|
CT SACRUM/COCCYX C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Hospital Charge Code |
41207426
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.15 |
| 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 |
$131.15
|
| 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 |
$145.72
|
|
|
CT SACRUM/COCCYX C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Hospital Charge Code |
41207425
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.44 |
| 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 |
$96.44
|
| 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 |
$107.16
|
|
|
CT SACRUM/COCCYX C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72133 TC
|
| Hospital Charge Code |
41207427
|
|
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
|
|
|
CT SALIVARY GLAND C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
41207416
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$140.39 |
| 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 |
$140.39
|
| 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 |
$155.99
|
|
|
CT SALIVARY GLAND C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
41201072
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$105.31 |
| 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 |
$105.31
|
| 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 |
$117.01
|
|
|
CT SALIVARY GLAND C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
41207415
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$171.44 |
| 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 |
$171.44
|
| 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 |
$190.49
|
|
|
CT SELLA C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
41201020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$149.26 |
| 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 |
$149.26
|
| 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 |
$165.85
|
|
|
CT SELLA C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
41207400
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$114.92 |
| 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 |
$114.92
|
| 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 |
$127.69
|
|
|
CT SELLA C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
41207403
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$176.98 |
| 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 |
$176.98
|
| 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 |
$196.65
|
|
|
CT SHOULDERS C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41201066
|
|
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 SHOULDERS C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41201102
|
|
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
|
|
|
CT SHOULDERS C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
41207432
|
|
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 |
$225.04
|
| 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 |
$250.04
|
|
|
CT SOFT TISSUE NECK C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
41201084
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$140.39 |
| 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 |
$140.39
|
| 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 |
$155.99
|
|
|
CT SOFT TISSUE NECK C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
41201070
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$105.31 |
| 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 |
$105.31
|
| 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 |
$117.01
|
|
|
CT SOFT TISSUE NECK C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
41201026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$171.44 |
| 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 |
$171.44
|
| 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 |
$190.49
|
|
|
CT STROKE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
41202899
|
|
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 STROKE BRAIN C
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
41201182
|
|
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 THORACIC SPINE C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72129 TC
|
| Hospital Charge Code |
41201048
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.90 |
| 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 |
$131.90
|
| 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 |
$146.55
|
|
|
CT THORACIC SPINE C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72128 TC
|
| Hospital Charge Code |
41201050
|
|
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 THORACIC SPINE C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72130 TC
|
| Hospital Charge Code |
41201052
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$163.31 |
| 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 |
$163.31
|
| 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 |
$181.46
|
|
|
CT THORAX D X C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
41208756
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.15 |
| 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 |
$131.15
|
| 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 |
$145.72
|
|
|
CT THORAX D X C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
41209779
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.44 |
| 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 |
$96.44
|
| 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 |
$107.16
|
|
|
CT THORAX DX C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
41201028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.15 |
| 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 |
$131.15
|
| 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 |
$145.72
|
|
|
CT THORAX DX C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
41201060
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.44 |
| 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 |
$96.44
|
| 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 |
$107.16
|
|
|
CT THORAX D X C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
41208757
|
|
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
|
|
