|
TC99M CHOLETEC =< 15 MCI MEBROFENIN
|
Facility
|
OP
|
$508.82
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
4210060
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna of NY Medicare |
$234.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$203.53
|
| Rate for Payer: Cash Price |
$381.62
|
| Rate for Payer: Cash Price |
$381.62
|
| Rate for Payer: CDPHP Medicare |
$188.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$407.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$407.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$407.06
|
| Rate for Payer: EmblemHealth Medicaid |
$407.06
|
| Rate for Payer: EmblemHealth Medicare |
$173.00
|
| Rate for Payer: EmblemHealth Select Care |
$366.35
|
| Rate for Payer: Fidelis Medicare |
$203.53
|
| Rate for Payer: Galaxy Health Commercial |
$330.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$203.53
|
| Rate for Payer: Humana Medicare |
$203.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$234.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$286.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$213.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$187.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$76.32
|
| Rate for Payer: United Healthcare Commercial |
$187.21
|
| Rate for Payer: United Healthcare Medicare |
$203.53
|
| Rate for Payer: WellCare Medicare |
$279.85
|
|
|
TC99M CHOLETEC =< 15 MCI MEBROFENIN
|
Facility
|
IP
|
$508.82
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
4210060
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$330.73 |
| Max. Negotiated Rate |
$330.73 |
| Rate for Payer: Cash Price |
$381.62
|
| Rate for Payer: Galaxy Health Commercial |
$330.73
|
|
|
TC99M EXAMETAZIME =< 25 MCI
|
Facility
|
IP
|
$15,483.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
4210059
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$10,063.95 |
| Max. Negotiated Rate |
$10,063.95 |
| Rate for Payer: Cash Price |
$11,612.25
|
| Rate for Payer: Galaxy Health Commercial |
$10,063.95
|
|
|
TC99M EXAMETAZIME =< 25 MCI
|
Facility
|
OP
|
$15,483.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
4210059
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,322.45 |
| Max. Negotiated Rate |
$12,386.40 |
| Rate for Payer: Aetna of NY Medicare |
$7,122.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,193.20
|
| Rate for Payer: Cash Price |
$11,612.25
|
| Rate for Payer: Cash Price |
$11,612.25
|
| Rate for Payer: CDPHP Medicare |
$5,728.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12,386.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,386.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,386.40
|
| Rate for Payer: EmblemHealth Medicaid |
$12,386.40
|
| Rate for Payer: EmblemHealth Medicare |
$5,264.22
|
| Rate for Payer: EmblemHealth Select Care |
$11,147.76
|
| Rate for Payer: Fidelis Medicare |
$6,193.20
|
| Rate for Payer: Galaxy Health Commercial |
$10,063.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,193.20
|
| Rate for Payer: Humana Medicare |
$6,193.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,122.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,612.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,716.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,502.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,535.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,322.45
|
| Rate for Payer: United Healthcare Commercial |
$2,535.14
|
| Rate for Payer: United Healthcare Medicare |
$6,193.20
|
| Rate for Payer: WellCare Medicare |
$8,515.65
|
|
|
TC99M HEPATOLITE
|
Facility
|
OP
|
$142.14
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
4211214
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$118.54 |
| Rate for Payer: Aetna of NY Medicare |
$65.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.86
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: CDPHP Medicare |
$52.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.71
|
| Rate for Payer: EmblemHealth Medicaid |
$113.71
|
| Rate for Payer: EmblemHealth Medicare |
$48.33
|
| Rate for Payer: EmblemHealth Select Care |
$102.34
|
| Rate for Payer: Fidelis Medicare |
$56.86
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.86
|
| Rate for Payer: Humana Medicare |
$56.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$118.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.32
|
| Rate for Payer: United Healthcare Commercial |
$118.54
|
| Rate for Payer: United Healthcare Medicare |
$56.86
|
| Rate for Payer: WellCare Medicare |
$78.18
|
|
|
TC99M HEPATOLITE
|
Facility
|
IP
|
$142.14
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
4211214
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
|
|
TC99M LABELED RBC =< 30 MCI
|
Facility
|
IP
|
$409.94
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4210066
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$266.46 |
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
|
|
TC99M LABELED RBC =< 30 MCI
|
Facility
|
OP
|
$409.94
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4210066
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$327.95 |
| Rate for Payer: Aetna of NY Medicare |
$188.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.98
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: CDPHP Medicare |
$151.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$327.95
|
| Rate for Payer: EmblemHealth Medicaid |
$327.95
|
| Rate for Payer: EmblemHealth Medicare |
$139.38
|
| Rate for Payer: EmblemHealth Select Care |
$295.16
|
| Rate for Payer: Fidelis Medicare |
$163.98
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.98
|
| Rate for Payer: Humana Medicare |
$163.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$188.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$230.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$172.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$172.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.49
|
| Rate for Payer: United Healthcare Commercial |
$172.21
|
| Rate for Payer: United Healthcare Medicare |
$163.98
|
| Rate for Payer: WellCare Medicare |
$225.47
|
|
|
TC99M MAA =< 10 MCI
|
Facility
|
OP
|
$323.42
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
4210062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$258.74 |
| Rate for Payer: Aetna of NY Medicare |
$148.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$129.37
|
| Rate for Payer: Cash Price |
$242.56
|
| Rate for Payer: Cash Price |
$242.56
|
| Rate for Payer: CDPHP Medicare |
$119.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$258.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$258.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$258.74
|
| Rate for Payer: EmblemHealth Medicaid |
$258.74
|
| Rate for Payer: EmblemHealth Medicare |
$109.96
|
| Rate for Payer: EmblemHealth Select Care |
$232.86
|
| Rate for Payer: Fidelis Medicare |
$129.37
|
| Rate for Payer: Galaxy Health Commercial |
$210.22
|
| Rate for Payer: Hamaspik Choice Medicare |
$129.37
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$148.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.56
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$182.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$135.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.51
|
| Rate for Payer: United Healthcare Commercial |
$54.80
|
| Rate for Payer: United Healthcare Medicare |
$129.37
|
| Rate for Payer: WellCare Medicare |
$177.88
|
|
|
TC99M MAA =< 10 MCI
|
Facility
|
IP
|
$323.42
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
4210062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$210.22 |
| Rate for Payer: Cash Price |
$242.56
|
| Rate for Payer: Galaxy Health Commercial |
$210.22
|
|
|
TC99M MAG 3 =< 15 MCI MERTIATIDE
|
Facility
|
IP
|
$528.39
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
4210067
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$343.45 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Cash Price |
$396.29
|
| Rate for Payer: Galaxy Health Commercial |
$343.45
|
|
|
TC99M MAG 3 =< 15 MCI MERTIATIDE
|
Facility
|
OP
|
$528.39
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
4210067
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$79.26 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna of NY Medicare |
$243.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$211.36
|
| Rate for Payer: Cash Price |
$396.29
|
| Rate for Payer: Cash Price |
$396.29
|
| Rate for Payer: CDPHP Medicare |
$195.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$422.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$422.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$422.71
|
| Rate for Payer: EmblemHealth Medicaid |
$422.71
|
| Rate for Payer: EmblemHealth Medicare |
$179.65
|
| Rate for Payer: EmblemHealth Select Care |
$380.44
|
| Rate for Payer: Fidelis Medicare |
$211.36
|
| Rate for Payer: Galaxy Health Commercial |
$343.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$211.36
|
| Rate for Payer: Humana Medicare |
$211.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$243.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$297.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$221.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,327.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$79.26
|
| Rate for Payer: United Healthcare Commercial |
$1,327.95
|
| Rate for Payer: United Healthcare Medicare |
$211.36
|
| Rate for Payer: WellCare Medicare |
$290.61
|
|
|
TC99M MDP =< 30 MCI
|
Facility
|
OP
|
$451.14
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
4210054
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$360.91 |
| Rate for Payer: Aetna of NY Medicare |
$207.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.46
|
| Rate for Payer: Cash Price |
$338.36
|
| Rate for Payer: Cash Price |
$338.36
|
| Rate for Payer: CDPHP Medicare |
$166.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.91
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.91
|
| Rate for Payer: EmblemHealth Medicaid |
$360.91
|
| Rate for Payer: EmblemHealth Medicare |
$153.39
|
| Rate for Payer: EmblemHealth Select Care |
$324.82
|
| Rate for Payer: Fidelis Medicare |
$180.46
|
| Rate for Payer: Galaxy Health Commercial |
$293.24
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.46
|
| Rate for Payer: Humana Medicare |
$180.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$50.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$67.67
|
| Rate for Payer: United Healthcare Commercial |
$50.89
|
| Rate for Payer: United Healthcare Medicare |
$180.46
|
| Rate for Payer: WellCare Medicare |
$248.13
|
|
|
TC99M MDP =< 30 MCI
|
Facility
|
IP
|
$451.14
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
4210054
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$293.24 |
| Max. Negotiated Rate |
$293.24 |
| Rate for Payer: Cash Price |
$338.36
|
| Rate for Payer: Galaxy Health Commercial |
$293.24
|
|
|
TC99M PENTETATE =< 25 MCI
|
Facility
|
IP
|
$573.71
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
4210061
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$372.91 |
| Max. Negotiated Rate |
$372.91 |
| Rate for Payer: Cash Price |
$430.28
|
| Rate for Payer: Galaxy Health Commercial |
$372.91
|
|
|
TC99M PENTETATE =< 25 MCI
|
Facility
|
OP
|
$573.71
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
4210061
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$458.97 |
| Rate for Payer: Aetna of NY Medicare |
$263.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.48
|
| Rate for Payer: Cash Price |
$430.28
|
| Rate for Payer: Cash Price |
$430.28
|
| Rate for Payer: CDPHP Medicare |
$212.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.97
|
| Rate for Payer: EmblemHealth Medicaid |
$458.97
|
| Rate for Payer: EmblemHealth Medicare |
$195.06
|
| Rate for Payer: EmblemHealth Select Care |
$413.07
|
| Rate for Payer: Fidelis Medicare |
$229.48
|
| Rate for Payer: Galaxy Health Commercial |
$372.91
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.48
|
| Rate for Payer: Humana Medicare |
$229.48
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$430.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$323.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$240.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$50.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$86.06
|
| Rate for Payer: United Healthcare Commercial |
$50.89
|
| Rate for Payer: United Healthcare Medicare |
$229.48
|
| Rate for Payer: WellCare Medicare |
$315.54
|
|
|
TC99M PERTECHNETATE
|
Facility
|
OP
|
$142.14
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
4211242
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$113.71 |
| Rate for Payer: Aetna of NY Medicare |
$65.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.86
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: CDPHP Medicare |
$52.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.71
|
| Rate for Payer: EmblemHealth Medicaid |
$113.71
|
| Rate for Payer: EmblemHealth Medicare |
$48.33
|
| Rate for Payer: EmblemHealth Select Care |
$102.34
|
| Rate for Payer: Fidelis Medicare |
$56.86
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.86
|
| Rate for Payer: Humana Medicare |
$56.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.32
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$56.86
|
| Rate for Payer: WellCare Medicare |
$78.18
|
|
|
TC99M PERTECHNETATE
|
Facility
|
IP
|
$142.14
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
4211242
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
|
|
TC99M SULFUR COLLOID =< 20 MCI
|
Facility
|
IP
|
$409.94
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
4210063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$266.46 |
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
|
|
TC99M SULFUR COLLOID =< 20 MCI
|
Facility
|
OP
|
$409.94
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
4210063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$566.97 |
| Rate for Payer: Aetna of NY Medicare |
$188.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.98
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: CDPHP Medicare |
$151.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$327.95
|
| Rate for Payer: EmblemHealth Medicaid |
$327.95
|
| Rate for Payer: EmblemHealth Medicare |
$139.38
|
| Rate for Payer: EmblemHealth Select Care |
$295.16
|
| Rate for Payer: Fidelis Medicare |
$163.98
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.98
|
| Rate for Payer: Humana Medicare |
$163.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$188.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$230.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$172.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$566.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.49
|
| Rate for Payer: United Healthcare Commercial |
$566.97
|
| Rate for Payer: United Healthcare Medicare |
$163.98
|
| Rate for Payer: WellCare Medicare |
$225.47
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4210068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$86.52 |
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.52
|
| Rate for Payer: EmblemHealth Medicaid |
$86.52
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$35.23
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4210068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4211248
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4211248
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$86.52 |
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.52
|
| Rate for Payer: EmblemHealth Medicaid |
$86.52
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$35.23
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
TECHNETIUM TC99M AUTO WBC EXAME PER DOSE
|
Facility
|
IP
|
$3,121.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
4210085
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,028.65 |
| Max. Negotiated Rate |
$2,028.65 |
| Rate for Payer: Cash Price |
$2,340.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,028.65
|
|
