Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CT ANGIOGRAPH PELV W/O & W/ DYE

Facility

$263.00

Service Code	HCPCS 72191 26
Hospital Charge Code	5220015
Hospital Revenue Code	960
Min. Negotiated Rate	$170.95
Max. Negotiated Rate	$170.95
Rate for Payer: Cash Price	$197.25
Rate for Payer: Galaxy Health Commercial	$170.95

CT ANGIOGRAPH PELV W/O&W/DYE

Facility

$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

$3,313.00

Service Code	HCPCS 72191 TC
Hospital Charge Code	4220015
Hospital Revenue Code	352
Min. Negotiated Rate	$496.95
Max. Negotiated Rate	$2,650.40
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$1,523.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,325.20
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 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	$1,325.20
Rate for Payer: Galaxy Health Commercial	$2,153.45
Rate for Payer: Hamaspik Choice Medicare	$1,325.20
Rate for Payer: Humana Medicare	$1,325.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$1,391.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$496.95
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$1,325.20
Rate for Payer: WellCare Medicare	$1,822.15

CT ANGIOGRAPHY CHEST

Facility

$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 CHEST

Facility

$267.00

Service Code	HCPCS 71275 26
Hospital Charge Code	5220892
Hospital Revenue Code	960
Min. Negotiated Rate	$173.55
Max. Negotiated Rate	$173.55
Rate for Payer: Cash Price	$200.25
Rate for Payer: Galaxy Health Commercial	$173.55

CT ANGIOGRAPHY CHEST

Facility

$2,692.00

Service Code	HCPCS 71275 TC
Hospital Charge Code	4220892
Hospital Revenue Code	352
Min. Negotiated Rate	$403.80
Max. Negotiated Rate	$2,153.60
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$1,238.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,076.80
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 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	$1,076.80
Rate for Payer: Galaxy Health Commercial	$1,749.80
Rate for Payer: Hamaspik Choice Medicare	$1,076.80
Rate for Payer: Humana Medicare	$1,076.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$1,130.64
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$403.80
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$1,076.80
Rate for Payer: WellCare Medicare	$1,480.60

CT ANGIOGRAPHY CHEST

Facility

$267.00

Service Code	HCPCS 71275 26
Hospital Charge Code	5220892
Hospital Revenue Code	960
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$122.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$106.80
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: CDPHP Medicare	$98.79
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$213.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$213.60
Rate for Payer: EmblemHealth Medicaid	$213.60
Rate for Payer: EmblemHealth Medicare	$90.78
Rate for Payer: Fidelis Medicare	$106.80
Rate for Payer: Galaxy Health Commercial	$173.55
Rate for Payer: Hamaspik Choice Medicare	$106.80
Rate for Payer: Humana Medicare	$106.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$122.82
Rate for Payer: MVP Health Care of NY Commercial	$200.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$150.32
Rate for Payer: MVP Health Care of NY Medicare	$112.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.05
Rate for Payer: United Healthcare Medicare	$106.80
Rate for Payer: WellCare Medicare	$146.85

CT ANGIOGRAPHY HEAD

Facility

$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 HEAD

Facility

$256.00

Service Code	HCPCS 70496 26
Hospital Charge Code	5220074
Hospital Revenue Code	960
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$117.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$102.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: CDPHP Medicare	$94.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$204.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$204.80
Rate for Payer: EmblemHealth Medicaid	$204.80
Rate for Payer: EmblemHealth Medicare	$87.04
Rate for Payer: Fidelis Medicare	$102.40
Rate for Payer: Galaxy Health Commercial	$166.40
Rate for Payer: Hamaspik Choice Medicare	$102.40
Rate for Payer: Humana Medicare	$102.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$117.76
Rate for Payer: MVP Health Care of NY Commercial	$192.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$144.13
Rate for Payer: MVP Health Care of NY Medicare	$107.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$38.40
Rate for Payer: United Healthcare Medicare	$102.40
Rate for Payer: WellCare Medicare	$140.80

CT ANGIOGRAPHY HEAD

Facility

$256.00

Service Code	HCPCS 70496 26
Hospital Charge Code	5220074
Hospital Revenue Code	960
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$166.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Galaxy Health Commercial	$166.40

CT ANGIOGRAPHY HEAD

Facility

$2,588.00

Service Code	HCPCS 70496 TC
Hospital Charge Code	4220074
Hospital Revenue Code	351
Min. Negotiated Rate	$388.20
Max. Negotiated Rate	$2,070.40
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$1,190.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,035.20
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 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	$1,035.20
Rate for Payer: Galaxy Health Commercial	$1,682.20
Rate for Payer: Hamaspik Choice Medicare	$1,035.20
Rate for Payer: Humana Medicare	$1,035.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$1,086.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$388.20
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$1,035.20
Rate for Payer: WellCare Medicare	$1,423.40

CT ANGIOGRAPHY NECK

Facility

$256.00

Service Code	HCPCS 70498 26
Hospital Charge Code	5220891
Hospital Revenue Code	960
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$166.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Galaxy Health Commercial	$166.40

CT ANGIOGRAPHY NECK

Facility

$2,588.00

Service Code	HCPCS 70498 TC
Hospital Charge Code	4220891
Hospital Revenue Code	350
Min. Negotiated Rate	$388.20
Max. Negotiated Rate	$2,070.40
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$1,190.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,035.20
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 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	$1,035.20
Rate for Payer: Galaxy Health Commercial	$1,682.20
Rate for Payer: Hamaspik Choice Medicare	$1,035.20
Rate for Payer: Humana Medicare	$1,035.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$1,086.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$388.20
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$1,035.20
Rate for Payer: WellCare Medicare	$1,423.40

CT ANGIOGRAPHY NECK

Facility

$256.00

Service Code	HCPCS 70498 26
Hospital Charge Code	5220891
Hospital Revenue Code	960
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$117.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$102.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: CDPHP Medicare	$94.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$204.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$204.80
Rate for Payer: EmblemHealth Medicaid	$204.80
Rate for Payer: EmblemHealth Medicare	$87.04
Rate for Payer: Fidelis Medicare	$102.40
Rate for Payer: Galaxy Health Commercial	$166.40
Rate for Payer: Hamaspik Choice Medicare	$102.40
Rate for Payer: Humana Medicare	$102.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$117.76
Rate for Payer: MVP Health Care of NY Commercial	$192.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$144.13
Rate for Payer: MVP Health Care of NY Medicare	$107.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$38.40
Rate for Payer: United Healthcare Medicare	$102.40
Rate for Payer: WellCare Medicare	$140.80

CT ANGIOGRAPHY NECK

Facility

$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

$276.00

Service Code	HCPCS 73706 26
Hospital Charge Code	5220090
Hospital Revenue Code	960
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Cash Price	$207.00
Rate for Payer: Galaxy Health Commercial	$179.40

CT ANGIO LWR EXTR W/O & W/DYE

Facility

$276.00

Service Code	HCPCS 73706 26
Hospital Charge Code	5220090
Hospital Revenue Code	960
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$126.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$110.40
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: CDPHP Medicare	$102.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$220.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$220.80
Rate for Payer: EmblemHealth Medicaid	$220.80
Rate for Payer: EmblemHealth Medicare	$93.84
Rate for Payer: Fidelis Medicare	$110.40
Rate for Payer: Galaxy Health Commercial	$179.40
Rate for Payer: Hamaspik Choice Medicare	$110.40
Rate for Payer: Humana Medicare	$110.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$126.96
Rate for Payer: MVP Health Care of NY Commercial	$207.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$155.39
Rate for Payer: MVP Health Care of NY Medicare	$115.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$41.40
Rate for Payer: United Healthcare Medicare	$110.40
Rate for Payer: WellCare Medicare	$151.80

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	$114.00
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$349.60
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$304.00
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 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	$304.00
Rate for Payer: Galaxy Health Commercial	$494.00
Rate for Payer: Hamaspik Choice Medicare	$304.00
Rate for Payer: Humana Medicare	$304.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$319.20
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$114.00
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$304.00
Rate for Payer: WellCare Medicare	$418.00

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

$263.00

Service Code	HCPCS 73206 26
Hospital Charge Code	5220072
Hospital Revenue Code	960
Min. Negotiated Rate	$170.95
Max. Negotiated Rate	$170.95
Rate for Payer: Cash Price	$197.25
Rate for Payer: Galaxy Health Commercial	$170.95

CT ANGIO UPR EXTRM W/O & W/ DYE

Facility

$263.00

Service Code	HCPCS 73206 26
Hospital Charge Code	5220072
Hospital Revenue Code	960
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$120.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$105.20
Rate for Payer: Cash Price	$197.25
Rate for Payer: Cash Price	$197.25
Rate for Payer: CDPHP Medicare	$97.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$210.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$210.40
Rate for Payer: EmblemHealth Medicaid	$210.40
Rate for Payer: EmblemHealth Medicare	$89.42
Rate for Payer: Fidelis Medicare	$105.20
Rate for Payer: Galaxy Health Commercial	$170.95
Rate for Payer: Hamaspik Choice Medicare	$105.20
Rate for Payer: Humana Medicare	$105.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$120.98
Rate for Payer: MVP Health Care of NY Commercial	$197.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$148.07
Rate for Payer: MVP Health Care of NY Medicare	$110.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$39.45
Rate for Payer: United Healthcare Medicare	$105.20
Rate for Payer: WellCare Medicare	$144.65

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 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	$388.20
Max. Negotiated Rate	$2,070.40
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$1,190.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,035.20
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 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	$1,035.20
Rate for Payer: Galaxy Health Commercial	$1,682.20
Rate for Payer: Hamaspik Choice Medicare	$1,035.20
Rate for Payer: Humana Medicare	$1,035.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
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	$1,086.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$388.20
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$1,035.20
Rate for Payer: WellCare Medicare	$1,423.40

CT BONE DENSITY AXIAL

Facility

$37.00

Service Code	HCPCS 77078 26
Hospital Charge Code	5220100
Hospital Revenue Code	960
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$24.05
Rate for Payer: Cash Price	$27.75
Rate for Payer: Galaxy Health Commercial	$24.05

CT BONE DENSITY AXIAL

Facility

$267.00

Service Code	HCPCS 77078 TC
Hospital Charge Code	4220100
Hospital Revenue Code	350
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$122.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$106.80
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: CDPHP Medicare	$98.79
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$186.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$213.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$213.60
Rate for Payer: EmblemHealth Medicaid	$213.60
Rate for Payer: EmblemHealth Medicare	$90.78
Rate for Payer: EmblemHealth Select Care	$173.55
Rate for Payer: Fidelis Medicare	$106.80
Rate for Payer: Galaxy Health Commercial	$173.55
Rate for Payer: Hamaspik Choice Medicare	$106.80
Rate for Payer: Humana Medicare	$106.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$122.82
Rate for Payer: MVP Health Care of NY Commercial	$200.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$150.32
Rate for Payer: MVP Health Care of NY Medicare	$112.14
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.05
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$106.80
Rate for Payer: WellCare Medicare	$146.85

Know your out-of-pocket cost for care.

All Charges