|
EAPG 880: HIV INFECTION
|
Facility
|
OP
|
$293.38
|
|
|
Service Code
|
EAPG 0880
|
| Min. Negotiated Rate |
$130.39 |
| Max. Negotiated Rate |
$293.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$293.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.39
|
| Rate for Payer: CDPHP Essential Plan |
$293.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.39
|
| Rate for Payer: EmblemHealth Medicaid |
$130.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$293.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$280.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$280.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.91
|
|
|
EAPG 881: AIDS
|
Facility
|
OP
|
$334.19
|
|
|
Service Code
|
EAPG 0881
|
| Min. Negotiated Rate |
$148.53 |
| Max. Negotiated Rate |
$334.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$334.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$148.53
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$148.53
|
| Rate for Payer: CDPHP Essential Plan |
$334.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.53
|
| Rate for Payer: EmblemHealth Medicaid |
$148.53
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$334.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$148.53
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$148.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$319.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$319.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.53
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$155.96
|
|
|
EAPG 882: GENETIC COUNSELING
|
Facility
|
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0882
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 883: ALTERATION IN CONSCIOUSNESS
|
Facility
|
OP
|
$302.56
|
|
|
Service Code
|
EAPG 0883
|
| Min. Negotiated Rate |
$134.47 |
| Max. Negotiated Rate |
$302.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$302.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$134.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$134.47
|
| Rate for Payer: CDPHP Essential Plan |
$302.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.47
|
| Rate for Payer: EmblemHealth Medicaid |
$134.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$302.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$134.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$134.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$289.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$289.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$134.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$141.19
|
|
|
EAPG 90: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES
|
Facility
|
OP
|
$2,090.43
|
|
|
Service Code
|
EAPG 0090
|
| Min. Negotiated Rate |
$929.08 |
| Max. Negotiated Rate |
$2,090.43 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,090.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$929.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$929.08
|
| Rate for Payer: CDPHP Essential Plan |
$2,090.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,114.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$929.08
|
| Rate for Payer: EmblemHealth Medicaid |
$929.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,090.43
|
| Rate for Payer: Hamaspik Choice Medicaid |
$929.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$929.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,997.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,997.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$929.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$975.53
|
|
|
EAPG 91: LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
|
OP
|
$5,100.26
|
|
|
Service Code
|
EAPG 0091
|
| Min. Negotiated Rate |
$2,266.78 |
| Max. Negotiated Rate |
$5,100.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,100.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,266.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,266.78
|
| Rate for Payer: CDPHP Essential Plan |
$5,100.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,720.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,266.78
|
| Rate for Payer: EmblemHealth Medicaid |
$2,266.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,100.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,266.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,266.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,873.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,873.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,266.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,380.12
|
|
|
EAPG 92: RESUSCITATION
|
Facility
|
OP
|
$1,144.01
|
|
|
Service Code
|
EAPG 0092
|
| Min. Negotiated Rate |
$508.45 |
| Max. Negotiated Rate |
$1,144.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,144.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$508.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$508.45
|
| Rate for Payer: CDPHP Essential Plan |
$1,144.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$610.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$508.45
|
| Rate for Payer: EmblemHealth Medicaid |
$508.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,144.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$508.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$508.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,093.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,093.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$508.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$533.87
|
|
|
EAPG 93: CARDIOVERSION
|
Facility
|
OP
|
$1,061.21
|
|
|
Service Code
|
EAPG 0093
|
| Min. Negotiated Rate |
$471.65 |
| Max. Negotiated Rate |
$1,061.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,061.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$471.65
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$471.65
|
| Rate for Payer: CDPHP Essential Plan |
$1,061.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$471.65
|
| Rate for Payer: EmblemHealth Medicaid |
$471.65
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,061.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$471.65
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$471.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,014.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,014.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$471.65
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$495.23
|
|
|
EAPG 94: CARDIAC REHABILITATION
|
Facility
|
OP
|
$75.89
|
|
|
Service Code
|
EAPG 0094
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$75.89 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$33.73
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$33.73
|
| Rate for Payer: CDPHP Essential Plan |
$75.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.73
|
| Rate for Payer: EmblemHealth Medicaid |
$33.73
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$75.89
|
| Rate for Payer: Hamaspik Choice Medicaid |
$33.73
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$72.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$72.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.73
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$35.42
|
|
|
EAPG 95: THROMBOLYSIS
|
Facility
|
OP
|
$418.68
|
|
|
Service Code
|
EAPG 0095
|
| Min. Negotiated Rate |
$186.08 |
| Max. Negotiated Rate |
$418.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$418.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$186.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$186.08
|
| Rate for Payer: CDPHP Essential Plan |
$418.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$223.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$186.08
|
| Rate for Payer: EmblemHealth Medicaid |
$186.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$418.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$186.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$186.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$400.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$400.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$195.38
|
|
|
EAPG 96: ATRIAL AND VENTRICULAR RECORDING AND PACING
|
Facility
|
OP
|
$1,069.81
|
|
|
Service Code
|
EAPG 0096
|
| Min. Negotiated Rate |
$475.47 |
| Max. Negotiated Rate |
$1,069.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,069.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$475.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$475.47
|
| Rate for Payer: CDPHP Essential Plan |
$1,069.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$570.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$475.47
|
| Rate for Payer: EmblemHealth Medicaid |
$475.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,069.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$475.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$475.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,022.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,022.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$475.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$499.24
|
|
|
EAPG 97: AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT
|
Facility
|
OP
|
$29,951.28
|
|
|
Service Code
|
EAPG 0097
|
| Min. Negotiated Rate |
$13,311.68 |
| Max. Negotiated Rate |
$29,951.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$29,951.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13,311.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13,311.68
|
| Rate for Payer: CDPHP Essential Plan |
$29,951.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,974.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,311.68
|
| Rate for Payer: EmblemHealth Medicaid |
$13,311.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$29,951.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$13,311.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$13,311.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28,620.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28,620.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13,311.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$13,977.26
|
|
|
EAPG 99: LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES
|
Facility
|
OP
|
$5,326.70
|
|
|
Service Code
|
EAPG 0099
|
| Min. Negotiated Rate |
$2,367.42 |
| Max. Negotiated Rate |
$5,326.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,326.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,367.42
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,367.42
|
| Rate for Payer: CDPHP Essential Plan |
$5,326.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,840.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,367.42
|
| Rate for Payer: EmblemHealth Medicaid |
$2,367.42
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,326.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,367.42
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,367.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,089.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,089.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,367.42
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,485.79
|
|
|
EAPG 9: LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
|
OP
|
$1,256.47
|
|
|
Service Code
|
EAPG 0009
|
| Min. Negotiated Rate |
$558.43 |
| Max. Negotiated Rate |
$1,256.47 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,256.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$558.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$558.43
|
| Rate for Payer: CDPHP Essential Plan |
$1,256.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$670.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$558.43
|
| Rate for Payer: EmblemHealth Medicaid |
$558.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,256.47
|
| Rate for Payer: Hamaspik Choice Medicaid |
$558.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$558.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,200.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,200.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$558.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$586.35
|
|
|
EASY CAP CO2 DETECTOR
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4479167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
EASY CAP CO2 DETECTOR
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
4479167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
EBV PROFILE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
4300291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
|
|
EBV PROFILE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
4300291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna of NY Commercial |
$48.75
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.50
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Commercial |
$60.38
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$45.00
|
| Rate for Payer: Fidelis Medicare |
$28.58
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.75
|
| Rate for Payer: Humana Medicare |
$27.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$56.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$56.25
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
ECG/MONITORING AND ANALYSIS
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
4480042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$222.98 |
| Rate for Payer: Aetna of NY Commercial |
$180.05
|
| Rate for Payer: Aetna of NY Medicare |
$127.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$207.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$207.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$138.50
|
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: CDPHP Commercial |
$222.98
|
| Rate for Payer: CDPHP Medicare |
$102.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$193.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$221.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.60
|
| Rate for Payer: EmblemHealth Medicaid |
$221.60
|
| Rate for Payer: EmblemHealth Medicare |
$94.18
|
| Rate for Payer: EmblemHealth Select Care |
$180.05
|
| Rate for Payer: Fidelis Medicare |
$105.56
|
| Rate for Payer: Galaxy Health Commercial |
$180.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.49
|
| Rate for Payer: Humana Medicare |
$102.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$180.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$107.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
| Rate for Payer: United Healthcare Medicare |
$102.49
|
| Rate for Payer: WellCare Medicare |
$152.35
|
|
|
ECG/MONITORING AND ANALYSIS
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
4480042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$180.05 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: Galaxy Health Commercial |
$180.05
|
|
|
ECHOBRIGHT 20GX100MM NEEDLE
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
4479211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
|
|
ECHOBRIGHT 20GX100MM NEEDLE
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
4479211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
ECHOBRIGHT 20GX1501MM NEEDLE
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
4479212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
ECHOBRIGHT 20GX1501MM NEEDLE
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
4479212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
|
|
ECHOBRIGHT 22GX50MM NEEDLE
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
4479210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
