|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 70490 26
|
| Hospital Charge Code |
5220034
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: CDPHP Medicare |
$69.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.40
|
| Rate for Payer: EmblemHealth Medicaid |
$150.40
|
| Rate for Payer: EmblemHealth Medicare |
$63.92
|
| Rate for Payer: Fidelis Medicare |
$75.20
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.20
|
| Rate for Payer: Humana Medicare |
$75.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.20
|
| Rate for Payer: United Healthcare Medicare |
$75.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
4220034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$189.45 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$580.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$505.20
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: CDPHP Medicare |
$467.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$884.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$429.42
|
| Rate for Payer: EmblemHealth Select Care |
$820.95
|
| Rate for Payer: Fidelis Medicare |
$505.20
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$505.20
|
| Rate for Payer: Humana Medicare |
$505.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$580.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$947.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$711.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$530.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$189.45
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$505.20
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
CT SOFT TISSUE NECK W/O & W/ DYE
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 70492 26
|
| Hospital Charge Code |
5220035
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$108.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.40
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: CDPHP Medicare |
$87.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$188.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$188.80
|
| Rate for Payer: EmblemHealth Medicaid |
$188.80
|
| Rate for Payer: EmblemHealth Medicare |
$80.24
|
| Rate for Payer: Fidelis Medicare |
$94.40
|
| Rate for Payer: Galaxy Health Commercial |
$153.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.40
|
| Rate for Payer: Humana Medicare |
$94.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$108.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$132.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.40
|
| Rate for Payer: United Healthcare Medicare |
$94.40
|
| Rate for Payer: WellCare Medicare |
$129.80
|
|
|
CT SOFT TISSUE NECK W/O & W/ DYE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 70492 26
|
| Hospital Charge Code |
5220035
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$153.40 |
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Galaxy Health Commercial |
$153.40
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
4224309
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$248.40
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: CDPHP Medicare |
$229.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$434.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.80
|
| Rate for Payer: EmblemHealth Medicaid |
$496.80
|
| Rate for Payer: EmblemHealth Medicare |
$211.14
|
| Rate for Payer: EmblemHealth Select Care |
$403.65
|
| Rate for Payer: Fidelis Medicare |
$248.40
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$248.40
|
| Rate for Payer: Humana Medicare |
$248.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$260.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$248.40
|
| Rate for Payer: WellCare Medicare |
$341.55
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 71271 26
|
| Hospital Charge Code |
5224309
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$72.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.20
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: CDPHP Medicare |
$58.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.40
|
| Rate for Payer: EmblemHealth Medicaid |
$126.40
|
| Rate for Payer: EmblemHealth Medicare |
$53.72
|
| Rate for Payer: Fidelis Medicare |
$63.20
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.20
|
| Rate for Payer: Humana Medicare |
$63.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$63.20
|
| Rate for Payer: WellCare Medicare |
$86.90
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 71271 26
|
| Hospital Charge Code |
5224309
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
|
|
CT THORAX LUNG CANCER SCR W/O CONTRAST
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
4224309
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$403.65 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Galaxy Health Commercial |
$403.65
|
|
|
CT THORAX W/ DYE
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 71260 26
|
| Hospital Charge Code |
5220012
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: CDPHP Medicare |
$63.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.80
|
| Rate for Payer: EmblemHealth Medicaid |
$136.80
|
| Rate for Payer: EmblemHealth Medicare |
$58.14
|
| Rate for Payer: Fidelis Medicare |
$68.40
|
| Rate for Payer: Galaxy Health Commercial |
$111.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.40
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$96.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.65
|
| Rate for Payer: United Healthcare Medicare |
$68.40
|
| Rate for Payer: WellCare Medicare |
$94.05
|
|
|
CT THORAX W/ DYE
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 71260 26
|
| Hospital Charge Code |
5220012
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Galaxy Health Commercial |
$111.15
|
|
|
CT THORAX W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
4220012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$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 THORAX W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
4220012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$978.25 |
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
|
|
CT THORAX W/O DYE
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 71250 26
|
| Hospital Charge Code |
5220010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
|
|
CT THORAX W/O DYE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
4220010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$496.80
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$869.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$807.30
|
| Rate for Payer: Fidelis Medicare |
$496.80
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$496.80
|
| Rate for Payer: Humana Medicare |
$496.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$521.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.30
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$496.80
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
CT THORAX W/O DYE
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 71250 26
|
| Hospital Charge Code |
5220010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$72.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.20
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: CDPHP Medicare |
$58.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.40
|
| Rate for Payer: EmblemHealth Medicaid |
$126.40
|
| Rate for Payer: EmblemHealth Medicare |
$53.72
|
| Rate for Payer: Fidelis Medicare |
$63.20
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.20
|
| Rate for Payer: Humana Medicare |
$63.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$63.20
|
| Rate for Payer: WellCare Medicare |
$86.90
|
|
|
CT THORAX W/O DYE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
4220010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$807.30 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
|
|
CT THORAX W/O & W/ DYE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 71270 26
|
| Hospital Charge Code |
5220011
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
|
|
CT THORAX W/O & W/ DYE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 71270 26
|
| Hospital Charge Code |
5220011
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$84.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.20
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: CDPHP Medicare |
$67.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.40
|
| Rate for Payer: EmblemHealth Medicaid |
$146.40
|
| Rate for Payer: EmblemHealth Medicare |
$62.22
|
| Rate for Payer: Fidelis Medicare |
$73.20
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.20
|
| Rate for Payer: Humana Medicare |
$73.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$84.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$103.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.45
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WellCare Medicare |
$100.65
|
|
|
CT THORAX W/O & W/DYE
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
4220011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$239.25 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$733.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$638.00
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: CDPHP Medicare |
$590.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,116.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicare |
$542.30
|
| Rate for Payer: EmblemHealth Select Care |
$1,036.75
|
| Rate for Payer: Fidelis Medicare |
$638.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$638.00
|
| Rate for Payer: Humana Medicare |
$638.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$733.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,196.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$897.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$669.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$239.25
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WellCare Medicare |
$877.25
|
|
|
CT THORAX W/O & W/DYE
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
4220011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$1,036.75 |
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
|
|
CT UPPER EXTREMITY W/ DYE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 73201 26
|
| Hospital Charge Code |
5220047
|
|
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 UPPER EXTREMITY W/ DYE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 73201 26
|
| Hospital Charge Code |
5220047
|
|
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 UPPER EXTREMITY W/DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
4220047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$918.45 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
|
|
CT UPPER EXTREMITY W/DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
4220047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$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 UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
4220048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$865.80 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
|
