|
CARBOXYHEMOGLOBIN; QUANTITATIVE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
4302010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
|
|
CARBOXY HGB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4301017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
CARBOXY HGB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4301017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
CARDENE IV SOLUTION 20 MG / 200 ML
|
Facility
|
IP
|
$352.26
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
4409163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.74 |
| Max. Negotiated Rate |
$228.97 |
| Rate for Payer: Cash Price |
$264.20
|
| Rate for Payer: Galaxy Health Commercial |
$228.97
|
| Rate for Payer: WellCare Medicare |
$193.74
|
|
|
CARDENE IV SOLUTION 20 MG / 200 ML
|
Facility
|
OP
|
$352.26
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
4409163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$281.81 |
| Rate for Payer: Aetna of NY Commercial |
$246.58
|
| Rate for Payer: Aetna of NY Medicare |
$162.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$264.20
|
| Rate for Payer: CDPHP Medicare |
$130.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$281.81
|
| Rate for Payer: EmblemHealth Medicaid |
$281.81
|
| Rate for Payer: EmblemHealth Medicare |
$119.77
|
| Rate for Payer: EmblemHealth Select Care |
$253.63
|
| Rate for Payer: Fidelis Medicare |
$140.90
|
| Rate for Payer: Galaxy Health Commercial |
$228.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$140.90
|
| Rate for Payer: Humana Medicare |
$140.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$246.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.19
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$198.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$147.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$52.84
|
| Rate for Payer: United Healthcare Medicare |
$140.90
|
| Rate for Payer: WellCare Medicare |
$193.74
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4210009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 78472 26
|
| Hospital Charge Code |
5210009
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of NY Commercial |
$98.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: CDPHP Medicare |
$51.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.00
|
| Rate for Payer: EmblemHealth Medicaid |
$112.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.60
|
| Rate for Payer: Fidelis Medicare |
$56.00
|
| Rate for Payer: Galaxy Health Commercial |
$91.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.00
|
| Rate for Payer: Humana Medicare |
$56.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$98.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$78.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$56.00
|
| Rate for Payer: WellCare Medicare |
$77.00
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 78472 26
|
| Hospital Charge Code |
5210009
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Galaxy Health Commercial |
$91.00
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4210009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
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 |
$63.60 |
| Max. Negotiated Rate |
$339.20 |
| 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) Medicare |
$169.60
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| 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 |
$169.60
|
| Rate for Payer: Galaxy Health Commercial |
$275.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$169.60
|
| Rate for Payer: Humana Medicare |
$169.60
|
| 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 |
$178.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$231.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$63.60
|
| Rate for Payer: United Healthcare Commercial |
$231.00
|
| Rate for Payer: United Healthcare Medicare |
$169.60
|
| Rate for Payer: WellCare Medicare |
$233.20
|
|
|
CARDIAC REHAB W/O MONITOR
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
4660002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna of NY Commercial |
$276.50
|
| Rate for Payer: Aetna of NY Medicare |
$181.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$158.00
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: CDPHP Medicare |
$146.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$316.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$316.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$316.00
|
| Rate for Payer: EmblemHealth Medicaid |
$316.00
|
| Rate for Payer: EmblemHealth Medicare |
$134.30
|
| Rate for Payer: EmblemHealth Select Care |
$284.40
|
| Rate for Payer: Fidelis Medicare |
$158.00
|
| Rate for Payer: Galaxy Health Commercial |
$256.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$158.00
|
| Rate for Payer: Humana Medicare |
$158.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$276.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$222.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$231.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.25
|
| Rate for Payer: United Healthcare Commercial |
$231.00
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
| Rate for Payer: WellCare Medicare |
$217.25
|
|
|
CARDIAC REHAB W/O MONITOR
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
4660002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$256.75 |
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Galaxy Health Commercial |
$256.75
|
|
|
CARDIAC RHYTHM MONITORING 1-3 LEADS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
4601723
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Aetna of NY Commercial |
$117.65
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$126.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$117.65
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$117.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
CARDIAC RHYTHM MONITORING 1-3 LEADS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
4601723
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
CARDIAC SPECT MULTI
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
4210027
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.45 |
| Max. Negotiated Rate |
$3,250.40 |
| 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) Medicare |
$1,625.20
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| 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 |
$1,625.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,625.20
|
| Rate for Payer: Humana Medicare |
$1,625.20
|
| 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 |
$1,706.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$609.45
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$1,625.20
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
CARDIAC SPECT MULTI
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 78452 26
|
| Hospital Charge Code |
5210027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Galaxy Health Commercial |
$150.15
|
|
|
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 MULTI
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 78452 26
|
| Hospital Charge Code |
5210027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: Aetna of NY Commercial |
$161.70
|
| Rate for Payer: Aetna of NY Medicare |
$106.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.40
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: CDPHP Medicare |
$85.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.80
|
| Rate for Payer: EmblemHealth Medicaid |
$184.80
|
| Rate for Payer: EmblemHealth Medicare |
$78.54
|
| Rate for Payer: Fidelis Medicare |
$92.40
|
| Rate for Payer: Galaxy Health Commercial |
$150.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.40
|
| Rate for Payer: Humana Medicare |
$92.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$106.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$130.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$97.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.65
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WellCare Medicare |
$127.05
|
|
|
CARDIAC SPECT SINGLE
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
4210028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.45 |
| Max. Negotiated Rate |
$3,250.40 |
| 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) Medicare |
$1,625.20
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| 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 |
$1,625.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,625.20
|
| Rate for Payer: Humana Medicare |
$1,625.20
|
| 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 |
$1,706.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$609.45
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$1,625.20
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
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
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 78451 26
|
| Hospital Charge Code |
5210028
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Galaxy Health Commercial |
$127.40
|
|
|
CARDIAC SPECT SINGLE
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 78451 26
|
| Hospital Charge Code |
5210028
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$156.80 |
| Rate for Payer: Aetna of NY Commercial |
$137.20
|
| Rate for Payer: Aetna of NY Medicare |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$78.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: CDPHP Medicare |
$72.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.80
|
| Rate for Payer: EmblemHealth Medicaid |
$156.80
|
| Rate for Payer: EmblemHealth Medicare |
$66.64
|
| Rate for Payer: Fidelis Medicare |
$78.40
|
| Rate for Payer: Galaxy Health Commercial |
$127.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$78.40
|
| Rate for Payer: Humana Medicare |
$78.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$137.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$90.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$110.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$82.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.40
|
| Rate for Payer: United Healthcare Medicare |
$78.40
|
| Rate for Payer: WellCare Medicare |
$107.80
|
|
|
CARDIO CRP
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
4301033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
CARDIO CRP
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
4301033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
