|
EBV PROFILE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
4300291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
EBV PROFILE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
4300291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
ECG/MONITORING AND ANALYSIS
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
4480042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$232.80 |
| Rate for Payer: Aetna of NY Commercial |
$189.15
|
| Rate for Payer: Aetna of NY Medicare |
$133.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.40
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: CDPHP Medicare |
$107.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$203.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$232.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$232.80
|
| Rate for Payer: EmblemHealth Medicaid |
$232.80
|
| Rate for Payer: EmblemHealth Medicare |
$98.94
|
| Rate for Payer: EmblemHealth Select Care |
$189.15
|
| Rate for Payer: Fidelis Medicare |
$116.40
|
| Rate for Payer: Galaxy Health Commercial |
$189.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.40
|
| Rate for Payer: Humana Medicare |
$116.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$133.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$218.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$163.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$43.65
|
| Rate for Payer: United Healthcare Medicare |
$116.40
|
| Rate for Payer: WellCare Medicare |
$160.05
|
|
|
ECG/MONITORING AND ANALYSIS
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
4480042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Galaxy Health Commercial |
$189.15
|
|
|
ECHOBRIGHT 20GX100MM NEEDLE
|
Facility
|
OP
|
$60.77
|
|
| Hospital Charge Code |
4479211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Aetna of NY Commercial |
$42.54
|
| Rate for Payer: Aetna of NY Medicare |
$27.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.31
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: CDPHP Medicare |
$22.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.62
|
| Rate for Payer: EmblemHealth Medicaid |
$48.62
|
| Rate for Payer: EmblemHealth Medicare |
$20.66
|
| Rate for Payer: EmblemHealth Select Care |
$43.75
|
| Rate for Payer: Fidelis Medicare |
$24.31
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.31
|
| Rate for Payer: Humana Medicare |
$24.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$24.31
|
| Rate for Payer: WellCare Medicare |
$33.42
|
|
|
ECHOBRIGHT 20GX100MM NEEDLE
|
Facility
|
IP
|
$60.77
|
|
| Hospital Charge Code |
4479211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
|
|
ECHOBRIGHT 20GX1501MM NEEDLE
|
Facility
|
OP
|
$60.77
|
|
| Hospital Charge Code |
4479212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Aetna of NY Commercial |
$42.54
|
| Rate for Payer: Aetna of NY Medicare |
$27.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.31
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: CDPHP Medicare |
$22.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.62
|
| Rate for Payer: EmblemHealth Medicaid |
$48.62
|
| Rate for Payer: EmblemHealth Medicare |
$20.66
|
| Rate for Payer: EmblemHealth Select Care |
$43.75
|
| Rate for Payer: Fidelis Medicare |
$24.31
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.31
|
| Rate for Payer: Humana Medicare |
$24.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$24.31
|
| Rate for Payer: WellCare Medicare |
$33.42
|
|
|
ECHOBRIGHT 20GX1501MM NEEDLE
|
Facility
|
IP
|
$60.77
|
|
| Hospital Charge Code |
4479212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
|
|
ECHOBRIGHT 22GX50MM NEEDLE
|
Facility
|
IP
|
$60.77
|
|
| Hospital Charge Code |
4479210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
|
|
ECHOBRIGHT 22GX50MM NEEDLE
|
Facility
|
OP
|
$60.77
|
|
| Hospital Charge Code |
4479210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Aetna of NY Commercial |
$42.54
|
| Rate for Payer: Aetna of NY Medicare |
$27.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.31
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: CDPHP Medicare |
$22.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.62
|
| Rate for Payer: EmblemHealth Medicaid |
$48.62
|
| Rate for Payer: EmblemHealth Medicare |
$20.66
|
| Rate for Payer: EmblemHealth Select Care |
$43.75
|
| Rate for Payer: Fidelis Medicare |
$24.31
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.31
|
| Rate for Payer: Humana Medicare |
$24.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$24.31
|
| Rate for Payer: WellCare Medicare |
$33.42
|
|
|
ECHOCARDIOGRAPHY, TRANSTHORACIC FOLLOW-UP OR LIMITED STUDY
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4480107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
ECHOCARDIOGRAPHY, TRANSTHORACIC FOLLOW-UP OR LIMITED STUDY
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4480107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Aetna of NY Commercial |
$475.15
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$475.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$411.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$548.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$548.25
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
ECHOLONG 18GX100MM NEEDLE
|
Facility
|
OP
|
$141.11
|
|
| Hospital Charge Code |
4479214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$112.89 |
| Rate for Payer: Aetna of NY Commercial |
$98.78
|
| Rate for Payer: Aetna of NY Medicare |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$105.83
|
| Rate for Payer: CDPHP Medicare |
$52.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.89
|
| Rate for Payer: EmblemHealth Medicaid |
$112.89
|
| Rate for Payer: EmblemHealth Medicare |
$47.98
|
| Rate for Payer: EmblemHealth Select Care |
$101.60
|
| Rate for Payer: Fidelis Medicare |
$56.44
|
| Rate for Payer: Galaxy Health Commercial |
$91.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.44
|
| Rate for Payer: Humana Medicare |
$56.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$98.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$79.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.17
|
| Rate for Payer: United Healthcare Medicare |
$56.44
|
| Rate for Payer: WellCare Medicare |
$77.61
|
|
|
ECHOLONG 18GX100MM NEEDLE
|
Facility
|
IP
|
$141.11
|
|
| Hospital Charge Code |
4479214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Cash Price |
$105.83
|
| Rate for Payer: Galaxy Health Commercial |
$91.72
|
|
|
ECHOLONG 18GX150MM NEEDLE
|
Facility
|
OP
|
$164.80
|
|
| Hospital Charge Code |
4479215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$131.84 |
| Rate for Payer: Aetna of NY Commercial |
$115.36
|
| Rate for Payer: Aetna of NY Medicare |
$75.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$65.92
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: CDPHP Medicare |
$60.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.84
|
| Rate for Payer: EmblemHealth Medicaid |
$131.84
|
| Rate for Payer: EmblemHealth Medicare |
$56.03
|
| Rate for Payer: EmblemHealth Select Care |
$118.66
|
| Rate for Payer: Fidelis Medicare |
$65.92
|
| Rate for Payer: Galaxy Health Commercial |
$107.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$65.92
|
| Rate for Payer: Humana Medicare |
$65.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.72
|
| Rate for Payer: United Healthcare Medicare |
$65.92
|
| Rate for Payer: WellCare Medicare |
$90.64
|
|
|
ECHOLONG 18GX150MM NEEDLE
|
Facility
|
IP
|
$164.80
|
|
| Hospital Charge Code |
4479215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Galaxy Health Commercial |
$107.12
|
|
|
ECHOLONG 18GX50MM NEEDLE
|
Facility
|
OP
|
$141.11
|
|
| Hospital Charge Code |
4479213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$112.89 |
| Rate for Payer: Aetna of NY Commercial |
$98.78
|
| Rate for Payer: Aetna of NY Medicare |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$105.83
|
| Rate for Payer: CDPHP Medicare |
$52.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.89
|
| Rate for Payer: EmblemHealth Medicaid |
$112.89
|
| Rate for Payer: EmblemHealth Medicare |
$47.98
|
| Rate for Payer: EmblemHealth Select Care |
$101.60
|
| Rate for Payer: Fidelis Medicare |
$56.44
|
| Rate for Payer: Galaxy Health Commercial |
$91.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.44
|
| Rate for Payer: Humana Medicare |
$56.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$98.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$79.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.17
|
| Rate for Payer: United Healthcare Medicare |
$56.44
|
| Rate for Payer: WellCare Medicare |
$77.61
|
|
|
ECHOLONG 18GX50MM NEEDLE
|
Facility
|
IP
|
$141.11
|
|
| Hospital Charge Code |
4479213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Cash Price |
$105.83
|
| Rate for Payer: Galaxy Health Commercial |
$91.72
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 93312 26
|
| Hospital Charge Code |
5201042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$242.25
|
| Rate for Payer: Galaxy Health Commercial |
$209.95
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
4201042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,088.75 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
4201042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,088.75
|
| Rate for Payer: Aetna of NY Medicare |
$770.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.00
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: CDPHP Medicare |
$619.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,172.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicare |
$569.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,088.75
|
| Rate for Payer: Fidelis Medicare |
$670.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.00
|
| Rate for Payer: Humana Medicare |
$670.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,088.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$770.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$943.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$251.25
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$670.00
|
| Rate for Payer: WellCare Medicare |
$921.25
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 93312 26
|
| Hospital Charge Code |
5201042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of NY Commercial |
$209.95
|
| Rate for Payer: Aetna of NY Medicare |
$148.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$129.20
|
| Rate for Payer: Cash Price |
$242.25
|
| Rate for Payer: CDPHP Medicare |
$119.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$258.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$258.40
|
| Rate for Payer: EmblemHealth Medicaid |
$258.40
|
| Rate for Payer: EmblemHealth Medicare |
$109.82
|
| Rate for Payer: Fidelis Medicare |
$129.20
|
| Rate for Payer: Galaxy Health Commercial |
$209.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$129.20
|
| Rate for Payer: Humana Medicare |
$129.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$209.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$148.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$181.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$135.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.45
|
| Rate for Payer: United Healthcare Medicare |
$129.20
|
| Rate for Payer: WellCare Medicare |
$177.65
|
|
|
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
4480087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,088.75 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
|
|
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
4480087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,088.75
|
| Rate for Payer: Aetna of NY Medicare |
$770.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.00
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: CDPHP Medicare |
$619.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,172.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicare |
$569.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,088.75
|
| Rate for Payer: Fidelis Medicare |
$670.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.00
|
| Rate for Payer: Humana Medicare |
$670.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,088.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$770.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$943.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,256.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$251.25
|
| Rate for Payer: United Healthcare Commercial |
$1,256.25
|
| Rate for Payer: United Healthcare Medicare |
$670.00
|
| Rate for Payer: WellCare Medicare |
$921.25
|
|
|
ECONOMY COTTON STOCKINETTE 5"
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4471422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
