|
TX/PROPH/DG ADDL
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4451250
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
|
|
TX/PROPH/DG ADDL
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4451250
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna of NY Commercial |
$154.70
|
| Rate for Payer: Aetna of NY Medicare |
$101.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.40
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: CDPHP Medicare |
$81.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$176.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$176.80
|
| Rate for Payer: EmblemHealth Medicaid |
$176.80
|
| Rate for Payer: EmblemHealth Medicare |
$75.14
|
| Rate for Payer: EmblemHealth Select Care |
$159.12
|
| Rate for Payer: Fidelis Medicare |
$88.40
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.40
|
| Rate for Payer: Humana Medicare |
$88.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$154.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$101.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$124.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$92.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$165.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.15
|
| Rate for Payer: United Healthcare Commercial |
$165.75
|
| Rate for Payer: United Healthcare Medicare |
$88.40
|
| Rate for Payer: WellCare Medicare |
$121.55
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
4670260
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$34.00
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.00
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
4670260
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59
|
| Hospital Charge Code |
4670298
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59
|
| Hospital Charge Code |
4670298
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$34.00
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.00
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59 W KX)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59,KX
|
| Hospital Charge Code |
4670314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$34.00
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.00
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59 W KX)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59,KX
|
| Hospital Charge Code |
4670314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (W/ KX)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,KX
|
| Hospital Charge Code |
4670276
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (W/ KX)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,KX
|
| Hospital Charge Code |
4670276
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$34.00
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.00
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX TARSAL BONE FX; W MANIP
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
4850163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$3,942.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,449.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,266.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,971.20
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: CDPHP Medicare |
$1,823.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,675.52
|
| Rate for Payer: EmblemHealth Select Care |
$3,548.16
|
| Rate for Payer: Fidelis Medicare |
$1,971.20
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,971.20
|
| Rate for Payer: Humana Medicare |
$1,971.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,449.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,266.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,696.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,774.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,069.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$739.20
|
| Rate for Payer: United Healthcare Medicare |
$1,971.20
|
| Rate for Payer: WellCare Medicare |
$2,710.40
|
|
|
TX TARSAL BONE FX; W MANIP
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
4850163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,203.20 |
| Max. Negotiated Rate |
$3,203.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
|
|
TYLENOL (APAP) EXTRA STRENGTH 500MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
4401278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
TYLENOL (APAP) EXTRA STRENGTH 500MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
4401278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
UGI W BX. SGL/MULTIPLE
|
Facility
|
IP
|
$2,780.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
4851925
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,807.00 |
| Max. Negotiated Rate |
$1,807.00 |
| Rate for Payer: Cash Price |
$2,085.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,807.00
|
|
|
UGI W BX. SGL/MULTIPLE
|
Facility
|
OP
|
$2,780.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
4851925
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,278.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,112.00
|
| Rate for Payer: Cash Price |
$2,085.00
|
| Rate for Payer: Cash Price |
$2,085.00
|
| Rate for Payer: CDPHP Medicare |
$1,028.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,224.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,224.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,224.00
|
| Rate for Payer: EmblemHealth Medicare |
$945.20
|
| Rate for Payer: EmblemHealth Select Care |
$2,001.60
|
| Rate for Payer: Fidelis Medicare |
$1,112.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,807.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,112.00
|
| Rate for Payer: Humana Medicare |
$1,112.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,278.80
|
| Rate for Payer: Multiplan Commercial |
$2,224.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,085.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,565.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,167.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$417.00
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$1,112.00
|
| Rate for Payer: WellCare Medicare |
$1,529.00
|
|
|
ULTRASONIC GUIDANCE, INTRAOPERATIVE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 76998
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.95
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Hospital Charge Code |
4201086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Hospital Charge Code |
4201086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$161.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: CDPHP Medicare |
$85.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.00
|
| Rate for Payer: EmblemHealth Medicaid |
$184.00
|
| Rate for Payer: EmblemHealth Medicare |
$78.20
|
| Rate for Payer: EmblemHealth Select Care |
$149.50
|
| Rate for Payer: Fidelis Medicare |
$92.00
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.00
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$129.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.50
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$92.00
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 76983 26
|
| Hospital Charge Code |
5201086
|
|
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
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 76983 26
|
| Hospital Charge Code |
5201086
|
|
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
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 76982 26
|
| Hospital Charge Code |
5201085
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$70.40 |
| Rate for Payer: Aetna of NY Commercial |
$61.60
|
| Rate for Payer: Aetna of NY Medicare |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: CDPHP Medicare |
$32.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$70.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.40
|
| Rate for Payer: EmblemHealth Medicaid |
$70.40
|
| Rate for Payer: EmblemHealth Medicare |
$29.92
|
| Rate for Payer: Fidelis Medicare |
$35.20
|
| Rate for Payer: Galaxy Health Commercial |
$57.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.20
|
| Rate for Payer: Humana Medicare |
$35.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$61.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.20
|
| Rate for Payer: United Healthcare Medicare |
$35.20
|
| Rate for Payer: WellCare Medicare |
$48.40
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Hospital Charge Code |
4201085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 76982 26
|
| Hospital Charge Code |
5201085
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Galaxy Health Commercial |
$57.20
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Hospital Charge Code |
4201085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$224.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
