|
DUPLEX EXT VEINS; UNIL/LIMIT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4480081
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DUPLEX EXT VEINS; UNIL/LIMIT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4201023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DUPLEX SCAN EXTRACRANIAL AR COMPL BI STUDY
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 93880 26
|
| Hospital Charge Code |
5200066
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of NY Commercial |
$76.05
|
| 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: 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 |
$76.05
|
| 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
|
|
|
DUPLEX SCAN EXTRACRANIAL AR COMPL BI STUDY
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 93880 26
|
| Hospital Charge Code |
5200066
|
|
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
|
|
|
DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
4200066
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$761.15 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Cash Price |
$878.25
|
| Rate for Payer: Galaxy Health Commercial |
$761.15
|
|
|
DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
4200066
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$936.80 |
| Rate for Payer: Aetna of NY Commercial |
$761.15
|
| Rate for Payer: Aetna of NY Medicare |
$538.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$468.40
|
| Rate for Payer: Cash Price |
$878.25
|
| Rate for Payer: Cash Price |
$878.25
|
| Rate for Payer: CDPHP Medicare |
$433.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$819.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$936.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$936.80
|
| Rate for Payer: EmblemHealth Medicaid |
$936.80
|
| Rate for Payer: EmblemHealth Medicare |
$398.14
|
| Rate for Payer: EmblemHealth Select Care |
$761.15
|
| Rate for Payer: Fidelis Medicare |
$468.40
|
| Rate for Payer: Galaxy Health Commercial |
$761.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$468.40
|
| Rate for Payer: Humana Medicare |
$468.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$761.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$538.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$878.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$659.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$491.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$175.65
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$468.40
|
| Rate for Payer: WellCare Medicare |
$644.05
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93882 LT,TC
|
| Hospital Charge Code |
4201064
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, LEFT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93882 LT,TC
|
| Hospital Charge Code |
4201064
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 93882 26,LT
|
| Hospital Charge Code |
5201064
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, LEFT
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 93882 26,LT
|
| Hospital Charge Code |
5201064
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$28.80
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.80
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.80
|
| Rate for Payer: United Healthcare Medicare |
$28.80
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93882 RT,TC
|
| Hospital Charge Code |
4201065
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93882 RT,TC
|
| Hospital Charge Code |
4201065
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 93882 26,RT
|
| Hospital Charge Code |
5201065
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$28.80
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.80
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.80
|
| Rate for Payer: United Healthcare Medicare |
$28.80
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 93882 26,RT
|
| Hospital Charge Code |
5201065
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
DUPLEX SCAN HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
4201089
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DUPLEX SCAN HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 93990 26
|
| Hospital Charge Code |
5201089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
DUPLEX SCAN HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 93990 26
|
| Hospital Charge Code |
5201089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$28.80
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.80
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.80
|
| Rate for Payer: United Healthcare Medicare |
$28.80
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
DUPLEX SCAN HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
4201089
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DUPLEX UE ART/BPG, UNIL/LIMIT, RT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26
|
| Hospital Charge Code |
5200127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$56.80 |
| Rate for Payer: Aetna of NY Commercial |
$46.15
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.40
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: Fidelis Medicare |
$28.40
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.40
|
| Rate for Payer: Humana Medicare |
$28.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.65
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
DUPLEX UE ART/BPG, UNIL/LIMIT, RT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26
|
| Hospital Charge Code |
5200127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
DUPLEX UE ART/BPG; UNIL/LIMIT RT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
4200127
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DUPLEX UE ART/BPG; UNIL/LIMIT RT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
4200127
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
4201024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
4201024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Aetna of NY Commercial |
$475.15
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$475.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$411.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 93975 26
|
| Hospital Charge Code |
5201024
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$135.20 |
| Rate for Payer: Aetna of NY Commercial |
$109.85
|
| 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: 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 |
$109.85
|
| 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
|
|
