|
US EXAM K TRANSPL W/DOPPLER
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76776 TC
|
| Hospital Charge Code |
4200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US EXAM OF HEAD AND NECK
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US EXAM SPINAL CANAL
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
4201049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4850119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$150.50
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.00
|
| Rate for Payer: EmblemHealth Medicaid |
$172.00
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$150.50
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.00
|
| Rate for Payer: EmblemHealth Medicaid |
$172.00
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$150.50
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.00
|
| Rate for Payer: EmblemHealth Medicaid |
$172.00
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4000371
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$150.50
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.00
|
| Rate for Payer: EmblemHealth Medicaid |
$172.00
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4609651
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$150.50
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.00
|
| Rate for Payer: EmblemHealth Medicaid |
$172.00
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDE INTRAOP
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4200090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$392.00
|
| Rate for Payer: Aetna of NY Medicare |
$257.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$207.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$280.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: CDPHP Commercial |
$450.80
|
| Rate for Payer: CDPHP Medicare |
$207.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$448.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$448.00
|
| Rate for Payer: EmblemHealth Medicaid |
$448.00
|
| Rate for Payer: EmblemHealth Medicare |
$190.40
|
| Rate for Payer: Fidelis Medicare |
$213.42
|
| Rate for Payer: Galaxy Health Commercial |
$364.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$207.20
|
| Rate for Payer: Humana Medicare |
$207.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$392.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$257.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$420.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$315.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$217.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.95
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$207.20
|
| Rate for Payer: WellCare Medicare |
$308.00
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
4201044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$102.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$73.50
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: CDPHP Commercial |
$118.34
|
| Rate for Payer: CDPHP Medicare |
$54.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$49.98
|
| Rate for Payer: Fidelis Medicare |
$56.02
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.39
|
| Rate for Payer: Humana Medicare |
$54.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$102.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$54.39
|
| Rate for Payer: WellCare Medicare |
$80.85
|
|
|
US HYSTEROSALPINGOGRAM
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
4150197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$420.60
|
| 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 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: 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 |
$420.60
|
| 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 |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76882 TC
|
| Hospital Charge Code |
4200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG, LEFT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76882 LT,TC
|
| Hospital Charge Code |
4201063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG, RIGHT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76882 RT,TC
|
| Hospital Charge Code |
4201062
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76883
|
| Hospital Charge Code |
4201091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US OF GALLBLADDER
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Hospital Charge Code |
4200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.74 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$322.70
|
| Rate for Payer: Aetna of NY Medicare |
$212.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$345.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$345.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$170.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$230.50
|
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: CDPHP Commercial |
$371.10
|
| Rate for Payer: CDPHP Medicare |
$170.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$368.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$368.80
|
| Rate for Payer: EmblemHealth Medicaid |
$368.80
|
| Rate for Payer: EmblemHealth Medicare |
$156.74
|
| Rate for Payer: Fidelis Medicare |
$175.69
|
| Rate for Payer: Galaxy Health Commercial |
$299.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$170.57
|
| Rate for Payer: Humana Medicare |
$170.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$322.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$212.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$259.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$179.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$170.57
|
| Rate for Payer: WellCare Medicare |
$253.55
|
|
|
US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Facility
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 76856 TC
|
| Hospital Charge Code |
4200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$167.96 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$345.80
|
| Rate for Payer: Aetna of NY Medicare |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$182.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$247.00
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: CDPHP Commercial |
$397.67
|
| Rate for Payer: CDPHP Medicare |
$182.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$395.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$395.20
|
| Rate for Payer: EmblemHealth Medicaid |
$395.20
|
| Rate for Payer: EmblemHealth Medicare |
$167.96
|
| Rate for Payer: Fidelis Medicare |
$188.26
|
| Rate for Payer: Galaxy Health Commercial |
$321.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$182.78
|
| Rate for Payer: Humana Medicare |
$182.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$345.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$227.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$278.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$191.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$182.78
|
| Rate for Payer: WellCare Medicare |
$271.70
|
|
|
US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 76801 TC
|
| Hospital Charge Code |
4200086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$499.90 |
| Rate for Payer: Aetna of NY Commercial |
$434.70
|
| Rate for Payer: Aetna of NY Medicare |
$285.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$310.50
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: CDPHP Commercial |
$499.90
|
| Rate for Payer: CDPHP Medicare |
$229.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.80
|
| Rate for Payer: EmblemHealth Medicaid |
$496.80
|
| Rate for Payer: EmblemHealth Medicare |
$211.14
|
| Rate for Payer: Fidelis Medicare |
$236.66
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.77
|
| Rate for Payer: Humana Medicare |
$229.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$434.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$241.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$229.77
|
| Rate for Payer: WellCare Medicare |
$341.55
|
|
|
US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Hospital Charge Code |
4200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Facility
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 76802 TC
|
| Hospital Charge Code |
4200085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$239.70 |
| Max. Negotiated Rate |
$567.52 |
| Rate for Payer: Aetna of NY Commercial |
$493.50
|
| Rate for Payer: Aetna of NY Medicare |
$324.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.50
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: CDPHP Commercial |
$567.52
|
| Rate for Payer: CDPHP Medicare |
$260.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$564.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$564.00
|
| Rate for Payer: EmblemHealth Medicaid |
$564.00
|
| Rate for Payer: EmblemHealth Medicare |
$239.70
|
| Rate for Payer: Fidelis Medicare |
$268.68
|
| Rate for Payer: Galaxy Health Commercial |
$458.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.85
|
| Rate for Payer: Humana Medicare |
$260.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$493.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$324.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.89
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$260.85
|
| Rate for Payer: WellCare Medicare |
$387.75
|
|
|
US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 76810 TC
|
| Hospital Charge Code |
4200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$261.80
|
| Rate for Payer: Aetna of NY Medicare |
$172.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$138.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$187.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: CDPHP Commercial |
$301.07
|
| Rate for Payer: CDPHP Medicare |
$138.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$299.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$299.20
|
| Rate for Payer: EmblemHealth Medicaid |
$299.20
|
| Rate for Payer: EmblemHealth Medicare |
$127.16
|
| Rate for Payer: Fidelis Medicare |
$142.53
|
| Rate for Payer: Galaxy Health Commercial |
$243.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$138.38
|
| Rate for Payer: Humana Medicare |
$138.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$261.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$172.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$280.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$210.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$145.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$138.38
|
| Rate for Payer: WellCare Medicare |
$205.70
|
|
|
US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Facility
OP
|
$601.00
|
|
|
Service Code
|
HCPCS 76805 TC
|
| Hospital Charge Code |
4200116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.34 |
| Max. Negotiated Rate |
$483.80 |
| Rate for Payer: Aetna of NY Commercial |
$420.70
|
| Rate for Payer: Aetna of NY Medicare |
$276.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$450.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$450.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$222.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$300.50
|
| Rate for Payer: Cash Price |
$450.75
|
| Rate for Payer: Cash Price |
$450.75
|
| Rate for Payer: CDPHP Commercial |
$483.80
|
| Rate for Payer: CDPHP Medicare |
$222.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$480.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$480.80
|
| Rate for Payer: EmblemHealth Medicaid |
$480.80
|
| Rate for Payer: EmblemHealth Medicare |
$204.34
|
| Rate for Payer: Fidelis Medicare |
$229.04
|
| Rate for Payer: Galaxy Health Commercial |
$390.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$222.37
|
| Rate for Payer: Humana Medicare |
$222.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$420.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$276.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$338.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$233.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$222.37
|
| Rate for Payer: WellCare Medicare |
$330.55
|
|
|
US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Facility
OP
|
$807.00
|
|
|
Service Code
|
HCPCS 76812 TC
|
| Hospital Charge Code |
4200087
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$274.38 |
| Max. Negotiated Rate |
$649.64 |
| Rate for Payer: Aetna of NY Commercial |
$564.90
|
| Rate for Payer: Aetna of NY Medicare |
$371.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$605.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$605.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$298.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$403.50
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: CDPHP Commercial |
$649.64
|
| Rate for Payer: CDPHP Medicare |
$298.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$645.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$645.60
|
| Rate for Payer: EmblemHealth Medicaid |
$645.60
|
| Rate for Payer: EmblemHealth Medicare |
$274.38
|
| Rate for Payer: Fidelis Medicare |
$307.55
|
| Rate for Payer: Galaxy Health Commercial |
$524.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$298.59
|
| Rate for Payer: Humana Medicare |
$298.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$564.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$371.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$454.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$313.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$298.59
|
| Rate for Payer: WellCare Medicare |
$443.85
|
|
|
US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76816 TC
|
| Hospital Charge Code |
4200115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
