|
US SCROTUM & CONTENTS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 76870 26
|
| Hospital Charge Code |
5200016
|
|
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 STRESS ECHOGARDIOGRAM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4201029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,088.75 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 93351 26
|
| Hospital Charge Code |
5201029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$200.80 |
| Rate for Payer: Aetna of NY Commercial |
$163.15
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.40
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: CDPHP Medicare |
$92.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$200.80
|
| Rate for Payer: EmblemHealth Medicaid |
$200.80
|
| Rate for Payer: EmblemHealth Medicare |
$85.34
|
| Rate for Payer: Fidelis Medicare |
$100.40
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.40
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$163.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.65
|
| Rate for Payer: United Healthcare Medicare |
$100.40
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4201029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,088.75
|
| Rate for Payer: Aetna of NY Medicare |
$770.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.00
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: CDPHP Medicare |
$619.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,172.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicare |
$569.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,088.75
|
| Rate for Payer: Fidelis Medicare |
$670.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.00
|
| Rate for Payer: Humana Medicare |
$670.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,088.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$770.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$943.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,256.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$251.25
|
| Rate for Payer: United Healthcare Commercial |
$1,256.25
|
| Rate for Payer: United Healthcare Medicare |
$670.00
|
| Rate for Payer: WellCare Medicare |
$921.25
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 93351 26
|
| Hospital Charge Code |
5201029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
|
|
US TRANSRECTAL
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 76872 26
|
| Hospital Charge Code |
5200089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
US TRANSRECTAL
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4200089
|
|
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
|
|
|
US TRANSRECTAL
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 76872 26
|
| Hospital Charge Code |
5200089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of NY Commercial |
$70.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: Fidelis Medicare |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
US TRANSRECTAL
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4200089
|
|
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 TRANSVAGINAL
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Hospital Charge Code |
4201043
|
|
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
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 76830 26
|
| Hospital Charge Code |
5201043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Galaxy Health Commercial |
$66.30
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Hospital Charge Code |
4201043
|
|
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 TRANSVAGINAL
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 76830 26
|
| Hospital Charge Code |
5201043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna of NY Commercial |
$71.40
|
| Rate for Payer: Aetna of NY Medicare |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.80
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: CDPHP Medicare |
$37.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$81.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$81.60
|
| Rate for Payer: EmblemHealth Medicaid |
$81.60
|
| Rate for Payer: EmblemHealth Medicare |
$34.68
|
| Rate for Payer: Fidelis Medicare |
$40.80
|
| Rate for Payer: Galaxy Health Commercial |
$66.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.80
|
| Rate for Payer: Humana Medicare |
$40.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$71.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.30
|
| Rate for Payer: United Healthcare Medicare |
$40.80
|
| Rate for Payer: WellCare Medicare |
$56.10
|
|
|
US VEIN ETREMITY LOWER LEFT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 TC,LT
|
| Hospital Charge Code |
4201030
|
|
Hospital Revenue Code
|
921
|
| 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 VEIN ETREMITY LOWER LEFT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 TC,LT
|
| Hospital Charge Code |
4201030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| 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 |
$208.00
|
| 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 |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
US VEIN EXTREMITY LOWER, LEFT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,LT
|
| Hospital Charge Code |
5201030
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
US VEIN EXTREMITY LOWER, LEFT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,LT
|
| Hospital Charge Code |
5201030
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
US VEIN EXTREMITY LOWER RIGHT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4201031
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| 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 |
$208.00
|
| 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 |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
US VEIN EXTREMITY LOWER RIGHT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4201031
|
|
Hospital Revenue Code
|
921
|
| 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 VEIN EXTREMITY LOWER, RIGHT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Hospital Charge Code |
5201031
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
US VEIN EXTREMITY LOWER, RIGHT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Hospital Charge Code |
5201031
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
US VEIN EXTREMITY UPPER BILATERAL
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 93970 50
|
| Hospital Charge Code |
4201032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Aetna of NY Commercial |
$475.15
|
| 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 |
$475.15
|
| 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 |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
US VEIN EXTREMITY UPPER BILATERAL
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 93970 50
|
| Hospital Charge Code |
4201032
|
|
Hospital Revenue Code
|
921
|
| 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 VEIN EXTREMITY UPPER, BILATERAL
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 93970 26,50
|
| Hospital Charge Code |
5201032
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
US VEIN EXTREMITY UPPER, BILATERAL
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 93970 26,50
|
| Hospital Charge Code |
5201032
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of NY Commercial |
$65.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: Fidelis Medicare |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
