|
US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Hospital Charge Code |
4200023
|
|
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 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 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 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 CBP/EPO/PPO/HMO/Network Access |
$493.50
|
| 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: EmblemHealth Select Care |
$458.25
|
| 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 14 WK TRANSABDL EACH GESTATION
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 76802 TC
|
| Hospital Charge Code |
4200085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.25 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Galaxy Health Commercial |
$458.25
|
|
|
US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 76810 TC
|
| Hospital Charge Code |
4200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Galaxy Health Commercial |
$243.10
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$261.80
|
| 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: EmblemHealth Select Care |
$243.10
|
| 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
|
IP
|
$601.00
|
|
|
Service Code
|
HCPCS 76805 TC
|
| Hospital Charge Code |
4200116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.65 |
| Max. Negotiated Rate |
$390.65 |
| Rate for Payer: Cash Price |
$450.75
|
| Rate for Payer: Galaxy Health Commercial |
$390.65
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$420.70
|
| 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: EmblemHealth Select Care |
$390.65
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$564.90
|
| 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: EmblemHealth Select Care |
$524.55
|
| 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 DETAIL FETAL ANAT EXAM EA GESTAT
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
HCPCS 76812 TC
|
| Hospital Charge Code |
4200087
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$524.55 |
| Max. Negotiated Rate |
$524.55 |
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Galaxy Health Commercial |
$524.55
|
|
|
US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76816 TC
|
| Hospital Charge Code |
4200115
|
|
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 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: 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 PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
4200100
|
|
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 PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
4200100
|
|
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 PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 76811 TC
|
| Hospital Charge Code |
4200088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$652.60 |
| Max. Negotiated Rate |
$652.60 |
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Galaxy Health Commercial |
$652.60
|
|
|
US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 76811 TC
|
| Hospital Charge Code |
4200088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$341.36 |
| Max. Negotiated Rate |
$808.22 |
| Rate for Payer: Aetna of NY Commercial |
$702.80
|
| Rate for Payer: Aetna of NY Medicare |
$461.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$753.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$753.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$371.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$502.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: CDPHP Commercial |
$808.22
|
| Rate for Payer: CDPHP Medicare |
$371.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$702.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$803.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$803.20
|
| Rate for Payer: EmblemHealth Medicaid |
$803.20
|
| Rate for Payer: EmblemHealth Medicare |
$341.36
|
| Rate for Payer: EmblemHealth Select Care |
$652.60
|
| Rate for Payer: Fidelis Medicare |
$382.62
|
| Rate for Payer: Galaxy Health Commercial |
$652.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$371.48
|
| Rate for Payer: Humana Medicare |
$371.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$702.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$461.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$565.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$390.05
|
| 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 |
$371.48
|
| Rate for Payer: WellCare Medicare |
$552.20
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
4200001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$507.96 |
| Rate for Payer: Aetna of NY Commercial |
$441.70
|
| Rate for Payer: Aetna of NY Medicare |
$290.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$473.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$473.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$233.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$315.50
|
| Rate for Payer: Cash Price |
$473.25
|
| Rate for Payer: Cash Price |
$473.25
|
| Rate for Payer: CDPHP Commercial |
$507.96
|
| Rate for Payer: CDPHP Medicare |
$233.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$441.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$504.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$504.80
|
| Rate for Payer: EmblemHealth Medicaid |
$504.80
|
| Rate for Payer: EmblemHealth Medicare |
$214.54
|
| Rate for Payer: EmblemHealth Select Care |
$410.15
|
| Rate for Payer: Fidelis Medicare |
$240.47
|
| Rate for Payer: Galaxy Health Commercial |
$410.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$233.47
|
| Rate for Payer: Humana Medicare |
$233.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$441.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$290.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$355.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$245.14
|
| 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 |
$233.47
|
| Rate for Payer: WellCare Medicare |
$347.05
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
4200001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.15 |
| Max. Negotiated Rate |
$410.15 |
| Rate for Payer: Cash Price |
$473.25
|
| Rate for Payer: Galaxy Health Commercial |
$410.15
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
4200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Galaxy Health Commercial |
$325.00
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
4200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$350.00
|
| Rate for Payer: Aetna of NY Medicare |
$230.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$250.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: CDPHP Commercial |
$402.50
|
| Rate for Payer: CDPHP Medicare |
$185.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$350.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$400.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$400.00
|
| Rate for Payer: EmblemHealth Medicaid |
$400.00
|
| Rate for Payer: EmblemHealth Medicare |
$170.00
|
| Rate for Payer: EmblemHealth Select Care |
$325.00
|
| Rate for Payer: Fidelis Medicare |
$190.55
|
| Rate for Payer: Galaxy Health Commercial |
$325.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$185.00
|
| Rate for Payer: Humana Medicare |
$185.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$350.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$375.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$281.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$194.25
|
| 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 |
$185.00
|
| Rate for Payer: WellCare Medicare |
$275.00
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
4200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.02 |
| Max. Negotiated Rate |
$525.66 |
| Rate for Payer: Aetna of NY Commercial |
$457.10
|
| Rate for Payer: Aetna of NY Medicare |
$300.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$489.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$489.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$241.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$326.50
|
| Rate for Payer: Cash Price |
$489.75
|
| Rate for Payer: Cash Price |
$489.75
|
| Rate for Payer: CDPHP Commercial |
$525.66
|
| Rate for Payer: CDPHP Medicare |
$241.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$457.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$522.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$522.40
|
| Rate for Payer: EmblemHealth Medicaid |
$522.40
|
| Rate for Payer: EmblemHealth Medicare |
$222.02
|
| Rate for Payer: EmblemHealth Select Care |
$424.45
|
| Rate for Payer: Fidelis Medicare |
$248.86
|
| Rate for Payer: Galaxy Health Commercial |
$424.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$241.61
|
| Rate for Payer: Humana Medicare |
$241.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$457.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$300.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$367.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$253.69
|
| 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 |
$241.61
|
| Rate for Payer: WellCare Medicare |
$359.15
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
4200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$424.45 |
| Max. Negotiated Rate |
$424.45 |
| Rate for Payer: Cash Price |
$489.75
|
| Rate for Payer: Galaxy Health Commercial |
$424.45
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4201029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,105.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,026.35
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$143.42
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4201029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
|
|
US TRANSRECTAL
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4200089
|
|
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
|
|
