|
US EXAM SPINAL CANAL
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
4201049
|
|
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
|
|
|
US EXAM SPINAL CANAL
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 76800 26
|
| Hospital Charge Code |
5201049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: Aetna of NY Commercial |
$139.30
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: Fidelis Medicare |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$139.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
US EXAM SPINAL CANAL
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 76800 26
|
| Hospital Charge Code |
5201049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4000371
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$489.00 |
| 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) Medicare |
$86.00
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| 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 |
$86.00
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.00
|
| Rate for Payer: Humana Medicare |
$86.00
|
| 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 |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$86.00
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
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
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$489.00 |
| 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) Medicare |
$86.00
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| 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 |
$86.00
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.00
|
| Rate for Payer: Humana Medicare |
$86.00
|
| 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 |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$86.00
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 76942 26
|
| Hospital Charge Code |
5200002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna of NY Commercial |
$65.80
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: Fidelis Medicare |
$37.60
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.60
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.10
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4850119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$146.30
|
| Rate for Payer: Aetna of NY Medicare |
$96.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.60
|
| Rate for Payer: Cash Price |
$156.75
|
| Rate for Payer: Cash Price |
$156.75
|
| Rate for Payer: CDPHP Medicare |
$77.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$146.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$167.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$167.20
|
| Rate for Payer: EmblemHealth Medicaid |
$167.20
|
| Rate for Payer: EmblemHealth Medicare |
$71.06
|
| Rate for Payer: EmblemHealth Select Care |
$135.85
|
| Rate for Payer: Fidelis Medicare |
$83.60
|
| Rate for Payer: Galaxy Health Commercial |
$135.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.60
|
| Rate for Payer: Humana Medicare |
$83.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$96.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$117.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$83.60
|
| Rate for Payer: WellCare Medicare |
$114.95
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$489.00 |
| 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) Medicare |
$86.00
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| 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 |
$86.00
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.00
|
| Rate for Payer: Humana Medicare |
$86.00
|
| 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 |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$86.00
|
| Rate for Payer: WellCare Medicare |
$118.25
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 76942 26
|
| Hospital Charge Code |
5200002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
US GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4609651
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$489.00 |
| 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) Medicare |
$86.00
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| 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 |
$86.00
|
| Rate for Payer: Galaxy Health Commercial |
$139.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.00
|
| Rate for Payer: Humana Medicare |
$86.00
|
| 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 |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$86.00
|
| 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 |
4000371
|
|
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
|
$209.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4850119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$156.75
|
| Rate for Payer: Galaxy Health Commercial |
$135.85
|
|
|
US GUIDE INTRAOP
|
Facility
|
IP
|
$576.80
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4200090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$374.92 |
| Max. Negotiated Rate |
$374.92 |
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Galaxy Health Commercial |
$374.92
|
|
|
US GUIDE INTRAOP
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 76998 26
|
| Hospital Charge Code |
5200090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
|
|
US GUIDE INTRAOP
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 76998 26
|
| Hospital Charge Code |
5200090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna of NY Commercial |
$102.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.80
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: CDPHP Medicare |
$54.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$49.98
|
| Rate for Payer: Fidelis Medicare |
$58.80
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.80
|
| Rate for Payer: Humana Medicare |
$58.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$102.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.05
|
| Rate for Payer: United Healthcare Medicare |
$58.80
|
| Rate for Payer: WellCare Medicare |
$80.85
|
|
|
US GUIDE INTRAOP
|
Facility
|
OP
|
$576.80
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4200090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$403.76
|
| Rate for Payer: Aetna of NY Medicare |
$265.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$230.72
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: CDPHP Medicare |
$213.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$403.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$461.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$461.44
|
| Rate for Payer: EmblemHealth Medicaid |
$461.44
|
| Rate for Payer: EmblemHealth Medicare |
$196.11
|
| Rate for Payer: EmblemHealth Select Care |
$374.92
|
| Rate for Payer: Fidelis Medicare |
$230.72
|
| Rate for Payer: Galaxy Health Commercial |
$374.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$230.72
|
| Rate for Payer: Humana Medicare |
$230.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$403.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$265.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$324.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$242.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$86.52
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$230.72
|
| Rate for Payer: WellCare Medicare |
$317.24
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 76937 26
|
| Hospital Charge Code |
5201044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of NY Commercial |
$29.40
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: Fidelis Medicare |
$16.80
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 76937 26
|
| Hospital Charge Code |
5201044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
4201044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
4201044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$102.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.80
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: CDPHP Medicare |
$54.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$102.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$49.98
|
| Rate for Payer: EmblemHealth Select Care |
$95.55
|
| Rate for Payer: Fidelis Medicare |
$58.80
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.80
|
| Rate for Payer: Humana Medicare |
$58.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$102.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.05
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$58.80
|
| Rate for Payer: WellCare Medicare |
$80.85
|
|
|
US HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
4150197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
US HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
4150197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Aetna of NY Commercial |
$438.60
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$438.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$411.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
