|
XR HUMERUS 1 VIEW
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Hospital Charge Code |
41102850
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR HUMERUS 1 VIEW
|
Facility
|
IP
|
$50.67
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107504
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR HUMERUS 1 VIEW
|
Facility
|
OP
|
$50.67
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$107.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$25.34
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR HUMERUS 1 VIEW
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Hospital Charge Code |
41102850
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
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 |
$580.39 |
| Max. Negotiated Rate |
$2,260.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,260.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,912.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$580.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$704.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$737.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$737.93
|
| Rate for Payer: Group Health Inc Commercial |
$746.22
|
| Rate for Payer: Group Health Inc Medicare |
$746.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
XR INTERSTIT APPL COMP
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Hospital Charge Code |
66542960
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
XR INTERSTIT APPL INTER
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66542959
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
XR INTERSTIT APPL INTER
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66542959
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$710.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$97.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.42
|
| Rate for Payer: Group Health Inc Commercial |
$124.80
|
| Rate for Payer: Group Health Inc Medicare |
$124.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
|
XR INTERSTIT APPL SIMP
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66542958
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$710.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$97.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.42
|
| Rate for Payer: Group Health Inc Commercial |
$124.80
|
| Rate for Payer: Group Health Inc Medicare |
$124.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
|
XR INTERSTIT APPL SIMP
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66542958
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
XR KNEE 1 VIEW
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Hospital Charge Code |
41102856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR KNEE 1 VIEW
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Hospital Charge Code |
41102856
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR KNEE 2 VIEWS
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Hospital Charge Code |
41102086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR KNEE 2 VIEWS
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Hospital Charge Code |
41102086
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR KNEE 2 W/OBL-PAT-TUN
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Hospital Charge Code |
41102484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.27 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| 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 |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
XR KNEE 2 W/OBL-PAT-TUN
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Hospital Charge Code |
41102484
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73562 TC
|
| Hospital Charge Code |
41102482
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 73562 TC
|
| Hospital Charge Code |
41102482
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR LOCALIZE F.B. FOR CHILD
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76010 TC
|
| Hospital Charge Code |
41102640
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR LOCALIZE F.B. FOR CHILD
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 76010 TC
|
| Hospital Charge Code |
41102640
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR LOWER EXTREMITY (INFANT)
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 73592 TC
|
| Hospital Charge Code |
41102486
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
XR LOWER EXTREMITY (INFANT)
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 73592 TC
|
| Hospital Charge Code |
41102486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| 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 |
$120.86
|
| 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: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare 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
|
|
|
XR LOWER SPINE DISK LUMBAR
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 72295 TC
|
| Hospital Charge Code |
41109980
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
XR LOWER SPINE DISK LUMBAR
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 72295 TC
|
| Hospital Charge Code |
41109980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,562.96 |
| Max. Negotiated Rate |
$3,346.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,864.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,346.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,832.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,562.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,009.52
|
| Rate for Payer: Group Health Inc Medicare |
$2,009.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,009.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,232.80
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
XR LUMBAR SPINE AP/LATERAL
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 72110 TC
|
| Hospital Charge Code |
41102262
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
