|
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
|
|
|
ECHOCARDIOGRAPHY, TRANSTHORACIC FOLLOW-UP OR LIMITED STUDY
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4480107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: EmblemHealth Select Care |
$455.65
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$525.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$525.75
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
ECHOCARDIOGRAPHY, TRANSTHORACIC FOLLOW-UP OR LIMITED STUDY
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4480107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
ECHOLONG 18GX100MM NEEDLE
|
Facility
|
IP
|
$137.00
|
|
| Hospital Charge Code |
4479214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
ECHOLONG 18GX100MM NEEDLE
|
Facility
|
OP
|
$137.00
|
|
| Hospital Charge Code |
4479214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$95.90
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
ECHOLONG 18GX150MM NEEDLE
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
4479215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
ECHOLONG 18GX150MM NEEDLE
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
4479215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$80.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Commercial |
$128.80
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$115.20
|
| Rate for Payer: Fidelis Medicare |
$60.98
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.20
|
| Rate for Payer: Humana Medicare |
$59.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.16
|
| Rate for Payer: United Healthcare Medicare |
$59.20
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
ECHOLONG 18GX50MM NEEDLE
|
Facility
|
OP
|
$137.00
|
|
| Hospital Charge Code |
4479213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$95.90
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
ECHOLONG 18GX50MM NEEDLE
|
Facility
|
IP
|
$137.00
|
|
| Hospital Charge Code |
4479213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
4201042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
4201042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,105.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,026.35
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.05
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
4480087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$536.86 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,105.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,026.35
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
4480087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
|
|
ECONOMY COTTON STOCKINETTE 5"
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4471422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
ECONOMY COTTON STOCKINETTE 5"
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4471422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
ECUP TEST
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
4304882
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
|
|
ECUP TEST
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
4304882
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$46.69 |
| Rate for Payer: Aetna of NY Commercial |
$40.60
|
| Rate for Payer: Aetna of NY Medicare |
$26.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.00
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: CDPHP Commercial |
$46.69
|
| Rate for Payer: CDPHP Medicare |
$21.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.40
|
| Rate for Payer: EmblemHealth Medicaid |
$46.40
|
| Rate for Payer: EmblemHealth Medicare |
$19.72
|
| Rate for Payer: EmblemHealth Select Care |
$41.76
|
| Rate for Payer: Fidelis Medicare |
$22.10
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.46
|
| Rate for Payer: Humana Medicare |
$21.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.53
|
| Rate for Payer: United Healthcare Medicare |
$21.46
|
| Rate for Payer: WellCare Medicare |
$31.90
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480013
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna of NY Commercial |
$126.75
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$126.75
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.58
|
| Rate for Payer: United Healthcare Medicare |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480013
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480086
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna of NY Commercial |
$126.75
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$126.75
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.58
|
| Rate for Payer: United Healthcare Medicare |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480086
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
ELBOW ORTHOTIC (EO), WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
4690162
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$521.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$360.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$360.90
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$401.00
|
| Rate for Payer: EmblemHealth Select Care |
$401.00
|
| Rate for Payer: Galaxy Health Commercial |
$521.30
|
| Rate for Payer: Multiplan Commercial |
$360.90
|
| Rate for Payer: WellCare Medicare |
$441.10
|
|
|
ELBOW ORTHOTIC (EO), WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
4690162
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.68 |
| Max. Negotiated Rate |
$645.61 |
| Rate for Payer: Aetna of NY Commercial |
$561.40
|
| Rate for Payer: Aetna of NY Medicare |
$368.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$360.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$360.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$296.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$401.00
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: CDPHP Commercial |
$645.61
|
| Rate for Payer: CDPHP Medicare |
$296.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$401.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$641.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$641.60
|
| Rate for Payer: EmblemHealth Medicaid |
$641.60
|
| Rate for Payer: EmblemHealth Medicare |
$272.68
|
| Rate for Payer: EmblemHealth Select Care |
$401.00
|
| Rate for Payer: Fidelis Medicare |
$305.64
|
| Rate for Payer: Galaxy Health Commercial |
$521.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$296.74
|
| Rate for Payer: Humana Medicare |
$296.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$561.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$368.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$601.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$451.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$311.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$281.03
|
| Rate for Payer: United Healthcare Medicare |
$296.74
|
| Rate for Payer: WellCare Medicare |
$441.10
|
|
|
ELECTRICAL STIMULATION EA 15 MINS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
ELECTRICAL STIMULATION EA 15 MINS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
