|
CT ABDOMEN C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41201086
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT ABDOMEN C-/C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41201086
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$668.97 |
| 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 |
$668.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$566.05
|
| 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 |
$267.39
|
| 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/PELVIS C+
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Hospital Charge Code |
41207575
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$239.85 |
| Max. Negotiated Rate |
$636.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$444.73
|
| Rate for Payer: Aetna Government |
$444.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$311.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$311.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$311.31
|
| Rate for Payer: Brighton Health Commercial |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$444.73
|
| 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 |
$444.73
|
| Rate for Payer: EmblemHealth Commercial |
$311.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$378.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$444.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.81
|
| Rate for Payer: Group Health Inc Commercial |
$400.26
|
| Rate for Payer: Group Health Inc Medicare |
$400.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$444.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.73
|
| Rate for Payer: Healthfirst QHP |
$444.73
|
| Rate for Payer: Humana Medicare |
$453.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$444.73
|
| Rate for Payer: United Healthcare Commercial |
$239.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$444.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$355.78
|
| Rate for Payer: Wellcare Medicare |
$422.49
|
|
|
CT ABDOMEN/PELVIS C+
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Hospital Charge Code |
41207575
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
CT ABDOMEN/PELVIS C-
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Hospital Charge Code |
41207574
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
CT ABDOMEN/PELVIS C-
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Hospital Charge Code |
41207574
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$155.08 |
| Max. Negotiated Rate |
$388.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$155.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
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 |
$267.39 |
| Max. Negotiated Rate |
$668.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$444.73
|
| Rate for Payer: Aetna Government |
$444.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$311.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$311.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$311.31
|
| Rate for Payer: Brighton Health Commercial |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$668.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$566.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$444.73
|
| Rate for Payer: EmblemHealth Commercial |
$311.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$378.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$444.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.81
|
| Rate for Payer: Group Health Inc Commercial |
$400.26
|
| Rate for Payer: Group Health Inc Medicare |
$400.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$444.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.73
|
| Rate for Payer: Healthfirst QHP |
$444.73
|
| Rate for Payer: Humana Medicare |
$453.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$444.73
|
| Rate for Payer: United Healthcare Commercial |
$267.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$444.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$355.78
|
| Rate for Payer: Wellcare Medicare |
$422.49
|
|
|
CT ABDOMEN/PELVIS C-/C+
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Hospital Charge Code |
41207576
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
CTA CHEST
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Hospital Charge Code |
41209608
|
|
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 CHEST
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Hospital Charge Code |
41209608
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT ADRENAL C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201088
|
|
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 ADRENAL C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
41201088
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT ADRENAL C-
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41207424
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
CT ADRENAL C-
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
41207424
|
|
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 ADRENAL C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41207421
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT ADRENAL C-/C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
41207421
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$668.97 |
| 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 |
$668.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$566.05
|
| 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 |
$267.39
|
| 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 HEAD
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Hospital Charge Code |
41209606
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CTA HEAD
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Hospital Charge Code |
41209606
|
|
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 HEAD
|
Facility
|
OP
|
$5,240.00
|
|
| Hospital Charge Code |
41207569
|
|
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: Brighton Health Commercial |
$3,930.00
|
| 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 |
$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 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: Brighton Health Commercial |
$3,930.00
|
| 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
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73706 TC
|
| Hospital Charge Code |
41209611
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CTA NECK
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Hospital Charge Code |
41209607
|
|
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 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: Brighton Health Commercial |
$110.54
|
| 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
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Hospital Charge Code |
41209607
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
