Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CT ANGIO LWR EXTR W/O&W/DYE

Facility

$760.00

Service Code	HCPCS 73706
Hospital Charge Code	4220090
Hospital Revenue Code	350
Min. Negotiated Rate	$494.00
Max. Negotiated Rate	$494.00
Rate for Payer: Cash Price	$570.00
Rate for Payer: Galaxy Health Commercial	$494.00

CT ANGIO UPR EXTRM W/O&W/DYE

Facility

$2,588.00

Service Code	HCPCS 73206
Hospital Charge Code	4220072
Hospital Revenue Code	352
Min. Negotiated Rate	$256.54
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 CHIP/Family Health Plus/Medicaid	$256.54
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 ANGIO UPR EXTRM W/O&W/DYE

Facility

$2,588.00

Service Code	HCPCS 73206
Hospital Charge Code	4220072
Hospital Revenue Code	352
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 BONE DENSITY AXIAL

Facility

$261.00

Service Code	HCPCS 77078 TC
Hospital Charge Code	4220100
Hospital Revenue Code	350
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$169.65
Rate for Payer: Cash Price	$195.75
Rate for Payer: Galaxy Health Commercial	$169.65

CT BONE DENSITY AXIAL

Facility

$261.00

Service Code	HCPCS 77078 TC
Hospital Charge Code	4220100
Hospital Revenue Code	350
Min. Negotiated Rate	$88.74
Max. Negotiated Rate	$1,036.00
Rate for Payer: Aetna of NY Commercial	$1,036.00
Rate for Payer: Aetna of NY Medicare	$120.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$195.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$195.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$96.57
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$666.00
Rate for Payer: Cash Price	$195.75
Rate for Payer: Cash Price	$195.75
Rate for Payer: Cash Price	$195.75
Rate for Payer: CDPHP Commercial	$210.10
Rate for Payer: CDPHP Medicare	$96.57
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$182.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$208.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$208.80
Rate for Payer: EmblemHealth Medicaid	$208.80
Rate for Payer: EmblemHealth Medicare	$88.74
Rate for Payer: EmblemHealth Select Care	$169.65
Rate for Payer: Fidelis Medicare	$99.47
Rate for Payer: Galaxy Health Commercial	$169.65
Rate for Payer: Hamaspik Choice Medicare	$96.57
Rate for Payer: Humana Medicare	$96.57
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,036.00
Rate for Payer: Local 1199SEIU Medicare	$120.06
Rate for Payer: MVP Health Care of NY Commercial	$195.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$146.94
Rate for Payer: MVP Health Care of NY Medicare	$101.40
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	$96.57
Rate for Payer: WellCare Medicare	$143.55

CT CALCIUM SCORING

Facility

$100.00

Service Code	HCPCS 75571 TC
Hospital Charge Code	4224310
Hospital Revenue Code	350
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Galaxy Health Commercial	$65.00

CT CALCIUM SCORING

Facility

$100.00

Service Code	HCPCS 75571 TC
Hospital Charge Code	4224310
Hospital Revenue Code	350
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$1,036.00
Rate for Payer: Aetna of NY Commercial	$1,036.00
Rate for Payer: Aetna of NY Medicare	$46.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$75.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$75.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$37.00
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$666.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: CDPHP Commercial	$80.50
Rate for Payer: CDPHP Medicare	$37.00
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$70.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$80.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$80.00
Rate for Payer: EmblemHealth Medicaid	$80.00
Rate for Payer: EmblemHealth Medicare	$34.00
Rate for Payer: EmblemHealth Select Care	$65.00
Rate for Payer: Fidelis Medicare	$38.11
Rate for Payer: Galaxy Health Commercial	$65.00
Rate for Payer: Hamaspik Choice Medicare	$37.00
Rate for Payer: Humana Medicare	$37.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,036.00
Rate for Payer: Local 1199SEIU Medicare	$46.00
Rate for Payer: MVP Health Care of NY Commercial	$75.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$56.30
Rate for Payer: MVP Health Care of NY Medicare	$38.85
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	$37.00
Rate for Payer: WellCare Medicare	$55.00

CT CHEST SPINE W/DYE

Facility

$1,915.00

Service Code	HCPCS 72129 TC
Hospital Charge Code	4220089
Hospital Revenue Code	352
Min. Negotiated Rate	$651.10
Max. Negotiated Rate	$1,541.58
Rate for Payer: Aetna of NY Commercial	$1,036.00
Rate for Payer: Aetna of NY Medicare	$880.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$1,436.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$1,436.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$708.55
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$666.00
Rate for Payer: Cash Price	$1,436.25
Rate for Payer: Cash Price	$1,436.25
Rate for Payer: Cash Price	$1,436.25
Rate for Payer: CDPHP Commercial	$1,541.58
Rate for Payer: CDPHP Medicare	$708.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,340.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,532.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,532.00
Rate for Payer: EmblemHealth Medicaid	$1,532.00
Rate for Payer: EmblemHealth Medicare	$651.10
Rate for Payer: EmblemHealth Select Care	$1,244.75
Rate for Payer: Fidelis Medicare	$729.81
Rate for Payer: Galaxy Health Commercial	$1,244.75
Rate for Payer: Hamaspik Choice Medicare	$708.55
Rate for Payer: Humana Medicare	$708.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,036.00
Rate for Payer: Local 1199SEIU Medicare	$880.90
Rate for Payer: MVP Health Care of NY Commercial	$1,436.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,078.14
Rate for Payer: MVP Health Care of NY Medicare	$743.98
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	$708.55
Rate for Payer: WellCare Medicare	$1,053.25

CT CHEST SPINE W/DYE

Facility

$1,915.00

Service Code	HCPCS 72129 TC
Hospital Charge Code	4220089
Hospital Revenue Code	352
Min. Negotiated Rate	$1,244.75
Max. Negotiated Rate	$1,244.75
Rate for Payer: Cash Price	$1,436.25
Rate for Payer: Galaxy Health Commercial	$1,244.75

CT CHEST SPINE W/O DYE

Facility

$1,346.00

Service Code	HCPCS 72128 TC
Hospital Charge Code	4220045
Hospital Revenue Code	352
Min. Negotiated Rate	$874.90
Max. Negotiated Rate	$874.90
Rate for Payer: Cash Price	$1,009.50
Rate for Payer: Galaxy Health Commercial	$874.90

CT CHEST SPINE W/O DYE

Facility

$1,346.00

Service Code	HCPCS 72128 TC
Hospital Charge Code	4220045
Hospital Revenue Code	352
Min. Negotiated Rate	$457.64
Max. Negotiated Rate	$1,083.53
Rate for Payer: Aetna of NY Commercial	$1,036.00
Rate for Payer: Aetna of NY Medicare	$619.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$1,009.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$1,009.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$498.02
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$666.00
Rate for Payer: Cash Price	$1,009.50
Rate for Payer: Cash Price	$1,009.50
Rate for Payer: Cash Price	$1,009.50
Rate for Payer: CDPHP Commercial	$1,083.53
Rate for Payer: CDPHP Medicare	$498.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$942.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,076.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,076.80
Rate for Payer: EmblemHealth Medicaid	$1,076.80
Rate for Payer: EmblemHealth Medicare	$457.64
Rate for Payer: EmblemHealth Select Care	$874.90
Rate for Payer: Fidelis Medicare	$512.96
Rate for Payer: Galaxy Health Commercial	$874.90
Rate for Payer: Hamaspik Choice Medicare	$498.02
Rate for Payer: Humana Medicare	$498.02
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,036.00
Rate for Payer: Local 1199SEIU Medicare	$619.16
Rate for Payer: MVP Health Care of NY Commercial	$1,009.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$757.80
Rate for Payer: MVP Health Care of NY Medicare	$522.92
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	$498.02
Rate for Payer: WellCare Medicare	$740.30

CT CHEST SPINE W/O & W/DYE

Facility

$1,598.00

Service Code	HCPCS 72130 TC
Hospital Charge Code	4220046
Hospital Revenue Code	352
Min. Negotiated Rate	$1,038.70
Max. Negotiated Rate	$1,038.70
Rate for Payer: Cash Price	$1,198.50
Rate for Payer: Galaxy Health Commercial	$1,038.70

CT CHEST SPINE W/O & W/DYE

Facility

$1,598.00

Service Code	HCPCS 72130 TC
Hospital Charge Code	4220046
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 CBP/EPO/PPO/HMO/Network Access	$1,118.60
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: EmblemHealth Select Care	$1,038.70
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 COLONOGRAPHY DX

Facility

$2,692.00

Service Code	HCPCS 74261
Hospital Charge Code	4220078
Hospital Revenue Code	352
Min. Negotiated Rate	$121.60
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 CHIP/Family Health Plus/Medicaid	$121.60
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 COLONOGRAPHY DX

Facility

$2,692.00

Service Code	HCPCS 74261
Hospital Charge Code	4220078
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 COLONOGRAPHY DX W/DYE

Facility

$2,588.00

Service Code	HCPCS 74262
Hospital Charge Code	4220071
Hospital Revenue Code	352
Min. Negotiated Rate	$138.43
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 CHIP/Family Health Plus/Medicaid	$138.43
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 COLONOGRAPHY DX W/DYE

Facility

$2,588.00

Service Code	HCPCS 74262
Hospital Charge Code	4220071
Hospital Revenue Code	352
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 HEAD/BRAIN W/DYE

Facility

$1,239.00

Service Code	HCPCS 70460 TC
Hospital Charge Code	4220024
Hospital Revenue Code	351
Min. Negotiated Rate	$805.35
Max. Negotiated Rate	$805.35
Rate for Payer: Cash Price	$929.25
Rate for Payer: Galaxy Health Commercial	$805.35

CT HEAD/BRAIN W/DYE

Facility

$1,239.00

Service Code	HCPCS 70460 TC
Hospital Charge Code	4220024
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 CBP/EPO/PPO/HMO/Network Access	$867.30
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: EmblemHealth Select Care	$805.35
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 HEAD/BRAIN W/O DYE

Facility

$1,151.00

Service Code	HCPCS 70450 TC
Hospital Charge Code	4220022
Hospital Revenue Code	351
Min. Negotiated Rate	$748.15
Max. Negotiated Rate	$748.15
Rate for Payer: Cash Price	$863.25
Rate for Payer: Galaxy Health Commercial	$748.15

CT HEAD/BRAIN W/O DYE

Facility

$1,151.00

Service Code	HCPCS 70450 TC
Hospital Charge Code	4220022
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 CBP/EPO/PPO/HMO/Network Access	$805.70
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: EmblemHealth Select Care	$748.15
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 HEAD/BRAIN W/O & W/DYE

Facility

$1,332.00

Service Code	HCPCS 70470 TC
Hospital Charge Code	4220023
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 CBP/EPO/PPO/HMO/Network Access	$932.40
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: EmblemHealth Select Care	$865.80
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 HEAD/BRAIN W/O & W/DYE

Facility

$1,332.00

Service Code	HCPCS 70470 TC
Hospital Charge Code	4220023
Hospital Revenue Code	351
Min. Negotiated Rate	$865.80
Max. Negotiated Rate	$865.80
Rate for Payer: Cash Price	$999.00
Rate for Payer: Galaxy Health Commercial	$865.80

CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Facility

$610.00

Service Code	HCPCS 75572 TC
Hospital Charge Code	4220103
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

CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Facility

$610.00

Service Code	HCPCS 75572 TC
Hospital Charge Code	4220103
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

Know your out-of-pocket cost for care.

All Charges