|
US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
4201047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
4201047
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Hospital Charge Code |
4200018
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Hospital Charge Code |
4200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US EXAM ABDO BACK WALL LIM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US EXAM ABDO BACK WALL LIM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4200005
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 EXAM ABDOM COMPLETE
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
4201045
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 EXAM ABDOM COMPLETE
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
4201045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
4201054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
4201054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$182.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: EmblemHealth Select Care |
$169.00
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$182.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| 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 |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
US EXAM INFANT HIPS STATIC
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
4201055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
US EXAM INFANT HIPS STATIC
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
4201055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$182.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: EmblemHealth Select Care |
$169.00
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$182.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 K TRANSPL W/DOPPLER
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76776 TC
|
| Hospital Charge Code |
4200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 OF HEAD AND NECK
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 EXAM SPINAL CANAL
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
4201049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$150.50
|
| 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: EmblemHealth Select Care |
$139.75
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$150.50
|
| 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: EmblemHealth Select Care |
$139.75
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$150.50
|
| 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: EmblemHealth Select Care |
$139.75
|
| 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 |
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 CBP/EPO/PPO/HMO/Network Access |
$150.50
|
| 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: EmblemHealth Select Care |
$139.75
|
| 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
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4609651
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
|
