|
CT NECK SPINE W/O & W/DYE
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
4220008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,699.75 |
| Max. Negotiated Rate |
$1,699.75 |
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,699.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4224307
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$223.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Commercial |
$487.02
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$423.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: EmblemHealth Select Care |
$393.25
|
| Rate for Payer: Fidelis Medicare |
$230.57
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$223.85
|
| Rate for Payer: Humana Medicare |
$223.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$235.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$223.85
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4220037
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$223.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Commercial |
$487.02
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$423.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: EmblemHealth Select Care |
$393.25
|
| Rate for Payer: Fidelis Medicare |
$230.57
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$223.85
|
| Rate for Payer: Humana Medicare |
$223.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$235.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$223.85
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4224307
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4220037
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4220038
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Commercial |
$273.70
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: EmblemHealth Select Care |
$221.00
|
| Rate for Payer: Fidelis Medicare |
$129.57
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.80
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$125.80
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4220038
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4224308
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Commercial |
$273.70
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: EmblemHealth Select Care |
$221.00
|
| Rate for Payer: Fidelis Medicare |
$129.57
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.80
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$125.80
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4224308
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
|
|
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
4220039
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$452.88 |
| Max. Negotiated Rate |
$1,072.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$612.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$999.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$492.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: CDPHP Commercial |
$1,072.26
|
| Rate for Payer: CDPHP Medicare |
$492.84
|
| Rate for Payer: EmblemHealth 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 ORBIT/EAR/FOSSA W/O&W/DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
4220039
|
|
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 PELVIS W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Hospital Charge Code |
4220042
|
|
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
|
|
|
CT PELVIS W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Hospital Charge Code |
4220042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth 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 PELVIS W/O DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Hospital Charge Code |
4220040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.42 |
| Max. Negotiated Rate |
$1,137.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,059.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$522.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: CDPHP Commercial |
$1,137.46
|
| Rate for Payer: CDPHP Medicare |
$522.81
|
| Rate for Payer: EmblemHealth 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 PELVIS W/O DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Hospital Charge Code |
4220040
|
|
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 PELVIS W/O & W/DYE
|
Facility
|
IP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
4220041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,547.65 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
|
|
CT PELVIS W/O & W/DYE
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
4220041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$1,916.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$880.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: CDPHP Commercial |
$1,916.70
|
| Rate for Payer: CDPHP Medicare |
$880.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,666.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,904.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicare |
$809.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,547.65
|
| Rate for Payer: Fidelis Medicare |
$907.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$880.97
|
| Rate for Payer: Humana Medicare |
$880.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,095.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,785.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,340.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$925.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$880.97
|
| Rate for Payer: WellCare Medicare |
$1,309.55
|
|
|
CT PERFUSION W/CONTRAST CBF
|
Facility
|
OP
|
$2,822.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
4220076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$141.85 |
| Max. Negotiated Rate |
$2,271.71 |
| Rate for Payer: Aetna of NY Commercial |
$1,834.30
|
| Rate for Payer: Aetna of NY Medicare |
$1,298.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,116.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,116.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,044.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: CDPHP Commercial |
$2,271.71
|
| Rate for Payer: CDPHP Medicare |
$1,044.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,975.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,257.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,257.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,257.60
|
| Rate for Payer: EmblemHealth Medicare |
$959.48
|
| Rate for Payer: EmblemHealth Select Care |
$1,834.30
|
| Rate for Payer: Fidelis Medicare |
$1,075.46
|
| Rate for Payer: Galaxy Health Commercial |
$1,834.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,044.14
|
| Rate for Payer: Humana Medicare |
$1,044.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,834.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,298.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,116.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,588.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,096.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.85
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.14
|
| Rate for Payer: WellCare Medicare |
$1,552.10
|
|
|
CT PERFUSION W/CONTRAST CBF
|
Facility
|
IP
|
$2,822.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
4220076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,834.30 |
| Max. Negotiated Rate |
$1,834.30 |
| Rate for Payer: Cash Price |
$2,116.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,834.30
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 77011
|
| Hospital Charge Code |
4220073
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,716.00 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,716.00
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 77011
|
| Hospital Charge Code |
4220073
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$2,125.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,214.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,980.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,980.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$976.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: CDPHP Commercial |
$2,125.20
|
| Rate for Payer: CDPHP Medicare |
$976.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,848.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,112.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicare |
$897.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,716.00
|
| Rate for Payer: Fidelis Medicare |
$1,006.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,716.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$976.80
|
| Rate for Payer: Humana Medicare |
$976.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,214.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,980.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,486.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,025.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$160.45
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$976.80
|
| Rate for Payer: WellCare Medicare |
$1,452.00
|
|
|
CT SFT TSUE NCK W/O & W/DYE
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
4220035
|
|
Hospital Revenue Code
|
351
|
| 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 SFT TSUE NCK W/O & W/DYE
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
4220035
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$542.30 |
| Max. Negotiated Rate |
$1,283.98 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$733.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,196.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,196.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$590.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: CDPHP Commercial |
$1,283.98
|
| Rate for Payer: CDPHP Medicare |
$590.15
|
| Rate for Payer: EmblemHealth 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 SOFT TISSUE NECK W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
4220036
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth 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 SOFT TISSUE NECK W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
4220036
|
|
Hospital Revenue Code
|
351
|
| 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
|
|
