|
CT CHEST SPINE W/O & W/DYE
|
Facility
|
OP
|
$1,598.00
|
|
|
Service Code
|
HCPCS 72130 TC
|
| Hospital Charge Code |
4220046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$239.70 |
| Max. Negotiated Rate |
$1,278.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$735.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$639.20
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: Cash Price |
$1,198.50
|
| Rate for Payer: CDPHP Medicare |
$591.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,118.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,278.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,278.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,278.40
|
| Rate for Payer: EmblemHealth Medicare |
$543.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,038.70
|
| Rate for Payer: Fidelis Medicare |
$639.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,038.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$639.20
|
| Rate for Payer: Humana Medicare |
$639.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$735.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,198.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$899.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$671.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$239.70
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$639.20
|
| Rate for Payer: WellCare Medicare |
$878.90
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
4220078
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,749.80 |
| Max. Negotiated Rate |
$1,749.80 |
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
HCPCS 74261 26
|
| Hospital Charge Code |
5220078
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$229.45 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Cash Price |
$264.75
|
| Rate for Payer: Galaxy Health Commercial |
$229.45
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
4220078
|
|
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 COLONOGRAPHY DX
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 74261 26
|
| Hospital Charge Code |
5220078
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$162.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$141.20
|
| Rate for Payer: Cash Price |
$264.75
|
| Rate for Payer: Cash Price |
$264.75
|
| Rate for Payer: CDPHP Medicare |
$130.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$282.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$282.40
|
| Rate for Payer: EmblemHealth Medicaid |
$282.40
|
| Rate for Payer: EmblemHealth Medicare |
$120.02
|
| Rate for Payer: Fidelis Medicare |
$141.20
|
| Rate for Payer: Galaxy Health Commercial |
$229.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$141.20
|
| Rate for Payer: Humana Medicare |
$141.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$198.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$148.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$52.95
|
| Rate for Payer: United Healthcare Medicare |
$141.20
|
| Rate for Payer: WellCare Medicare |
$194.15
|
|
|
CT COLONOGRAPHY DX W/ DYE
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 74262 26
|
| Hospital Charge Code |
5220071
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$169.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$147.20
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: CDPHP Medicare |
$136.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$294.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$294.40
|
| Rate for Payer: EmblemHealth Medicaid |
$294.40
|
| Rate for Payer: EmblemHealth Medicare |
$125.12
|
| Rate for Payer: Fidelis Medicare |
$147.20
|
| Rate for Payer: Galaxy Health Commercial |
$239.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$147.20
|
| Rate for Payer: Humana Medicare |
$147.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$169.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$207.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$154.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.20
|
| Rate for Payer: United Healthcare Medicare |
$147.20
|
| Rate for Payer: WellCare Medicare |
$202.40
|
|
|
CT COLONOGRAPHY DX W/ DYE
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 74262 26
|
| Hospital Charge Code |
5220071
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Galaxy Health Commercial |
$239.20
|
|
|
CT COLONOGRAPHY DX W/DYE
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
4220071
|
|
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 COLONOGRAPHY DX W/DYE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
4220071
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$1,682.20 |
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
|
|
CT HEAD/BRAIN W/ DYE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 70460 26
|
| Hospital Charge Code |
5220024
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: CDPHP Medicare |
$61.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.00
|
| Rate for Payer: EmblemHealth Medicaid |
$132.00
|
| Rate for Payer: EmblemHealth Medicare |
$56.10
|
| Rate for Payer: Fidelis Medicare |
$66.00
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.00
|
| Rate for Payer: Humana Medicare |
$66.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WellCare Medicare |
$90.75
|
|
|
CT HEAD/BRAIN W/ DYE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 70460 26
|
| Hospital Charge Code |
5220024
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
|
|
CT HEAD/BRAIN W/DYE
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
HCPCS 70460 TC
|
| Hospital Charge Code |
4220024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$805.35 |
| Max. Negotiated Rate |
$805.35 |
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: Galaxy Health Commercial |
$805.35
|
|
|
CT HEAD/BRAIN W/DYE
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
HCPCS 70460 TC
|
| Hospital Charge Code |
4220024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$185.85 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$569.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$495.60
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: Cash Price |
$929.25
|
| Rate for Payer: CDPHP Medicare |
$458.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$867.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$991.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$991.20
|
| Rate for Payer: EmblemHealth Medicaid |
$991.20
|
| Rate for Payer: EmblemHealth Medicare |
$421.26
|
| Rate for Payer: EmblemHealth Select Care |
$805.35
|
| Rate for Payer: Fidelis Medicare |
$495.60
|
| Rate for Payer: Galaxy Health Commercial |
$805.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$495.60
|
| Rate for Payer: Humana Medicare |
$495.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$569.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$929.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$697.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$520.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$185.85
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$495.60
|
| Rate for Payer: WellCare Medicare |
$681.45
|
|
|
CT HEAD/BRAIN W/O DYE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 70450 26
|
| Hospital Charge Code |
5220022
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: Fidelis Medicare |
$50.00
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.00
|
| Rate for Payer: Humana Medicare |
$50.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare |
$50.00
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
CT HEAD/BRAIN W/O DYE
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
4220022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$172.65 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$529.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$460.40
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: CDPHP Medicare |
$425.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$805.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$920.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$920.80
|
| Rate for Payer: EmblemHealth Medicaid |
$920.80
|
| Rate for Payer: EmblemHealth Medicare |
$391.34
|
| Rate for Payer: EmblemHealth Select Care |
$748.15
|
| Rate for Payer: Fidelis Medicare |
$460.40
|
| Rate for Payer: Galaxy Health Commercial |
$748.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$460.40
|
| Rate for Payer: Humana Medicare |
$460.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$529.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$648.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$483.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$172.65
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$460.40
|
| Rate for Payer: WellCare Medicare |
$633.05
|
|
|
CT HEAD/BRAIN W/O DYE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 70450 26
|
| Hospital Charge Code |
5220022
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
|
|
CT HEAD/BRAIN W/O DYE
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
4220022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$748.15 |
| Max. Negotiated Rate |
$748.15 |
| Rate for Payer: Cash Price |
$863.25
|
| Rate for Payer: Galaxy Health Commercial |
$748.15
|
|
|
CT HEAD/BRAIN W/O & W/ DYE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 70470 26
|
| Hospital Charge Code |
5220023
|
|
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 HEAD/BRAIN W/O & W/ DYE
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 70470 26
|
| Hospital Charge Code |
5220023
|
|
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 HEAD/BRAIN W/O & W/DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70470 TC
|
| Hospital Charge Code |
4220023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$865.80 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
|
|
CT HEAD/BRAIN W/O & W/DYE
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70470 TC
|
| Hospital Charge Code |
4220023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$612.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$532.80
|
| 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 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 |
$532.80
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$532.80
|
| Rate for Payer: Humana Medicare |
$532.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$559.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$199.80
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$532.80
|
| Rate for Payer: WellCare Medicare |
$732.60
|
|
|
CT HEART CONTRAST EVAL CARDIAC STRUCTURE & MORPH
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 75572 26
|
| Hospital Charge Code |
5220103
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$116.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$101.20
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: CDPHP Medicare |
$93.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$202.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$202.40
|
| Rate for Payer: EmblemHealth Medicaid |
$202.40
|
| Rate for Payer: EmblemHealth Medicare |
$86.02
|
| Rate for Payer: Fidelis Medicare |
$101.20
|
| Rate for Payer: Galaxy Health Commercial |
$164.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$101.20
|
| Rate for Payer: Humana Medicare |
$101.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$116.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$142.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$106.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.95
|
| Rate for Payer: United Healthcare Medicare |
$101.20
|
| Rate for Payer: WellCare Medicare |
$139.15
|
|
|
CT HEART CONTRAST EVAL CARDIAC STRUCTURE & MORPH
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 75572 26
|
| Hospital Charge Code |
5220103
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Galaxy Health Commercial |
$164.45
|
|
|
CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 75572 TC
|
| Hospital Charge Code |
4220103
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$492.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$428.40
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: CDPHP Medicare |
$396.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$749.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$856.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$856.80
|
| Rate for Payer: EmblemHealth Medicaid |
$856.80
|
| Rate for Payer: EmblemHealth Medicare |
$364.14
|
| Rate for Payer: EmblemHealth Select Care |
$696.15
|
| Rate for Payer: Fidelis Medicare |
$428.40
|
| Rate for Payer: Galaxy Health Commercial |
$696.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$428.40
|
| Rate for Payer: Humana Medicare |
$428.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$492.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$803.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$602.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$449.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$160.65
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$428.40
|
| Rate for Payer: WellCare Medicare |
$589.05
|
|
|
CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 75572 TC
|
| Hospital Charge Code |
4220103
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$696.15 |
| Max. Negotiated Rate |
$696.15 |
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Galaxy Health Commercial |
$696.15
|
|
