|
CT LUMBAR SPINE W/O DYE
|
Facility
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Hospital Charge Code |
4220028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.42 |
| Max. Negotiated Rate |
$1,137.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$522.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: CDPHP Commercial |
$1,137.46
|
| Rate for Payer: CDPHP Medicare |
$522.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,130.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicare |
$480.42
|
| Rate for Payer: Fidelis Medicare |
$538.49
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$522.81
|
| Rate for Payer: Humana Medicare |
$522.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$649.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,059.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$795.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$548.95
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$522.81
|
| Rate for Payer: WellCare Medicare |
$777.15
|
|
|
CT LUMBAR SPINE W/O & W/DYE
|
Facility
OP
|
$1,598.00
|
|
|
Service Code
|
HCPCS 72133 TC
|
| Hospital Charge Code |
4220029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$543.32 |
| Max. Negotiated Rate |
$1,286.39 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$735.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$591.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: CDPHP Commercial |
$1,286.39
|
| Rate for Payer: CDPHP Medicare |
$591.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,278.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,278.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,278.40
|
| Rate for Payer: EmblemHealth Medicare |
$543.32
|
| Rate for Payer: Fidelis Medicare |
$609.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,038.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$591.26
|
| Rate for Payer: Humana Medicare |
$591.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$735.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,198.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$899.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$620.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$591.26
|
| Rate for Payer: WellCare Medicare |
$878.90
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
4220026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT MAXILLOFACIAL W/DYE
|
Facility
OP
|
$1,239.00
|
|
|
Service Code
|
HCPCS 70487 TC
|
| Hospital Charge Code |
4220033
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$421.26 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$569.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$929.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$929.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$458.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: CDPHP Commercial |
$997.40
|
| Rate for Payer: CDPHP Medicare |
$458.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$991.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$991.20
|
| Rate for Payer: EmblemHealth Medicaid |
$991.20
|
| Rate for Payer: EmblemHealth Medicare |
$421.26
|
| Rate for Payer: Fidelis Medicare |
$472.18
|
| Rate for Payer: Galaxy Health Commercial |
$805.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$458.43
|
| Rate for Payer: Humana Medicare |
$458.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$569.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$929.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$697.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$481.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$458.43
|
| Rate for Payer: WellCare Medicare |
$681.45
|
|
|
CT MAXILLOFACIAL W/O DYE
|
Facility
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS 70486 TC
|
| Hospital Charge Code |
4220031
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$391.34 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$529.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$863.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$863.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$425.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: CDPHP Commercial |
$926.56
|
| Rate for Payer: CDPHP Medicare |
$425.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$920.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$920.80
|
| Rate for Payer: EmblemHealth Medicaid |
$920.80
|
| Rate for Payer: EmblemHealth Medicare |
$391.34
|
| Rate for Payer: Fidelis Medicare |
$438.65
|
| Rate for Payer: Galaxy Health Commercial |
$748.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$425.87
|
| Rate for Payer: Humana Medicare |
$425.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$529.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$648.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$447.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$425.87
|
| Rate for Payer: WellCare Medicare |
$633.05
|
|
|
CT MAXILLOFACIAL W/O & W/DYE
|
Facility
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70488 TC
|
| Hospital Charge Code |
4220032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$452.88 |
| Max. Negotiated Rate |
$1,072.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$612.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$492.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: CDPHP Commercial |
$1,072.26
|
| Rate for Payer: CDPHP Medicare |
$492.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,065.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicare |
$452.88
|
| Rate for Payer: Fidelis Medicare |
$507.63
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$492.84
|
| Rate for Payer: Humana Medicare |
$492.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$612.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$749.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$517.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$492.84
|
| Rate for Payer: WellCare Medicare |
$732.60
|
|
|
CT NECK SPINE W/DYE
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72126 TC
|
| Hospital Charge Code |
4220009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT NECK SPINE W/O DYE
|
Facility
OP
|
$1,506.00
|
|
|
Service Code
|
HCPCS 72125 TC
|
| Hospital Charge Code |
4220020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$512.04 |
| Max. Negotiated Rate |
$1,212.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,129.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,129.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$557.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: CDPHP Commercial |
$1,212.33
|
| Rate for Payer: CDPHP Medicare |
$557.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.80
|
| Rate for Payer: EmblemHealth Medicare |
$512.04
|
| Rate for Payer: Fidelis Medicare |
$573.94
|
| Rate for Payer: Galaxy Health Commercial |
$978.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$557.22
|
| Rate for Payer: Humana Medicare |
$557.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,129.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$585.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$557.22
|
| Rate for Payer: WellCare Medicare |
$828.30
|
|
|
CT NECK SPINE W/O & W/DYE
|
Facility
OP
|
$2,615.00
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
4220008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,105.08 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,202.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,961.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,961.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$967.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: CDPHP Commercial |
$2,105.08
|
| Rate for Payer: CDPHP Medicare |
$967.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,092.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicare |
$889.10
|
| Rate for Payer: Fidelis Medicare |
$996.58
|
| Rate for Payer: Galaxy Health Commercial |
$1,699.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$967.55
|
| Rate for Payer: Humana Medicare |
$967.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,202.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,961.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,472.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,015.93
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$967.55
|
| Rate for Payer: WellCare Medicare |
$1,438.25
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4224307
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$223.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Commercial |
$487.02
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: Fidelis Medicare |
$230.57
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$223.85
|
| Rate for Payer: Humana Medicare |
$223.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$235.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$223.85
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4220037
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$223.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Commercial |
$487.02
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: Fidelis Medicare |
$230.57
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$223.85
|
| Rate for Payer: Humana Medicare |
$223.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$235.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$223.85
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4220038
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Commercial |
$273.70
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: Fidelis Medicare |
$129.57
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.80
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$125.80
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4224308
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Commercial |
$273.70
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: Fidelis Medicare |
$129.57
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.80
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$125.80
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
Facility
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
4220039
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$452.88 |
| Max. Negotiated Rate |
$1,072.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$612.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$492.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: CDPHP Commercial |
$1,072.26
|
| Rate for Payer: CDPHP Medicare |
$492.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,065.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicare |
$452.88
|
| Rate for Payer: Fidelis Medicare |
$507.63
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$492.84
|
| Rate for Payer: Humana Medicare |
$492.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$612.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$749.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$517.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$492.84
|
| Rate for Payer: WellCare Medicare |
$732.60
|
|
|
CT PELVIS W/DYE
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Hospital Charge Code |
4220042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT PELVIS W/O DYE
|
Facility
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Hospital Charge Code |
4220040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.42 |
| Max. Negotiated Rate |
$1,137.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$522.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: CDPHP Commercial |
$1,137.46
|
| Rate for Payer: CDPHP Medicare |
$522.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,130.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicare |
$480.42
|
| Rate for Payer: Fidelis Medicare |
$538.49
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$522.81
|
| Rate for Payer: Humana Medicare |
$522.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$649.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,059.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$795.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$548.95
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$522.81
|
| Rate for Payer: WellCare Medicare |
$777.15
|
|
|
CT PELVIS W/O & W/DYE
|
Facility
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
4220041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$1,916.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$880.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: CDPHP Commercial |
$1,916.70
|
| Rate for Payer: CDPHP Medicare |
$880.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,904.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicare |
$809.54
|
| Rate for Payer: Fidelis Medicare |
$907.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$880.97
|
| Rate for Payer: Humana Medicare |
$880.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,095.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,785.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,340.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$925.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$880.97
|
| Rate for Payer: WellCare Medicare |
$1,309.55
|
|
|
CT PERFUSION W/CONTRAST CBF
|
Facility
OP
|
$2,822.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
4220076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$141.85 |
| Max. Negotiated Rate |
$2,271.71 |
| Rate for Payer: Aetna of NY Commercial |
$1,834.30
|
| Rate for Payer: Aetna of NY Medicare |
$1,298.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,116.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,116.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,044.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: CDPHP Commercial |
$2,271.71
|
| Rate for Payer: CDPHP Medicare |
$1,044.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,257.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,257.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,257.60
|
| Rate for Payer: EmblemHealth Medicare |
$959.48
|
| Rate for Payer: Fidelis Medicare |
$1,075.46
|
| Rate for Payer: Galaxy Health Commercial |
$1,834.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,044.14
|
| Rate for Payer: Humana Medicare |
$1,044.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,834.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,298.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,116.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,588.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,096.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.85
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.14
|
| Rate for Payer: WellCare Medicare |
$1,552.10
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 77011
|
| Hospital Charge Code |
4220073
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$2,125.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,214.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,980.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,980.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$976.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: CDPHP Commercial |
$2,125.20
|
| Rate for Payer: CDPHP Medicare |
$976.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,112.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicare |
$897.60
|
| Rate for Payer: Fidelis Medicare |
$1,006.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,716.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$976.80
|
| Rate for Payer: Humana Medicare |
$976.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,214.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,980.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,486.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,025.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$160.45
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$976.80
|
| Rate for Payer: WellCare Medicare |
$1,452.00
|
|
|
CT SFT TSUE NCK W/O & W/DYE
|
Facility
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
4220035
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$542.30 |
| Max. Negotiated Rate |
$1,283.98 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$733.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,196.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,196.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$590.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: CDPHP Commercial |
$1,283.98
|
| Rate for Payer: CDPHP Medicare |
$590.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicare |
$542.30
|
| Rate for Payer: Fidelis Medicare |
$607.85
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$590.15
|
| Rate for Payer: Humana Medicare |
$590.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$733.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,196.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$897.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$619.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$590.15
|
| Rate for Payer: WellCare Medicare |
$877.25
|
|
|
CT SOFT TISSUE NECK W/DYE
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
4220036
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT SOFT TISSUE NECK W/O DYE
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
4220034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$429.42 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$580.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$947.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$947.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$467.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: CDPHP Commercial |
$1,016.72
|
| Rate for Payer: CDPHP Medicare |
$467.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$429.42
|
| Rate for Payer: Fidelis Medicare |
$481.33
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$467.31
|
| Rate for Payer: Humana Medicare |
$467.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$580.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$947.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$711.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$490.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$467.31
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
4224309
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: CDPHP Commercial |
$499.90
|
| Rate for Payer: CDPHP Medicare |
$229.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.80
|
| Rate for Payer: EmblemHealth Medicaid |
$496.80
|
| Rate for Payer: EmblemHealth Medicare |
$211.14
|
| Rate for Payer: Fidelis Medicare |
$236.66
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.77
|
| Rate for Payer: Humana Medicare |
$229.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$241.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$229.77
|
| Rate for Payer: WellCare Medicare |
$341.55
|
|
|
CT THORAX W/DYE
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
4220012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT THORAX W/O DYE
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
4220010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$422.28 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
