|
ER COLD PACK
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4609645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
|
ER COLD PACK
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4609645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
ER HOT PACK
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4609646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
ER HOT PACK
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4609646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
|
ER IODOFORM PAC </=1/2X5YD
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4472158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
ER IODOFORM PAC </=1/2X5YD
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4472158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
ER IODOFORM PAC >/= 1X5YD
|
Facility
|
IP
|
$19.57
|
|
| Hospital Charge Code |
4472159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
|
|
ER IODOFORM PAC >/= 1X5YD
|
Facility
|
OP
|
$19.57
|
|
| Hospital Charge Code |
4472159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Commercial |
$13.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$14.09
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
ER IODOFORM PACKING STRIP
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4472193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
ER IODOFORM PACKING STRIP
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4472193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
ER LEG SPLINT
|
Facility
|
IP
|
$53.56
|
|
| Hospital Charge Code |
4472166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
|
|
ER LEG SPLINT
|
Facility
|
OP
|
$53.56
|
|
| Hospital Charge Code |
4472166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna of NY Commercial |
$37.49
|
| Rate for Payer: Aetna of NY Medicare |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: CDPHP Medicare |
$19.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.85
|
| Rate for Payer: EmblemHealth Medicaid |
$42.85
|
| Rate for Payer: EmblemHealth Medicare |
$18.21
|
| Rate for Payer: EmblemHealth Select Care |
$38.56
|
| Rate for Payer: Fidelis Medicare |
$21.42
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.42
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.17
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.03
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
| Rate for Payer: WellCare Medicare |
$29.46
|
|
|
ERLICHIOSIS SEROLOGY
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
4301025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna of NY Commercial |
$75.40
|
| Rate for Payer: Aetna of NY Medicare |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: CDPHP Medicare |
$42.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.80
|
| Rate for Payer: EmblemHealth Medicaid |
$92.80
|
| Rate for Payer: EmblemHealth Medicare |
$39.44
|
| Rate for Payer: EmblemHealth Select Care |
$69.60
|
| Rate for Payer: Fidelis Medicare |
$46.40
|
| Rate for Payer: Galaxy Health Commercial |
$75.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.40
|
| Rate for Payer: Humana Medicare |
$46.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$87.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WellCare Medicare |
$63.80
|
|
|
ERLICHIOSIS SEROLOGY
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
4301025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Galaxy Health Commercial |
$75.40
|
|
|
ER PELVIC EXAM SUPPLIES
|
Facility
|
OP
|
$28.84
|
|
| Hospital Charge Code |
4472183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna of NY Commercial |
$20.19
|
| Rate for Payer: Aetna of NY Medicare |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.54
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: CDPHP Medicare |
$10.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.07
|
| Rate for Payer: EmblemHealth Medicaid |
$23.07
|
| Rate for Payer: EmblemHealth Medicare |
$9.81
|
| Rate for Payer: EmblemHealth Select Care |
$20.76
|
| Rate for Payer: Fidelis Medicare |
$11.54
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
ER PELVIC EXAM SUPPLIES
|
Facility
|
IP
|
$28.84
|
|
| Hospital Charge Code |
4472183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
|
|
ER PLAIN PACKING STRIP
|
Facility
|
IP
|
$10.30
|
|
| Hospital Charge Code |
4472192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
|
|
ER PLAIN PACKING STRIP
|
Facility
|
OP
|
$10.30
|
|
| Hospital Charge Code |
4472192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.12
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
| Rate for Payer: WellCare Medicare |
$5.67
|
|
|
ER PROCEDURE PULSE OXIMETRY ONLY
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4601749
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
ER PROCEDURE PULSE OXIMETRY ONLY
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4601749
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$8.45
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.20
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
ER RAPID RHINO/EPITAXIS ANY CM
|
Facility
|
IP
|
$96.82
|
|
| Hospital Charge Code |
4472177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.93 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: Galaxy Health Commercial |
$62.93
|
|
|
ER RAPID RHINO/EPITAXIS ANY CM
|
Facility
|
OP
|
$96.82
|
|
| Hospital Charge Code |
4472177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$77.46 |
| Rate for Payer: Aetna of NY Commercial |
$67.77
|
| Rate for Payer: Aetna of NY Medicare |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.73
|
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: CDPHP Medicare |
$35.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.46
|
| Rate for Payer: EmblemHealth Medicaid |
$77.46
|
| Rate for Payer: EmblemHealth Medicare |
$32.92
|
| Rate for Payer: EmblemHealth Select Care |
$69.71
|
| Rate for Payer: Fidelis Medicare |
$38.73
|
| Rate for Payer: Galaxy Health Commercial |
$62.93
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.73
|
| Rate for Payer: Humana Medicare |
$38.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$67.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$38.73
|
| Rate for Payer: WellCare Medicare |
$53.25
|
|
|
ER SIMPLE <2.5 CM LACERATION
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
4609020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
ER SIMPLE <2.5 CM LACERATION
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
4609020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
ER SIMPLE 2.6 TO 7.5 CM
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4609619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
