|
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: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$73.36
|
| 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 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 Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CRYOSURGERY
|
Facility
|
IP
|
$97.81
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
42201305
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
CRYPTOCOCCUS ANTIGEN
|
Facility
|
OP
|
$28.85
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
40614095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$21.64 |
| 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: Affinity Essential Plan 1&2 |
$8.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.08
|
| Rate for Payer: Brighton Health Commercial |
$21.64
|
| 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 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 Medicare Advantage |
$11.54
|
| Rate for Payer: Healthfirst QHP |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$12.91
|
| Rate for Payer: United Healthcare 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
|
Facility
|
IP
|
$28.85
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
40614095
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.54
|
|
|
CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
IP
|
$40.18
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
40619853
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$16.07
|
|
|
CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
OP
|
$40.18
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
40619853
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$30.14 |
| 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: Affinity Essential Plan 1&2 |
$11.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.25
|
| Rate for Payer: Brighton Health Commercial |
$30.14
|
| 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 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 Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Humana Medicare |
$16.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare 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 |
$4.19 |
| Max. Negotiated Rate |
$11.24 |
| 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: Affinity Essential Plan 1&2 |
$4.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.19
|
| Rate for Payer: Brighton Health Commercial |
$11.24
|
| 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 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 Medicare Advantage |
$5.99
|
| Rate for Payer: Healthfirst QHP |
$5.99
|
| Rate for Payer: Humana Medicare |
$6.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare 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
|
|
|
CRYPTOSPORDIA/ISOPORA EXAM
|
Facility
|
IP
|
$14.98
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
40614045
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$5.99
|
|
|
CRYSTAL IDENT W/POLAR LENS
|
Facility
|
IP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635486
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$7.33
|
|
|
CRYSTAL IDENT W/POLAR LENS
|
Facility
|
OP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$40.91 |
| 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: Affinity Essential Plan 1&2 |
$5.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.13
|
| Rate for Payer: Brighton Health Commercial |
$40.91
|
| 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 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 Medicare Advantage |
$7.33
|
| Rate for Payer: Healthfirst QHP |
$7.33
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.33
|
| Rate for Payer: United Healthcare Commercial |
$9.05
|
| Rate for Payer: United Healthcare 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
|
IP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635485
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$7.33
|
|
|
CRYSTAL IDENT W/POLAR LENS
|
Facility
|
OP
|
$54.55
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
40635486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$40.91 |
| 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: Affinity Essential Plan 1&2 |
$5.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.13
|
| Rate for Payer: Brighton Health Commercial |
$40.91
|
| 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 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 Medicare Advantage |
$7.33
|
| Rate for Payer: Healthfirst QHP |
$7.33
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.33
|
| Rate for Payer: United Healthcare Commercial |
$9.05
|
| Rate for Payer: United Healthcare 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 |
$8,223.00 |
| 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: Brighton Health Commercial |
$1,875.00
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
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: Brighton Health Commercial |
$193.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$161.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$185.15
|
| Rate for Payer: EmblemHealth Commercial |
$161.00
|
| 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: Brighton Health Commercial |
$5,092.50
|
| 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 |
$32.94 |
| Max. Negotiated Rate |
$906.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$623.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.94
|
| Rate for Payer: Aetna Government |
$32.94
|
| Rate for Payer: Brighton Health Commercial |
$849.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$906.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$770.37
|
| 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
|
|
|
CTA ABDOMEN
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Hospital Charge Code |
41209612
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$677.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$573.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Commercial |
$270.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
CTA ABDOMEN
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Hospital Charge Code |
41209612
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CTA AORTO-ILIOFEMORAL RUN-OFF
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 75635 TC
|
| Hospital Charge Code |
41209613
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
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 |
$148.73 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$677.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$573.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Commercial |
$270.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
CT ABDOMEN C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201078
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT ABDOMEN C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$600.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$507.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Commercial |
$239.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
CT ABDOMEN C-
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41201094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$387.98 |
| 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 |
$387.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.30
|
| 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 Commercial |
$155.08
|
| 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
|
|
|
CT ABDOMEN C-
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41201094
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$127.14
|
|
