|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
4220034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$820.95 |
| Max. Negotiated Rate |
$820.95 |
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
|
|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
4220034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$429.42 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$580.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$947.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$947.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$467.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: CDPHP Commercial |
$1,016.72
|
| Rate for Payer: CDPHP Medicare |
$467.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$884.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$429.42
|
| Rate for Payer: EmblemHealth Select Care |
$820.95
|
| Rate for Payer: Fidelis Medicare |
$481.33
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$467.31
|
| Rate for Payer: Humana Medicare |
$467.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$580.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$947.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$711.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$490.68
|
| 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 |
$467.31
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
4224309
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$403.65 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
4224309
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: CDPHP Commercial |
$499.90
|
| Rate for Payer: CDPHP Medicare |
$229.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$434.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.80
|
| Rate for Payer: EmblemHealth Medicaid |
$496.80
|
| Rate for Payer: EmblemHealth Medicare |
$211.14
|
| Rate for Payer: EmblemHealth Select Care |
$403.65
|
| Rate for Payer: Fidelis Medicare |
$236.66
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.77
|
| Rate for Payer: Humana Medicare |
$229.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$241.26
|
| 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 |
$229.77
|
| Rate for Payer: WellCare Medicare |
$341.55
|
|
|
CT THORAX W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
4220012
|
|
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 THORAX W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
4220012
|
|
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 THORAX W/O DYE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
4220010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$807.30 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
|
|
CT THORAX W/O DYE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
4220010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$422.28 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$869.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$807.30
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| 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 |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
CT THORAX W/O & W/DYE
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
4220011
|
|
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 THORAX W/O & W/DYE
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
4220011
|
|
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 UPPER EXTREMITY W/DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
4220047
|
|
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 UPPER EXTREMITY W/DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
4220047
|
|
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 UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
4220048
|
|
Hospital Revenue Code
|
352
|
| 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 UPPER EXTREMITY W/O DYE
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
4220048
|
|
Hospital Revenue Code
|
352
|
| 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 UPPR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
4220049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$454.24 |
| Max. Negotiated Rate |
$1,075.48 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$614.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,002.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,002.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$494.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: CDPHP Commercial |
$1,075.48
|
| Rate for Payer: CDPHP Medicare |
$494.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$935.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,068.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,068.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,068.80
|
| Rate for Payer: EmblemHealth Medicare |
$454.24
|
| Rate for Payer: EmblemHealth Select Care |
$868.40
|
| Rate for Payer: Fidelis Medicare |
$509.15
|
| Rate for Payer: Galaxy Health Commercial |
$868.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$494.32
|
| Rate for Payer: Humana Medicare |
$494.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$614.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$752.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$519.04
|
| 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 |
$494.32
|
| Rate for Payer: WellCare Medicare |
$734.80
|
|
|
CT UPPR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
4220049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$868.40 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Galaxy Health Commercial |
$868.40
|
|
|
CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
4300015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Commercial |
$20.93
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$9.91
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.62
|
| Rate for Payer: Humana Medicare |
$9.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.71
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
4300015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
CULTURE AFB URINE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
4301086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
|
|
CULTURE AFB URINE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
4301086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna of NY Commercial |
$67.60
|
| Rate for Payer: Aetna of NY Medicare |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: CDPHP Commercial |
$83.72
|
| Rate for Payer: CDPHP Medicare |
$38.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$62.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$83.20
|
| Rate for Payer: EmblemHealth Medicaid |
$83.20
|
| Rate for Payer: EmblemHealth Medicare |
$35.36
|
| Rate for Payer: EmblemHealth Select Care |
$62.40
|
| Rate for Payer: Fidelis Medicare |
$39.63
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.48
|
| Rate for Payer: Humana Medicare |
$38.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$67.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$58.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$78.00
|
| Rate for Payer: United Healthcare Medicare |
$38.48
|
| Rate for Payer: WellCare Medicare |
$57.20
|
|
|
CULTURE ANAEROBIC
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4300233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna of NY Commercial |
$57.85
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.50
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Commercial |
$71.64
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: EmblemHealth Select Care |
$53.40
|
| Rate for Payer: Fidelis Medicare |
$33.92
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.93
|
| Rate for Payer: Humana Medicare |
$32.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$57.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$66.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.47
|
| Rate for Payer: United Healthcare Commercial |
$66.75
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
CULTURE ANAEROBIC
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4300233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
|
|
CULTURE BLOOD
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4300235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
CULTURE BLOOD
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4300235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
CULTURE CSF
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300237
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
