|
CT CERVICAL SPINE C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
41201046
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
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: Brighton Health Commercial |
$60.89
|
| 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 |
$94.00 |
| 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: Brighton Health Commercial |
$6,937.50
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
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 |
$13.96 |
| Max. Negotiated Rate |
$388.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.96
|
| Rate for Payer: Aetna Government |
$13.96
|
| Rate for Payer: Brighton Health Commercial |
$364.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$388.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$330.55
|
| 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
|
|
|
CT CYSTOGRAM
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
41202901
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT CYSTOGRAM
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
41202901
|
|
Hospital Revenue Code
|
352
|
| 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 ELBOW C+
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41207434
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
CT ELBOW C+
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41207434
|
|
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 ELBOW C-
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41201116
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
CT ELBOW C-
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41201116
|
|
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 ELBOW C-/C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
41201106
|
|
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 ELBOW C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
41201106
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT FEET C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207408
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT FEET C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207408
|
|
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 FEET C-
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41207409
|
|
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 FEET C-
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41207409
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
CT FEET C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207414
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT FEET C-/C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207414
|
|
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 FEMUR(S) C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207404
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT FEMUR(S) C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207404
|
|
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 FEMUR(S) C-
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41201118
|
|
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 FEMUR(S) C-
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41201118
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
CT FEMUR(S) C-/C+
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207410
|
|
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 FEMUR(S) C-/C+
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207410
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
CT FOREARM C+
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41207436
|
|
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
|
|
