|
CT ABD & PELV 1/> REGNS
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Hospital Charge Code |
4220059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$1,036.75 |
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
|
|
CT ABD & PELV 1/> REGNS
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Hospital Charge Code |
4220059
|
|
Hospital Revenue Code
|
352
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$1,116.50
|
| 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: EmblemHealth Select Care |
$1,036.75
|
| 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 ABD & PELVIS W/O DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Hospital Charge Code |
4220057
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$989.10
|
| 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: EmblemHealth Select Care |
$918.45
|
| 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 ABD & PELVIS W/O DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Hospital Charge Code |
4220057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$918.45 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
|
|
CT ABD & PELV W/ DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Hospital Charge Code |
4220058
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,053.50
|
| 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: EmblemHealth Select Care |
$978.25
|
| 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 ABD & PELV W/ DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Hospital Charge Code |
4220058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$978.25 |
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
|
|
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 75574 TC
|
| Hospital Charge Code |
4220102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 75574 TC
|
| Hospital Charge Code |
4220102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$427.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$396.50
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| 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 |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
HCPCS 75635 TC
|
| Hospital Charge Code |
4220077
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,550.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,457.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,376.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,376.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,172.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: CDPHP Commercial |
$2,550.24
|
| Rate for Payer: CDPHP Medicare |
$1,172.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,217.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,534.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,534.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,534.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,077.12
|
| Rate for Payer: EmblemHealth Select Care |
$2,059.20
|
| Rate for Payer: Fidelis Medicare |
$1,207.32
|
| Rate for Payer: Galaxy Health Commercial |
$2,059.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,172.16
|
| Rate for Payer: Humana Medicare |
$1,172.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,457.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,376.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,783.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,230.77
|
| 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 |
$1,172.16
|
| Rate for Payer: WellCare Medicare |
$1,742.40
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
HCPCS 75635 TC
|
| Hospital Charge Code |
4220077
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,059.20 |
| Max. Negotiated Rate |
$2,059.20 |
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,059.20
|
|
|
CT ANGIO ABDOM W/O & W/DYE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Hospital Charge Code |
4220075
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,167.06 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$996.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Commercial |
$2,167.06
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,884.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicare |
$915.28
|
| Rate for Payer: EmblemHealth Select Care |
$1,749.80
|
| Rate for Payer: Fidelis Medicare |
$1,025.92
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$996.04
|
| Rate for Payer: Humana Medicare |
$996.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,238.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,019.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,515.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,045.84
|
| 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 |
$996.04
|
| Rate for Payer: WellCare Medicare |
$1,480.60
|
|
|
CT ANGIO ABDOM W/O & W/DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Hospital Charge Code |
4220075
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,749.80 |
| Max. Negotiated Rate |
$1,749.80 |
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Hospital Charge Code |
4220101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$383.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$518.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$417.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: CDPHP Commercial |
$908.04
|
| Rate for Payer: CDPHP Medicare |
$417.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$789.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$902.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$902.40
|
| Rate for Payer: EmblemHealth Medicaid |
$902.40
|
| Rate for Payer: EmblemHealth Medicare |
$383.52
|
| Rate for Payer: EmblemHealth Select Care |
$733.20
|
| Rate for Payer: Fidelis Medicare |
$429.88
|
| Rate for Payer: Galaxy Health Commercial |
$733.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$417.36
|
| Rate for Payer: Humana Medicare |
$417.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$518.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$846.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$635.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$438.23
|
| 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 |
$417.36
|
| Rate for Payer: WellCare Medicare |
$620.40
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Hospital Charge Code |
4220101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$733.20 |
| Max. Negotiated Rate |
$733.20 |
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Galaxy Health Commercial |
$733.20
|
|
|
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Hospital Charge Code |
4224311
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$733.20 |
| Max. Negotiated Rate |
$733.20 |
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Galaxy Health Commercial |
$733.20
|
|
|
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Hospital Charge Code |
4224311
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$383.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$518.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$417.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: CDPHP Commercial |
$908.04
|
| Rate for Payer: CDPHP Medicare |
$417.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$789.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$902.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$902.40
|
| Rate for Payer: EmblemHealth Medicaid |
$902.40
|
| Rate for Payer: EmblemHealth Medicare |
$383.52
|
| Rate for Payer: EmblemHealth Select Care |
$733.20
|
| Rate for Payer: Fidelis Medicare |
$429.88
|
| Rate for Payer: Galaxy Health Commercial |
$733.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$417.36
|
| Rate for Payer: Humana Medicare |
$417.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$518.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$846.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$635.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$438.23
|
| 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 |
$417.36
|
| Rate for Payer: WellCare Medicare |
$620.40
|
|
|
CT ANGIOGRAPH PELV W/O&W/DYE
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 72191 TC
|
| Hospital Charge Code |
4220015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,153.45 |
| Max. Negotiated Rate |
$2,153.45 |
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
|
|
CT ANGIOGRAPH PELV W/O&W/DYE
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 72191 TC
|
| Hospital Charge Code |
4220015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,666.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,523.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,484.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,484.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,225.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: CDPHP Commercial |
$2,666.96
|
| Rate for Payer: CDPHP Medicare |
$1,225.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,319.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,650.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,126.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,153.45
|
| Rate for Payer: Fidelis Medicare |
$1,262.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,225.81
|
| Rate for Payer: Humana Medicare |
$1,225.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,523.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,484.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,865.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,287.10
|
| 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 |
$1,225.81
|
| Rate for Payer: WellCare Medicare |
$1,822.15
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Hospital Charge Code |
4220892
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,167.06 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$996.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Commercial |
$2,167.06
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,884.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicare |
$915.28
|
| Rate for Payer: EmblemHealth Select Care |
$1,749.80
|
| Rate for Payer: Fidelis Medicare |
$1,025.92
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$996.04
|
| Rate for Payer: Humana Medicare |
$996.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,238.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,019.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,515.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,045.84
|
| 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 |
$996.04
|
| Rate for Payer: WellCare Medicare |
$1,480.60
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Hospital Charge Code |
4220892
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,749.80 |
| Max. Negotiated Rate |
$1,749.80 |
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
|
|
CT ANGIOGRAPHY HEAD
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Hospital Charge Code |
4220074
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,083.34 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,190.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$957.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: CDPHP Commercial |
$2,083.34
|
| Rate for Payer: CDPHP Medicare |
$957.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,811.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicare |
$879.92
|
| Rate for Payer: EmblemHealth Select Care |
$1,682.20
|
| Rate for Payer: Fidelis Medicare |
$986.29
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$957.56
|
| Rate for Payer: Humana Medicare |
$957.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,190.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,941.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,457.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,005.44
|
| 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 |
$957.56
|
| Rate for Payer: WellCare Medicare |
$1,423.40
|
|
|
CT ANGIOGRAPHY HEAD
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Hospital Charge Code |
4220074
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$1,682.20 |
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
|
|
CT ANGIOGRAPHY NECK
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Hospital Charge Code |
4220891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,083.34 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,190.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$957.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: CDPHP Commercial |
$2,083.34
|
| Rate for Payer: CDPHP Medicare |
$957.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,811.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicare |
$879.92
|
| Rate for Payer: EmblemHealth Select Care |
$1,682.20
|
| Rate for Payer: Fidelis Medicare |
$986.29
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$957.56
|
| Rate for Payer: Humana Medicare |
$957.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,190.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,941.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,457.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,005.44
|
| 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 |
$957.56
|
| Rate for Payer: WellCare Medicare |
$1,423.40
|
|
|
CT ANGIOGRAPHY NECK
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Hospital Charge Code |
4220891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$1,682.20 |
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
4220090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$256.54 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$281.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: CDPHP Commercial |
$611.80
|
| Rate for Payer: CDPHP Medicare |
$281.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$532.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$608.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$608.00
|
| Rate for Payer: EmblemHealth Medicaid |
$608.00
|
| Rate for Payer: EmblemHealth Medicare |
$258.40
|
| Rate for Payer: EmblemHealth Select Care |
$494.00
|
| Rate for Payer: Fidelis Medicare |
$289.64
|
| Rate for Payer: Galaxy Health Commercial |
$494.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$281.20
|
| Rate for Payer: Humana Medicare |
$281.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$349.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$570.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$427.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$295.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$256.54
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$281.20
|
| Rate for Payer: WellCare Medicare |
$418.00
|
|
