|
XR FINGER(S)
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73140 TC
|
| Hospital Charge Code |
41102072
|
|
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
|
|
|
XR FOOT 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73620 TC
|
| Hospital Charge Code |
41102862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.62 |
| 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 |
$23.62
|
| 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 |
$26.25
|
|
|
XR FOOT 2 VIEWS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73620 TC
|
| Hospital Charge Code |
41102492
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.62 |
| 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 |
$23.62
|
| 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 |
$26.25
|
|
|
XR FOOT 3 VIEWS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Hospital Charge Code |
41102074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.54 |
| 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 |
$29.54
|
| 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 |
$32.82
|
|
|
XR FOREARM
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73090 TC
|
| Hospital Charge Code |
41102076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.36 |
| 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 |
$24.36
|
| 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 |
$27.07
|
|
|
XR FOREARM 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73090 TC
|
| Hospital Charge Code |
41102846
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.36 |
| 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 |
$24.36
|
| 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 |
$27.07
|
|
|
XR FOREARM 1 VIEW
|
Facility
OP
|
$130.41
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$104.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.20
|
| Rate for Payer: Aetna Government |
$65.20
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.68
|
| Rate for Payer: Group Health Inc Commercial |
$65.20
|
| Rate for Payer: Group Health Inc Medicare |
$45.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.20
|
|
|
XR HAND 1 VIEW
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107496
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$129.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$117.50
|
| Rate for Payer: Aetna Government |
$117.50
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$188.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.80
|
| Rate for Payer: Group Health Inc Commercial |
$117.50
|
| Rate for Payer: Group Health Inc Medicare |
$82.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.50
|
|
|
XR HAND 1 VIEW
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Hospital Charge Code |
41102842
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.21 |
| 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 |
$26.21
|
| 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 |
$29.12
|
|
|
XR HAND 2 VIEWS
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Hospital Charge Code |
41102078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.21 |
| 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 |
$26.21
|
| 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 |
$29.12
|
|
|
XR HAND COMPLETE
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Hospital Charge Code |
41102674
|
|
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
|
|
|
XR HEAD ORTHODONTIC
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 70350 TC
|
| Hospital Charge Code |
41102929
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.21 |
| 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 |
$9.21
|
| 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 |
$10.23
|
|
|
XR HEAD ORTHODONTIC
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 70350 TC
|
| Hospital Charge Code |
30300140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.21 |
| 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 |
$9.21
|
| 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 |
$10.23
|
|
|
XR HIP 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73501 TC
|
| Hospital Charge Code |
41102470
|
|
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 HIP COMPLETE
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Hospital Charge Code |
41102472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.63 |
| 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 |
$40.63
|
| 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 |
$45.14
|
|
|
XR HIP DURING OR 4/> VW
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73503 TC
|
| Hospital Charge Code |
41102246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.71 |
| 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 |
$51.71
|
| 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 |
$57.46
|
|
|
XR HIPS 2 VIEWS BIL. W/PELVIS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73522 TC
|
| Hospital Charge Code |
41109979
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.32 |
| 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 |
$44.32
|
| 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 |
$49.25
|
|
|
XR HIPS 4 VIEWS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73503 TC
|
| Hospital Charge Code |
41102907
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.71 |
| 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 |
$51.71
|
| 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 |
$57.46
|
|
|
XR HIPS 5 VIEWS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73523 TC
|
| Hospital Charge Code |
41102908
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.45 |
| 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 |
$52.45
|
| 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 |
$58.28
|
|
|
XR HIPS COMPLETE BILATERAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Hospital Charge Code |
41102474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.34 |
| 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 |
$34.34
|
| 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 |
$38.16
|
|
|
XR HUMERUS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Hospital Charge Code |
41102082
|
|
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 HUMERUS 1 VIEW
|
Facility
OP
|
$50.67
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$40.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.34
|
| Rate for Payer: Aetna Government |
$25.34
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.34
|
| Rate for Payer: Group Health Inc Medicare |
$17.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.34
|
|
|
XR HUMERUS 1 VIEW
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Hospital Charge Code |
41102850
|
|
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 INTERSTIT APPL COMP
|
Facility
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Hospital Charge Code |
66542960
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$507.28 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,121.42
|
| Rate for Payer: Aetna Government |
$1,121.42
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.28
|
| Rate for Payer: Group Health Inc Commercial |
$1,121.42
|
| Rate for Payer: Group Health Inc Medicare |
$785.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,121.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$563.65
|
|
|
XR INTERSTIT APPL INTER
|
Facility
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66542959
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$130.08 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.82
|
| Rate for Payer: Aetna Government |
$185.82
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$297.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.72
|
| Rate for Payer: Group Health Inc Commercial |
$185.82
|
| Rate for Payer: Group Health Inc Medicare |
$130.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.82
|
|
