|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
4601088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
4852008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,015.35 |
| Max. Negotiated Rate |
$3,015.35 |
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
4852008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.75 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: EmblemHealth Select Care |
$3,340.08
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
EXCISION HYDROCELE BILATERAL
|
Facility
|
IP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 55041
|
| Hospital Charge Code |
4002059
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,434.35 |
| Max. Negotiated Rate |
$6,434.35 |
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
|
|
EXCISION HYDROCELE BILATERAL
|
Facility
|
OP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 55041
|
| Hospital Charge Code |
4002059
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$7,968.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,553.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,662.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: CDPHP Commercial |
$7,968.70
|
| Rate for Payer: CDPHP Medicare |
$3,662.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,365.66
|
| Rate for Payer: EmblemHealth Select Care |
$7,127.28
|
| Rate for Payer: Fidelis Medicare |
$3,772.51
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,662.63
|
| Rate for Payer: Humana Medicare |
$3,662.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,553.54
|
| Rate for Payer: Multiplan Commercial |
$7,919.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,424.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,573.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,845.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,296.34
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,662.63
|
| Rate for Payer: WellCare Medicare |
$5,444.45
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Facility
|
OP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
4002058
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$7,968.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,553.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,662.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: CDPHP Commercial |
$7,968.70
|
| Rate for Payer: CDPHP Medicare |
$3,662.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,365.66
|
| Rate for Payer: EmblemHealth Select Care |
$7,127.28
|
| Rate for Payer: Fidelis Medicare |
$3,772.51
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,662.63
|
| Rate for Payer: Humana Medicare |
$3,662.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,553.54
|
| Rate for Payer: Multiplan Commercial |
$7,919.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,424.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,573.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,845.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,296.34
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,662.63
|
| Rate for Payer: WellCare Medicare |
$5,444.45
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Facility
|
IP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
4002058
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,434.35 |
| Max. Negotiated Rate |
$6,434.35 |
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
4002056
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
4002056
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
4853043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,015.35 |
| Max. Negotiated Rate |
$3,015.35 |
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
|
|
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
4853043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.75 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: EmblemHealth Select Care |
$3,340.08
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
4002034
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,623.90 |
| Max. Negotiated Rate |
$9,623.90 |
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
|
|
EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Facility
|
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
4002034
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$11,918.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,810.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,478.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: CDPHP Commercial |
$11,918.83
|
| Rate for Payer: CDPHP Medicare |
$5,478.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicare |
$5,034.04
|
| Rate for Payer: EmblemHealth Select Care |
$10,660.32
|
| Rate for Payer: Fidelis Medicare |
$5,642.57
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,478.22
|
| Rate for Payer: Humana Medicare |
$5,478.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,810.76
|
| Rate for Payer: Multiplan Commercial |
$11,844.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,104.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,335.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,752.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,930.08
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
4002063
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
4002063
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
EXERCISE TST BRNCSPSM
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 94617
|
| Hospital Charge Code |
4530013
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$237.90
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.17
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
EXERCISE TST BRNCSPSM
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 94617
|
| Hospital Charge Code |
4530013
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
EXPRESS CURETTE
|
Facility
|
OP
|
$1,701.00
|
|
| Hospital Charge Code |
4478252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.34 |
| Max. Negotiated Rate |
$1,369.30 |
| Rate for Payer: Aetna of NY Commercial |
$1,190.70
|
| Rate for Payer: Aetna of NY Medicare |
$782.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,275.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,275.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$629.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$850.50
|
| Rate for Payer: Cash Price |
$1,275.75
|
| Rate for Payer: CDPHP Commercial |
$1,369.30
|
| Rate for Payer: CDPHP Medicare |
$629.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,360.80
|
| Rate for Payer: EmblemHealth Medicare |
$578.34
|
| Rate for Payer: EmblemHealth Select Care |
$1,224.72
|
| Rate for Payer: Fidelis Medicare |
$648.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,105.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$629.37
|
| Rate for Payer: Humana Medicare |
$629.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,190.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$782.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,275.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$957.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$660.84
|
| Rate for Payer: United Healthcare Medicare |
$629.37
|
| Rate for Payer: WellCare Medicare |
$935.55
|
|
|
EXPRESS CURETTE
|
Facility
|
IP
|
$1,701.00
|
|
| Hospital Charge Code |
4478252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,105.65 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Cash Price |
$1,275.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,105.65
|
|
|
EXTERNAL ECG SCANNING ANALYSIS REPORT
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
4150525
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
|
|
EXTERNAL ECG SCANNING ANALYSIS REPORT
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
4150525
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$277.72 |
| Rate for Payer: Aetna of NY Commercial |
$224.25
|
| Rate for Payer: Aetna of NY Medicare |
$158.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.50
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: CDPHP Commercial |
$277.72
|
| Rate for Payer: CDPHP Medicare |
$127.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$241.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$276.00
|
| Rate for Payer: EmblemHealth Medicare |
$117.30
|
| Rate for Payer: EmblemHealth Select Care |
$224.25
|
| Rate for Payer: Fidelis Medicare |
$131.48
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.65
|
| Rate for Payer: Humana Medicare |
$127.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$127.65
|
| Rate for Payer: WellCare Medicare |
$189.75
|
|
|
EXTREMITY DRAPE
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
4479127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
EXTREMITY DRAPE
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
4479127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
EYE DROPS (GENERIC VISINE)
|
Facility
|
OP
|
$6.44
|
|
|
Service Code
|
NDC 74300000803
|
| Hospital Charge Code |
4409002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna of NY Commercial |
$4.51
|
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.22
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Commercial |
$5.18
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.15
|
| Rate for Payer: EmblemHealth Medicaid |
$5.15
|
| Rate for Payer: EmblemHealth Medicare |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$4.64
|
| Rate for Payer: Fidelis Medicare |
$2.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.38
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
EYE DROPS (GENERIC VISINE)
|
Facility
|
IP
|
$6.44
|
|
|
Service Code
|
NDC 74300000803
|
| Hospital Charge Code |
4409002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
