|
CT HRT CONTRST CARDIAC STRUCT & MORPH CONG HRT D
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS 75573 26
|
| Hospital Charge Code |
5220104
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.95 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$171.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$149.20
|
| Rate for Payer: Cash Price |
$279.75
|
| Rate for Payer: Cash Price |
$279.75
|
| Rate for Payer: CDPHP Medicare |
$138.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$298.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$298.40
|
| Rate for Payer: EmblemHealth Medicaid |
$298.40
|
| Rate for Payer: EmblemHealth Medicare |
$126.82
|
| Rate for Payer: Fidelis Medicare |
$149.20
|
| Rate for Payer: Galaxy Health Commercial |
$242.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$149.20
|
| Rate for Payer: Humana Medicare |
$149.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$171.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$210.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$156.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.95
|
| Rate for Payer: United Healthcare Medicare |
$149.20
|
| Rate for Payer: WellCare Medicare |
$205.15
|
|
|
CT HRT CONTRST CARDIAC STRUCT & MORPH CONG HRT D
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS 75573 26
|
| Hospital Charge Code |
5220104
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$242.45 |
| Rate for Payer: Cash Price |
$279.75
|
| Rate for Payer: Galaxy Health Commercial |
$242.45
|
|
|
CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 75573 TC
|
| Hospital Charge Code |
4220104
|
|
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 HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 75573 TC
|
| Hospital Charge Code |
4220104
|
|
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
|
|
|
CT LOWER EXTREMITY W/ DYE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 73701 26
|
| Hospital Charge Code |
5220027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.60
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: CDPHP Medicare |
$62.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$135.20
|
| Rate for Payer: EmblemHealth Medicare |
$57.46
|
| Rate for Payer: Fidelis Medicare |
$67.60
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.60
|
| Rate for Payer: Humana Medicare |
$67.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.35
|
| Rate for Payer: United Healthcare Medicare |
$67.60
|
| Rate for Payer: WellCare Medicare |
$92.95
|
|
|
CT LOWER EXTREMITY W/ DYE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 73701 26
|
| Hospital Charge Code |
5220027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
|
|
CT LOWER EXTREMITY W/DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
4220027
|
|
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 LOWER EXTREMITY W/DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
4220027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$211.95 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$565.20
|
| 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 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 |
$565.20
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$565.20
|
| Rate for Payer: Humana Medicare |
$565.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$593.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$211.95
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$565.20
|
| Rate for Payer: WellCare Medicare |
$777.15
|
|
|
CT LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
4220025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$941.85 |
| Max. Negotiated Rate |
$941.85 |
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
|
|
CT LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 73700 26
|
| Hospital Charge Code |
5220025
|
|
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 LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 73700 26
|
| Hospital Charge Code |
5220025
|
|
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 LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
4220025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$217.35 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$666.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$579.60
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: CDPHP Medicare |
$536.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,014.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicare |
$492.66
|
| Rate for Payer: EmblemHealth Select Care |
$941.85
|
| Rate for Payer: Fidelis Medicare |
$579.60
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$579.60
|
| Rate for Payer: Humana Medicare |
$579.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$666.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,086.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$815.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$608.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$217.35
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$579.60
|
| Rate for Payer: WellCare Medicare |
$796.95
|
|
|
CT LOWER EXTREMITY W/O & W/ DYE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 73702 26
|
| Hospital Charge Code |
5220026
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.05 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Galaxy Health Commercial |
$115.05
|
|
|
CT LOWER EXTREMITY W/O & W/ DYE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 73702 26
|
| Hospital Charge Code |
5220026
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.80
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: CDPHP Medicare |
$65.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$141.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$141.60
|
| Rate for Payer: EmblemHealth Medicaid |
$141.60
|
| Rate for Payer: EmblemHealth Medicare |
$60.18
|
| Rate for Payer: Fidelis Medicare |
$70.80
|
| Rate for Payer: Galaxy Health Commercial |
$115.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.80
|
| Rate for Payer: Humana Medicare |
$70.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$99.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.55
|
| Rate for Payer: United Healthcare Medicare |
$70.80
|
| Rate for Payer: WellCare Medicare |
$97.35
|
|
|
CT LUMBAR SPINE W/ DYE
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 72132 26
|
| Hospital Charge Code |
5220030
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.20
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: CDPHP Medicare |
$65.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.40
|
| Rate for Payer: EmblemHealth Medicaid |
$142.40
|
| Rate for Payer: EmblemHealth Medicare |
$60.52
|
| Rate for Payer: Fidelis Medicare |
$71.20
|
| Rate for Payer: Galaxy Health Commercial |
$115.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.20
|
| Rate for Payer: Humana Medicare |
$71.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$81.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.70
|
| Rate for Payer: United Healthcare Medicare |
$71.20
|
| Rate for Payer: WellCare Medicare |
$97.90
|
|
|
CT LUMBAR SPINE W/ DYE
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 72132 26
|
| Hospital Charge Code |
5220030
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$115.70 |
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Galaxy Health Commercial |
$115.70
|
|
|
CT LUMBAR SPINE W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Hospital Charge Code |
4220030
|
|
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 LUMBAR SPINE W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Hospital Charge Code |
4220030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$1,204.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$602.00
|
| 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 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 |
$602.00
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$602.00
|
| Rate for Payer: Humana Medicare |
$602.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$632.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$602.00
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT LUMBAR SPINE W/O DYE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 72131 26
|
| Hospital Charge Code |
5220028
|
|
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 LUMBAR SPINE W/O DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Hospital Charge Code |
4220028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$211.95 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$565.20
|
| 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 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 |
$565.20
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$565.20
|
| Rate for Payer: Humana Medicare |
$565.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| 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 |
$593.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$211.95
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$565.20
|
| Rate for Payer: WellCare Medicare |
$777.15
|
|
|
CT LUMBAR SPINE W/O DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Hospital Charge Code |
4220028
|
|
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 LUMBAR SPINE W/O DYE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 72131 26
|
| Hospital Charge Code |
5220028
|
|
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 LUMBAR SPINE W/O & W/ DYE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 72133 26
|
| Hospital Charge Code |
5220029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Galaxy Health Commercial |
$120.25
|
|
|
CT LUMBAR SPINE W/O & W/ DYE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 72133 26
|
| Hospital Charge Code |
5220029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.00
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: CDPHP Medicare |
$68.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.00
|
| Rate for Payer: EmblemHealth Medicaid |
$148.00
|
| Rate for Payer: EmblemHealth Medicare |
$62.90
|
| Rate for Payer: Fidelis Medicare |
$74.00
|
| Rate for Payer: Galaxy Health Commercial |
$120.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.00
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$74.00
|
| Rate for Payer: WellCare Medicare |
$101.75
|
|
|
CT LUMBAR SPINE W/O & W/DYE
|
Facility
|
OP
|
$1,598.00
|
|
|
Service Code
|
HCPCS 72133 TC
|
| Hospital Charge Code |
4220029
|
|
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
|
|
