|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4210009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
CARDIAC REHAB W/ MONITOR
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
4660001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Galaxy Health Commercial |
$275.60
|
|
|
CARDIAC REHAB W/ MONITOR
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
4660001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna of NY Commercial |
$296.80
|
| Rate for Payer: Aetna of NY Medicare |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$156.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$212.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: CDPHP Commercial |
$341.32
|
| Rate for Payer: CDPHP Medicare |
$156.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$339.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$339.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$339.20
|
| Rate for Payer: EmblemHealth Medicaid |
$339.20
|
| Rate for Payer: EmblemHealth Medicare |
$144.16
|
| Rate for Payer: EmblemHealth Select Care |
$305.28
|
| Rate for Payer: Fidelis Medicare |
$161.59
|
| Rate for Payer: Galaxy Health Commercial |
$275.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$156.88
|
| Rate for Payer: Humana Medicare |
$156.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$296.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$195.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$238.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$164.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$224.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$224.00
|
| Rate for Payer: United Healthcare Medicare |
$156.88
|
| Rate for Payer: WellCare Medicare |
$233.20
|
|
|
CARDIAC REHAB W/O MONITOR
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
4660002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna of NY Commercial |
$268.80
|
| Rate for Payer: Aetna of NY Medicare |
$176.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$142.08
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$192.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: CDPHP Commercial |
$309.12
|
| Rate for Payer: CDPHP Medicare |
$142.08
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$307.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$307.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$307.20
|
| Rate for Payer: EmblemHealth Medicaid |
$307.20
|
| Rate for Payer: EmblemHealth Medicare |
$130.56
|
| Rate for Payer: EmblemHealth Select Care |
$276.48
|
| Rate for Payer: Fidelis Medicare |
$146.34
|
| Rate for Payer: Galaxy Health Commercial |
$249.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$142.08
|
| Rate for Payer: Humana Medicare |
$142.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$268.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$176.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$288.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$216.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$149.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$224.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.68
|
| Rate for Payer: United Healthcare Commercial |
$224.00
|
| Rate for Payer: United Healthcare Medicare |
$142.08
|
| Rate for Payer: WellCare Medicare |
$211.20
|
|
|
CARDIAC REHAB W/O MONITOR
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
4660002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Galaxy Health Commercial |
$249.60
|
|
|
CARDIAC RHYTHM MONITORING 1-3 LEADS
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
4601723
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$113.75
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$122.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$113.75
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
CARDIAC RHYTHM MONITORING 1-3 LEADS
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
4601723
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
CARDIAC SPECT MULTI
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
4210027
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,381.42 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$2,844.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,868.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,503.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,031.50
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: CDPHP Commercial |
$3,270.72
|
| Rate for Payer: CDPHP Medicare |
$1,503.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,381.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,640.95
|
| Rate for Payer: Fidelis Medicare |
$1,548.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,503.31
|
| Rate for Payer: Humana Medicare |
$1,503.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,844.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,868.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,047.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,287.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,578.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
CARDIAC SPECT MULTI
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
4210027
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
CARDIAC SPECT SINGLE
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
4210028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
CARDIAC SPECT SINGLE
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
4210028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.52 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$2,844.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,868.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,503.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,031.50
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: CDPHP Commercial |
$3,270.72
|
| Rate for Payer: CDPHP Medicare |
$1,503.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,381.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,640.95
|
| Rate for Payer: Fidelis Medicare |
$1,548.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,503.31
|
| Rate for Payer: Humana Medicare |
$1,503.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,844.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,868.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,047.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,287.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,578.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$140.52
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
CARDIO CRP
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
4301033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
|
|
CARDIO CRP
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
4301033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna of NY Commercial |
$55.90
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: EmblemHealth Select Care |
$51.60
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$64.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$64.50
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
CARDIOLITE UNIT DOSE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
4211240
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$743.46 |
| Rate for Payer: Aetna of NY Medicare |
$102.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$111.50
|
| Rate for Payer: Cash Price |
$167.25
|
| Rate for Payer: Cash Price |
$167.25
|
| Rate for Payer: CDPHP Commercial |
$179.52
|
| Rate for Payer: CDPHP Medicare |
$82.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$178.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$178.40
|
| Rate for Payer: EmblemHealth Medicaid |
$178.40
|
| Rate for Payer: EmblemHealth Medicare |
$75.82
|
| Rate for Payer: EmblemHealth Select Care |
$160.56
|
| Rate for Payer: Fidelis Medicare |
$84.99
|
| Rate for Payer: Galaxy Health Commercial |
$144.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.51
|
| Rate for Payer: Humana Medicare |
$82.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$102.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$125.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$86.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$743.46
|
| Rate for Payer: United Healthcare Commercial |
$743.46
|
| Rate for Payer: United Healthcare Medicare |
$82.51
|
| Rate for Payer: WellCare Medicare |
$122.65
|
|
|
CARDIOLITE UNIT DOSE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
4211240
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Cash Price |
$167.25
|
| Rate for Payer: Galaxy Health Commercial |
$144.95
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480026
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$583.70
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$628.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: EmblemHealth Select Care |
$583.70
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$583.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$673.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$673.50
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480026
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480085
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480085
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$583.70
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$628.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: EmblemHealth Select Care |
$583.70
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$583.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$673.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$673.50
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
CARDIOVERSION ELECTIVE; INT
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92961
|
| Hospital Charge Code |
4602201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,303.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,210.30
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARDIOVERSION ELECTIVE; INT
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92961
|
| Hospital Charge Code |
4602201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,210.30 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,210.30 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,303.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,210.30
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,303.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,210.30
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,210.30 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
|
