|
|
XR CHEST 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Hospital Charge Code |
41102014
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.56 |
| 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 |
$19.56
|
| 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 |
$21.73
|
|
|
XR CHEST 2 VIEWS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
41102016
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$26.21 |
| 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 |
$26.21
|
| 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 |
$29.12
|
|
|
XR CHEST 2 VIEWS W/APICAL
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71047 TC
|
| Hospital Charge Code |
41102412
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$32.86 |
| 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 |
$32.86
|
| 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 |
$36.51
|
|
|
XR CHEST 2 VIEWS W/OBLIQUES
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
41102414
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$26.21 |
| 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 |
$26.21
|
| 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 |
$29.12
|
|
|
XR CHEST 4 VIEWS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71048 TC
|
| Hospital Charge Code |
41109968
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.45 |
| 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 |
$35.45
|
| 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 |
$39.39
|
|
|
XR CHEST DECUBI UNI
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Hospital Charge Code |
41102018
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.56 |
| 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 |
$19.56
|
| 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 |
$21.73
|
|
|
XR CLAVICLE
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Hospital Charge Code |
41102062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.32 |
| 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 |
$27.32
|
| 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 |
$30.35
|
|
|
XR CLAVICLE 1 VIEW
|
Facility
OP
|
$53.51
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107506
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$42.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.39
|
| Rate for Payer: Group Health Inc Commercial |
$26.76
|
| Rate for Payer: Group Health Inc Medicare |
$18.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.76
|
|
|
XR CLAVICLE 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Hospital Charge Code |
41102852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.32 |
| 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 |
$27.32
|
| 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 |
$30.35
|
|
|
XR CONSULTATION X-RAY FILMS
|
Facility
OP
|
$81.19
|
|
|
Service Code
|
HCPCS 76140
|
| Hospital Charge Code |
41102930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Government |
$59.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.21
|
| Rate for Payer: Group Health Inc Commercial |
$40.60
|
| Rate for Payer: Group Health Inc Medicare |
$28.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
|
|
XR CONTIN PHYSICS SUPPORT
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77336
|
| Hospital Charge Code |
66542944
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.53 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.91
|
| Rate for Payer: Aetna Government |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$156.91
|
| Rate for Payer: EmblemHealth Commercial |
$156.91
|
| 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 Medicare Advantage |
$156.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$156.91
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.91
|
| Rate for Payer: Healthfirst QHP |
$156.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.53
|
| Rate for Payer: Wellcare Medicare |
$149.06
|
|
|
XR ELBOW 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Hospital Charge Code |
41102848
|
|
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 ELBOW 2 VIEWS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Hospital Charge Code |
41102064
|
|
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 ELBOW COMPLETE
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Hospital Charge Code |
41102460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.32 |
| 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 |
$27.32
|
| 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 |
$30.35
|
|
|
XR ENTIRE SPINE 2/3 VW
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72082 TC
|
| Hospital Charge Code |
41102434
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.70 |
| 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 |
$61.70
|
| 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 |
$68.55
|
|
|
XR ESOPHAGUS DILATION
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 74360 TC
|
| Hospital Charge Code |
41107678
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.64 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
|
|
XR EYE EXAM FOREIGN BODY
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 70030 TC
|
| Hospital Charge Code |
41108534
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.95 |
| 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 |
$26.95
|
| 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 |
$29.94
|
|
|
XR FACIAL BONES COMPLETE
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 70150 TC
|
| Hospital Charge Code |
41102164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.78 |
| 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 |
$38.78
|
| 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 |
$43.09
|
|
|
XR FACIAL BONES LIMITED
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
41102170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.47 |
| 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 |
$25.47
|
| 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 |
$28.30
|
|
|
XR FEMUR
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Hospital Charge Code |
41102070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.28 |
| 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 |
$30.28
|
| 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 |
$33.64
|
|
|
XR FEMUR 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73551 TC
|
| Hospital Charge Code |
41102854
|
|
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 FINGER 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73140 TC
|
| Hospital Charge Code |
41102840
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.08 |
| 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 |
$35.08
|
| 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 |
$38.98
|
|
