|
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
|
|
|
CTA LOWER EXTREMITY
|
Facility
OP
|
$5,240.00
|
|
| Hospital Charge Code |
41207570
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,834.00 |
| Max. Negotiated Rate |
$4,192.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,882.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,620.00
|
| Rate for Payer: Aetna Government |
$2,620.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,192.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,563.20
|
| Rate for Payer: Group Health Inc Commercial |
$2,620.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,834.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,620.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,620.00
|
|
|
CTA LOWER EXTREMITY
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73706 TC
|
| Hospital Charge Code |
41209611
|
|
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 |
$275.61
|
| 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 |
$306.23
|
|
|
CTA NECK
|
Facility
OP
|
$147.38
|
|
| Hospital Charge Code |
41207571
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.69
|
| Rate for Payer: Aetna Government |
$73.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.22
|
| Rate for Payer: Group Health Inc Commercial |
$73.69
|
| Rate for Payer: Group Health Inc Medicare |
$51.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.69
|
|
|
CTA NECK
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Hospital Charge Code |
41209607
|
|
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 |
$226.82
|
| 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 |
$252.02
|
|
|
CT ANKLES C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207407
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.52 |
| 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 |
$131.52
|
| 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 |
$146.13
|
|
|
CT ANKLES C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41201130
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.81 |
| 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 |
$96.81
|
| 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 |
$107.57
|
|
|
CT ANKLES C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207413
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$161.83 |
| 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 |
$161.83
|
| 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 |
$179.81
|
|
|
CTA PELVIS
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72191 TC
|
| Hospital Charge Code |
41209609
|
|
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 |
$259.34
|
| 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 |
$288.16
|
|
|
CT ASPIRATION CYST
|
Facility
OP
|
$1,978.77
|
|
|
Service Code
|
HCPCS 77012 TC
|
| Hospital Charge Code |
41201140
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,088.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$989.38
|
| Rate for Payer: Aetna Government |
$989.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,583.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,345.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.18
|
| Rate for Payer: Group Health Inc Commercial |
$989.38
|
| Rate for Payer: Group Health Inc Medicare |
$692.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$989.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.09
|
|
|
CTA UPPER EXTREMITY
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73206 TC
|
| Hospital Charge Code |
41209610
|
|
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 |
$250.47
|
| 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 |
$278.30
|
|
|
CT BIOPSY NEEDLE
|
Facility
OP
|
$1,978.77
|
|
|
Service Code
|
HCPCS 77012 TC
|
| Hospital Charge Code |
41201138
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,088.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$989.38
|
| Rate for Payer: Aetna Government |
$989.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,583.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,345.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.18
|
| Rate for Payer: Group Health Inc Commercial |
$989.38
|
| Rate for Payer: Group Health Inc Medicare |
$692.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$989.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.09
|
|
|
CT BONE LENGTH
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76380 TC
|
| Hospital Charge Code |
41108874
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$84.61 |
| 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 |
$101.25
|
| 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 |
$112.50
|
|
|
CT BRAIN C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70460 TC
|
| Hospital Charge Code |
41201008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$110.85 |
| 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 |
$110.85
|
| 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 |
$123.17
|
|
|
CT BRAIN C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
41201002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$77.59 |
| 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 |
$77.59
|
| 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 |
$86.21
|
|
|
CT BRAIN C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70470 TC
|
| Hospital Charge Code |
41201150
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$133.74 |
| 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 |
$133.74
|
| 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 |
$148.60
|
|
|
CT CERVICAL SPINE C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 72126 TC
|
| Hospital Charge Code |
41201044
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.78 |
| 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 |
$130.78
|
| 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 |
$145.31
|
|
|
CT CERVICAL SPINE C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72125 TC
|
| Hospital Charge Code |
41201042
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$97.18 |
| 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 |
$97.18
|
| 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 |
$107.98
|
|
|
CT CERVICAL SPINE C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
41201046
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$161.46 |
| 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 |
$161.46
|
| 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 |
$179.40
|
|
|
CT CO CONSULTATION-OUTSIDE FILMS
|
Facility
OP
|
$81.19
|
|
|
Service Code
|
HCPCS 76140
|
| Hospital Charge Code |
41209931
|
|
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
|
|
|
CT COPPER CU-64,DOTATATE,DIAGNOST
|
Facility
OP
|
$9,250.00
|
|
|
Service Code
|
HCPCS A9592
|
| Hospital Charge Code |
41202269
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$7,400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,087.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$724.50
|
| Rate for Payer: Aetna Government |
$724.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,290.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,625.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,237.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,625.00
|
|
|
CT COR/SAG/OBL - REFORMAT
|
Facility
OP
|
$486.10
|
|
|
Service Code
|
HCPCS 76376 TC
|
| Hospital Charge Code |
41201142
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$388.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.05
|
| Rate for Payer: Aetna Government |
$243.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$388.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$330.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.60
|
| Rate for Payer: Group Health Inc Commercial |
$243.05
|
| Rate for Payer: Group Health Inc Medicare |
$170.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.44
|
|
|
CT CYSTOGRAM
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
41202901
|
|
Hospital Revenue Code
|
352
|
| 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 |
$230.21
|
| 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 |
$255.79
|
|
|
CT ELBOW C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41207434
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$172.18 |
| 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 |
$172.18
|
| 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 |
$191.31
|
|
|
CT ELBOW C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41201116
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$118.81 |
| 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 |
$134.51
|
| 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 |
$149.46
|
|
