|
CRYOGLOBULIN, QI, SERUM
|
Facility
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 82595
|
| Hospital Charge Code |
40609063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
CRYOSURGERY
|
Facility
OP
|
$97.81
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
42201305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
CRYPTOCOCCUS ANTIGEN
|
Facility
OP
|
$28.85
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
40614095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna Government |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.54
|
| Rate for Payer: EmblemHealth Commercial |
$11.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Group Health Inc Commercial |
$11.54
|
| Rate for Payer: Group Health Inc Medicare |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.54
|
| Rate for Payer: Healthfirst QHP |
$11.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.23
|
| Rate for Payer: Wellcare Medicare |
$10.39
|
|
|
CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
40619853
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
CRYPTOSPORDIA/ISOPORA EXAM
|
Facility
OP
|
$14.98
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
40614045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna Government |
$5.99
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.99
|
| Rate for Payer: EmblemHealth Commercial |
$5.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.99
|
| Rate for Payer: Group Health Inc Medicare |
$5.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.79
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
|
|
CRYSTAL IDENT W/POLAR LENS
|
Facility
OP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.33
|
| Rate for Payer: Aetna Government |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.33
|
| Rate for Payer: EmblemHealth Commercial |
$7.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.33
|
| Rate for Payer: Group Health Inc Medicare |
$7.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.33
|
| Rate for Payer: Healthfirst QHP |
$7.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.86
|
| Rate for Payer: Wellcare Medicare |
$6.60
|
|
|
CRYSTAL IDENT W/POLAR LENS
|
Facility
OP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.33
|
| Rate for Payer: Aetna Government |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.33
|
| Rate for Payer: EmblemHealth Commercial |
$7.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.33
|
| Rate for Payer: Group Health Inc Medicare |
$7.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.33
|
| Rate for Payer: Healthfirst QHP |
$7.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.86
|
| Rate for Payer: Wellcare Medicare |
$6.60
|
|
|
C-SECTION L&D CHARGE
|
Facility
OP
|
$2,500.00
|
|
| Hospital Charge Code |
40251110
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,250.00
|
| Rate for Payer: Aetna Government |
$1,250.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,700.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
|
C-SHAPED FRACTURE PLT,4HOLES
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$338.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$161.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$185.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.10
|
| Rate for Payer: Group Health Inc Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.30
|
|
|
C-SHAPED FRACTURE PLT,4HOLES
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.00
|
|
|
CSI-PERIPL 1.50 145CM
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40004892
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
CT 3D RENDERING WITH POST PROCESS
|
Facility
OP
|
$1,132.90
|
|
|
Service Code
|
HCPCS 76377 TC
|
| Hospital Charge Code |
41209909
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$906.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$623.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$566.45
|
| Rate for Payer: Aetna Government |
$566.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$906.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$770.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.84
|
| Rate for Payer: Group Health Inc Commercial |
$566.45
|
| Rate for Payer: Group Health Inc Medicare |
$396.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.60
|
|
|
CTA ABDOMEN
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Hospital Charge Code |
41209612
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$260.08
|
| 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 |
$288.98
|
|
|
CTA AORTO-ILIOFEMORAL RUN-OFF
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 75635 TC
|
| Hospital Charge Code |
41209613
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$348.80
|
| 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 |
$387.55
|
|
|
CT ABDOMEN C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$204.71
|
| 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 |
$227.46
|
|
|
CT ABDOMEN C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41201094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$94.96 |
| 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 |
$94.96
|
| 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 |
$105.51
|
|
|
CT ABDOMEN C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41201086
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$231.33
|
| 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 |
$257.03
|
|
|
CT ABDOMEN/PELVIS C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Hospital Charge Code |
41207575
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.20
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.78
|
|
|
CT ABDOMEN/PELVIS C-
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Hospital Charge Code |
41207574
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$119.32 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.32
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.58
|
|
|
CT ABDOMEN/PELVIS C-/C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Hospital Charge Code |
41207576
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.10
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.33
|
|
|
CTA CHEST
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Hospital Charge Code |
41209608
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$229.77
|
| 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 |
$255.30
|
|
|
CT ADRENAL C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201088
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$204.71
|
| 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 |
$227.46
|
|
|
CT ADRENAL C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41207424
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$94.96 |
| 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 |
$94.96
|
| 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 |
$105.51
|
|
|
CT ADRENAL C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41207421
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$231.33
|
| 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 |
$257.03
|
|
|
CTA HEAD
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Hospital Charge Code |
41209606
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| 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 |
$227.19
|
| 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 |
$252.43
|
|
