|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 LT,TC
|
| Hospital Charge Code |
4200029
|
|
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 UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26,LT
|
| Hospital Charge Code |
5200029
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26,LT
|
| Hospital Charge Code |
5200029
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 LT,TC
|
| Hospital Charge Code |
4200029
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 RT,TC
|
| Hospital Charge Code |
4201039
|
|
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 UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93931 RT,TC
|
| Hospital Charge Code |
4201039
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26,RT
|
| Hospital Charge Code |
5201039
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 93931 26,RT
|
| Hospital Charge Code |
5201039
|
|
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
|
|
|
DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 93970 26
|
| Hospital Charge Code |
5200048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of NY Commercial |
$65.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: Fidelis Medicare |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 93970 26
|
| Hospital Charge Code |
5200048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
4200048
|
|
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 XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
4200048
|
|
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 XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
4200049
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
4200049
|
|
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 XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,LT
|
| Hospital Charge Code |
5201066
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 LT,TC
|
| Hospital Charge Code |
4201066
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,LT
|
| Hospital Charge Code |
5201066
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 LT,TC
|
| Hospital Charge Code |
4201066
|
|
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 XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,RT
|
| Hospital Charge Code |
5201067
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 RT,TC
|
| Hospital Charge Code |
4201067
|
|
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 XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26,RT
|
| Hospital Charge Code |
5201067
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 93971 RT,TC
|
| Hospital Charge Code |
4201067
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILAT / LIMITED STUDY
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Hospital Charge Code |
5200049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
DUP-SCAN XTR VEINS UNILAT / LIMITED STUDY
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Hospital Charge Code |
5200049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
DURAGESIC 100 MCG/HR PATCH 100 mcg, 5 eaches
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
NDC 50458010605
|
| Hospital Charge Code |
4401436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna of NY Commercial |
$428.40
|
| Rate for Payer: Aetna of NY Medicare |
$281.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$244.80
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: CDPHP Medicare |
$226.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$489.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$489.60
|
| Rate for Payer: EmblemHealth Medicare |
$208.08
|
| Rate for Payer: EmblemHealth Select Care |
$440.64
|
| Rate for Payer: Fidelis Medicare |
$244.80
|
| Rate for Payer: Galaxy Health Commercial |
$397.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$244.80
|
| Rate for Payer: Humana Medicare |
$244.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$428.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$281.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$344.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$257.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$91.80
|
| Rate for Payer: United Healthcare Medicare |
$244.80
|
| Rate for Payer: WellCare Medicare |
$336.60
|
|
