|
NM LUNG PERFUSION DIFFERENTIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 78597 26
|
| Hospital Charge Code |
5211256
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna of NY Commercial |
$72.80
|
| Rate for Payer: Aetna of NY Medicare |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: CDPHP Medicare |
$38.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$83.20
|
| Rate for Payer: EmblemHealth Medicaid |
$83.20
|
| Rate for Payer: EmblemHealth Medicare |
$35.36
|
| Rate for Payer: Fidelis Medicare |
$41.60
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$41.60
|
| Rate for Payer: Humana Medicare |
$41.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$58.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$43.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$41.60
|
| Rate for Payer: WellCare Medicare |
$57.20
|
|
|
NM LUNG PERFUSION DIFFERENTIAL
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78597
|
| Hospital Charge Code |
4211256
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
NM LUNG PERFUSION DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 78597 26
|
| Hospital Charge Code |
5211256
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 78580 26
|
| Hospital Charge Code |
5211255
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
4211255
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 78580 26
|
| Hospital Charge Code |
5211255
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: Aetna of NY Commercial |
$74.90
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.80
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: Fidelis Medicare |
$42.80
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.80
|
| Rate for Payer: Humana Medicare |
$42.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.05
|
| Rate for Payer: United Healthcare Medicare |
$42.80
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
4211255
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
NM LYMPH OR LYMPH NODES SCAN
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
4211254
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
|
|
NM LYMPH OR LYMPH NODES SCAN
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
4211254
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,164.80
|
| Rate for Payer: Aetna of NY Medicare |
$765.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$665.60
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: CDPHP Medicare |
$615.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,331.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicare |
$565.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,081.60
|
| Rate for Payer: Fidelis Medicare |
$665.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.60
|
| Rate for Payer: Humana Medicare |
$665.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,164.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$765.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,248.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$936.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$665.60
|
| Rate for Payer: WellCare Medicare |
$915.20
|
|
|
NM LYMPH OR LYMPH NODES SCAN
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 78195 26
|
| Hospital Charge Code |
5211254
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: Fidelis Medicare |
$68.00
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.00
|
| Rate for Payer: Humana Medicare |
$68.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$68.00
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
NM LYMPH OR LYMPH NODES SCAN
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 78195 26
|
| Hospital Charge Code |
5211254
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
|
|
NM ORAL RADIOPHARM RX
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
4211257
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$464.75 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Galaxy Health Commercial |
$464.75
|
|
|
NM ORAL RADIOPHARM RX
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
4211257
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$500.50
|
| Rate for Payer: Aetna of NY Medicare |
$328.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$286.00
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: CDPHP Medicare |
$264.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$500.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$572.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$572.00
|
| Rate for Payer: EmblemHealth Medicaid |
$572.00
|
| Rate for Payer: EmblemHealth Medicare |
$243.10
|
| Rate for Payer: EmblemHealth Select Care |
$464.75
|
| Rate for Payer: Fidelis Medicare |
$286.00
|
| Rate for Payer: Galaxy Health Commercial |
$464.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$286.00
|
| Rate for Payer: Humana Medicare |
$286.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$500.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$328.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$536.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$402.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$300.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$286.00
|
| Rate for Payer: WellCare Medicare |
$393.25
|
|
|
NM ORAL RADIOPHARM RX
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 79005 26
|
| Hospital Charge Code |
5211257
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Galaxy Health Commercial |
$167.70
|
|
|
NM ORAL RADIOPHARM RX
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 79005 26
|
| Hospital Charge Code |
5211257
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna of NY Commercial |
$180.60
|
| Rate for Payer: Aetna of NY Medicare |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$103.20
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: CDPHP Medicare |
$95.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$206.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$206.40
|
| Rate for Payer: EmblemHealth Medicaid |
$206.40
|
| Rate for Payer: EmblemHealth Medicare |
$87.72
|
| Rate for Payer: Fidelis Medicare |
$103.20
|
| Rate for Payer: Galaxy Health Commercial |
$167.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$103.20
|
| Rate for Payer: Humana Medicare |
$103.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$180.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$118.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$145.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.70
|
| Rate for Payer: United Healthcare Medicare |
$103.20
|
| Rate for Payer: WellCare Medicare |
$141.90
|
|
|
NM RAI UPTAKE SINGLE DET
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 78012 26
|
| Hospital Charge Code |
5210040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
NM RAI UPTAKE SINGLE DET
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
4210040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
NM RAI UPTAKE SINGLE DET
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 78012 26
|
| Hospital Charge Code |
5210040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
NM RAI UPTAKE SINGLE DET
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
4210040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
NM THYROID IMAGING W/BLOOD FLOW
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 78014 26
|
| Hospital Charge Code |
5211251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of NY Commercial |
$50.40
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$28.80
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.80
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.80
|
| Rate for Payer: United Healthcare Medicare |
$28.80
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
NM THYROID IMAGING W/BLOOD FLOW
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
4211251
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
NM THYROID IMAGING W/BLOOD FLOW
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
4211251
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
NM THYROID IMAGING W/BLOOD FLOW
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 78014 26
|
| Hospital Charge Code |
5211251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
NM THYROID METS, WHOLE BODY
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 78018 26
|
| Hospital Charge Code |
5211252
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
NM THYROID METS, WHOLE BODY
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 78018 26
|
| Hospital Charge Code |
5211252
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna of NY Commercial |
$83.30
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$83.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$67.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
