|
CT BONE DENSITY AXIAL
|
Facility
|
IP
|
$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
|
OP
|
$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
|
|
|
CT CALCIUM SCORING
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 75571 TC
|
| Hospital Charge Code |
4224310
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.00
|
| 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 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 |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$42.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
CT CALCIUM SCORING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Hospital Charge Code |
5224310
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
|
|
CT CALCIUM SCORING
|
Facility
|
IP
|
$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
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Hospital Charge Code |
5224310
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.40
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: Fidelis Medicare |
$34.40
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.40
|
| Rate for Payer: Humana Medicare |
$34.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.90
|
| Rate for Payer: United Healthcare Medicare |
$34.40
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
CT CERE PRFUJ ALYS C+ W/CT/CTA SAME ANATOMY
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 70472 26
|
| Hospital Charge Code |
5224313
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
|
|
CT CERE PRFUJ ALYS C+ W/CT/CTA SAME ANATOMY
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 70472 TC
|
| Hospital Charge Code |
4224313
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: EmblemHealth Select Care |
$163.80
|
| Rate for Payer: Fidelis Medicare |
$100.80
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.80
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
CT CERE PRFUJ ALYS C+ W/CT/CTA SAME ANATOMY
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 70472 TC
|
| Hospital Charge Code |
4224313
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
CT CERE PRFUJ ALYS C+ W/CT/CTA SAME ANATOMY
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 70472 26
|
| Hospital Charge Code |
5224313
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.80
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: Fidelis Medicare |
$46.80
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.80
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.55
|
| Rate for Payer: United Healthcare Medicare |
$46.80
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
|
CT CERE PRFUJ ALYS C+ W/O CT/CTA SAME ANATOMY
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 70473 TC
|
| Hospital Charge Code |
4224314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$143.60
|
| Rate for Payer: Cash Price |
$269.25
|
| Rate for Payer: Cash Price |
$269.25
|
| Rate for Payer: Cash Price |
$269.25
|
| Rate for Payer: CDPHP Medicare |
$132.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$251.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$287.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$287.20
|
| Rate for Payer: EmblemHealth Medicaid |
$287.20
|
| Rate for Payer: EmblemHealth Medicare |
$122.06
|
| Rate for Payer: EmblemHealth Select Care |
$233.35
|
| Rate for Payer: Fidelis Medicare |
$143.60
|
| Rate for Payer: Galaxy Health Commercial |
$233.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$143.60
|
| Rate for Payer: Humana Medicare |
$143.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$150.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.85
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$143.60
|
| Rate for Payer: WellCare Medicare |
$197.45
|
|
|
CT CERE PRFUJ ALYS C+ W/O CT/CTA SAME ANATOMY
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 70473 26
|
| Hospital Charge Code |
5224314
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Galaxy Health Commercial |
$98.80
|
|
|
CT CERE PRFUJ ALYS C+ W/O CT/CTA SAME ANATOMY
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 70473 TC
|
| Hospital Charge Code |
4224314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$233.35 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Cash Price |
$269.25
|
| Rate for Payer: Galaxy Health Commercial |
$233.35
|
|
|
CT CERE PRFUJ ALYS C+ W/O CT/CTA SAME ANATOMY
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 70473 26
|
| Hospital Charge Code |
5224314
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$69.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$60.80
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: CDPHP Medicare |
$56.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$121.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.60
|
| Rate for Payer: EmblemHealth Medicaid |
$121.60
|
| Rate for Payer: EmblemHealth Medicare |
$51.68
|
| Rate for Payer: Fidelis Medicare |
$60.80
|
| Rate for Payer: Galaxy Health Commercial |
$98.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$60.80
|
| Rate for Payer: Humana Medicare |
$60.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$69.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$85.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$63.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.80
|
| Rate for Payer: United Healthcare Medicare |
$60.80
|
| Rate for Payer: WellCare Medicare |
$83.60
|
|
|
CT CHEST SPINE W/ DYE
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 72129 26
|
| Hospital Charge Code |
5220089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
CT CHEST SPINE W/ DYE
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 72129 26
|
| Hospital Charge Code |
5220089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
CT CHEST SPINE W/DYE
|
Facility
|
IP
|
$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/DYE
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
HCPCS 72129 TC
|
| Hospital Charge Code |
4220089
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$287.25 |
| Max. Negotiated Rate |
$1,532.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$880.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.00
|
| 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 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 |
$766.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,244.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.00
|
| Rate for Payer: Humana Medicare |
$766.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$804.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$287.25
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$766.00
|
| Rate for Payer: WellCare Medicare |
$1,053.25
|
|
|
CT CHEST SPINE W/O DYE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 72128 26
|
| Hospital Charge Code |
5220045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.40
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: CDPHP Medicare |
$54.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.80
|
| Rate for Payer: EmblemHealth Medicaid |
$116.80
|
| Rate for Payer: EmblemHealth Medicare |
$49.64
|
| Rate for Payer: Fidelis Medicare |
$58.40
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.40
|
| Rate for Payer: Humana Medicare |
$58.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.90
|
| Rate for Payer: United Healthcare Medicare |
$58.40
|
| Rate for Payer: WellCare Medicare |
$80.30
|
|
|
CT CHEST SPINE W/O DYE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 72128 26
|
| Hospital Charge Code |
5220045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$94.90 |
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
|
|
CT CHEST SPINE W/O DYE
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
HCPCS 72128 TC
|
| Hospital Charge Code |
4220045
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$201.90 |
| Max. Negotiated Rate |
$1,076.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$619.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$538.40
|
| 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 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 |
$538.40
|
| Rate for Payer: Galaxy Health Commercial |
$874.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$538.40
|
| Rate for Payer: Humana Medicare |
$538.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$565.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$201.90
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$538.40
|
| Rate for Payer: WellCare Medicare |
$740.30
|
|
|
CT CHEST SPINE W/O DYE
|
Facility
|
IP
|
$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 & W/ DYE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 72130 26
|
| Hospital Charge Code |
5220046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
|
|
CT CHEST SPINE W/O & W/ DYE
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 72130 26
|
| Hospital Charge Code |
5220046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$85.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.40
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: CDPHP Medicare |
$68.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.80
|
| Rate for Payer: EmblemHealth Medicaid |
$148.80
|
| Rate for Payer: EmblemHealth Medicare |
$63.24
|
| Rate for Payer: Fidelis Medicare |
$74.40
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.40
|
| Rate for Payer: Humana Medicare |
$74.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.90
|
| Rate for Payer: United Healthcare Medicare |
$74.40
|
| Rate for Payer: WellCare Medicare |
$102.30
|
|
|
CT CHEST SPINE W/O & W/DYE
|
Facility
|
IP
|
$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
|
|
