|
RAD. REDUCING GLOVES SIZE 7.5
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
4471683
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$121.56 |
| Rate for Payer: Aetna of NY Commercial |
$105.70
|
| Rate for Payer: Aetna of NY Medicare |
$69.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$55.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$75.50
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: CDPHP Commercial |
$121.56
|
| Rate for Payer: CDPHP Medicare |
$55.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$120.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.80
|
| Rate for Payer: EmblemHealth Medicaid |
$120.80
|
| Rate for Payer: EmblemHealth Medicare |
$51.34
|
| Rate for Payer: EmblemHealth Select Care |
$108.72
|
| Rate for Payer: Fidelis Medicare |
$57.55
|
| Rate for Payer: Galaxy Health Commercial |
$98.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$55.87
|
| Rate for Payer: Humana Medicare |
$55.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$69.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$85.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.66
|
| Rate for Payer: United Healthcare Medicare |
$55.87
|
| Rate for Payer: WellCare Medicare |
$83.05
|
|
|
RANOLAZINE 500MG TABS 60 EA
|
Facility
OP
|
$20.60
|
|
| Hospital Charge Code |
4400676
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.58 |
| Rate for Payer: Aetna of NY Commercial |
$14.42
|
| Rate for Payer: Aetna of NY Medicare |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.30
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Commercial |
$16.58
|
| Rate for Payer: CDPHP Medicare |
$7.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.48
|
| Rate for Payer: EmblemHealth Medicaid |
$16.48
|
| Rate for Payer: EmblemHealth Medicare |
$7.00
|
| Rate for Payer: EmblemHealth Select Care |
$14.83
|
| Rate for Payer: Fidelis Medicare |
$7.85
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.62
|
| Rate for Payer: Humana Medicare |
$7.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.00
|
| Rate for Payer: United Healthcare Medicare |
$7.62
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
RANOLAZINE ER 500 MG TABLET 500 mg, 60 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
RAPID FIRE LIGATOR
|
Facility
OP
|
$265.00
|
|
| Hospital Charge Code |
4471003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$213.32 |
| Rate for Payer: Aetna of NY Commercial |
$185.50
|
| Rate for Payer: Aetna of NY Medicare |
$121.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$132.50
|
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: CDPHP Commercial |
$213.32
|
| Rate for Payer: CDPHP Medicare |
$98.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.00
|
| Rate for Payer: EmblemHealth Medicaid |
$212.00
|
| Rate for Payer: EmblemHealth Medicare |
$90.10
|
| Rate for Payer: EmblemHealth Select Care |
$190.80
|
| Rate for Payer: Fidelis Medicare |
$100.99
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.05
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$185.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$102.95
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
| Rate for Payer: WellCare Medicare |
$145.75
|
|
|
RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Facility
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
4002052
|
|
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 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: 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
|
|
|
RECOVER ROOM LEVEL3 10+ HOURS
|
Facility
OP
|
$2,556.00
|
|
| Hospital Charge Code |
4000216
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$869.04 |
| Max. Negotiated Rate |
$2,057.58 |
| Rate for Payer: Aetna of NY Commercial |
$1,789.20
|
| Rate for Payer: Aetna of NY Medicare |
$1,175.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,917.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,917.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$945.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: CDPHP Commercial |
$2,057.58
|
| Rate for Payer: CDPHP Medicare |
$945.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,044.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,044.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,044.80
|
| Rate for Payer: EmblemHealth Medicare |
$869.04
|
| Rate for Payer: Fidelis Medicare |
$974.09
|
| Rate for Payer: Galaxy Health Commercial |
$1,661.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$945.72
|
| Rate for Payer: Humana Medicare |
$945.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,789.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,175.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,917.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,439.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$993.01
|
| Rate for Payer: United Healthcare Medicare |
$945.72
|
| Rate for Payer: WellCare Medicare |
$1,405.80
|
|
|
RECOVERY ROOM - 121-150 MINS
|
Facility
OP
|
$1,021.00
|
|
| Hospital Charge Code |
4007614
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$347.14 |
| Max. Negotiated Rate |
$821.90 |
| Rate for Payer: Aetna of NY Commercial |
$714.70
|
| Rate for Payer: Aetna of NY Medicare |
$469.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$765.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$765.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$377.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$510.50
|
| Rate for Payer: Cash Price |
$765.75
|
| Rate for Payer: CDPHP Commercial |
$821.90
|
| Rate for Payer: CDPHP Medicare |
$377.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$816.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$816.80
|
| Rate for Payer: EmblemHealth Medicaid |
$816.80
|
| Rate for Payer: EmblemHealth Medicare |
$347.14
|
| Rate for Payer: Fidelis Medicare |
$389.10
|
| Rate for Payer: Galaxy Health Commercial |
$663.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$377.77
|
| Rate for Payer: Humana Medicare |
$377.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$714.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$469.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$574.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$396.66
|
| Rate for Payer: United Healthcare Medicare |
$377.77
|
| Rate for Payer: WellCare Medicare |
$561.55
|
|
|
RECOVERY ROOM - 151-180 MINS
|
Facility
OP
|
$1,201.00
|
|
| Hospital Charge Code |
4007615
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$966.80 |
| Rate for Payer: Aetna of NY Commercial |
$840.70
|
| Rate for Payer: Aetna of NY Medicare |
$552.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$900.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$900.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$444.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$600.50
|
| Rate for Payer: Cash Price |
$900.75
|
| Rate for Payer: CDPHP Commercial |
$966.80
|
| Rate for Payer: CDPHP Medicare |
$444.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$960.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$960.80
|
| Rate for Payer: EmblemHealth Medicaid |
$960.80
|
| Rate for Payer: EmblemHealth Medicare |
$408.34
|
| Rate for Payer: Fidelis Medicare |
$457.70
|
| Rate for Payer: Galaxy Health Commercial |
$780.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$444.37
|
| Rate for Payer: Humana Medicare |
$444.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$840.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$552.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$900.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$676.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$466.59
|
| Rate for Payer: United Healthcare Medicare |
$444.37
|
| Rate for Payer: WellCare Medicare |
$660.55
|
|
|
RECOVERY ROOM - 31-60 MINS
|
Facility
OP
|
$486.00
|
|
| Hospital Charge Code |
4007611
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$165.24 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna of NY Commercial |
$340.20
|
| Rate for Payer: Aetna of NY Medicare |
$223.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$179.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$243.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: CDPHP Commercial |
$391.23
|
| Rate for Payer: CDPHP Medicare |
$179.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$388.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$388.80
|
| Rate for Payer: EmblemHealth Medicaid |
$388.80
|
| Rate for Payer: EmblemHealth Medicare |
$165.24
|
| Rate for Payer: Fidelis Medicare |
$185.21
|
| Rate for Payer: Galaxy Health Commercial |
$315.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$179.82
|
| Rate for Payer: Humana Medicare |
$179.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$340.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$223.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$273.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$188.81
|
| Rate for Payer: United Healthcare Medicare |
$179.82
|
| Rate for Payer: WellCare Medicare |
$267.30
|
|
|
RECOVERY ROOM - 61-90 MINS
|
Facility
OP
|
$662.00
|
|
| Hospital Charge Code |
4007612
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$225.08 |
| Max. Negotiated Rate |
$532.91 |
| Rate for Payer: Aetna of NY Commercial |
$463.40
|
| Rate for Payer: Aetna of NY Medicare |
$304.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$244.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$331.00
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Commercial |
$532.91
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$529.60
|
| Rate for Payer: EmblemHealth Medicaid |
$529.60
|
| Rate for Payer: EmblemHealth Medicare |
$225.08
|
| Rate for Payer: Fidelis Medicare |
$252.29
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$244.94
|
| Rate for Payer: Humana Medicare |
$244.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$463.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$304.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$372.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$257.19
|
| Rate for Payer: United Healthcare Medicare |
$244.94
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
RECOVERY ROOM - 91-120 MINS
|
Facility
OP
|
$842.00
|
|
| Hospital Charge Code |
4007613
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$286.28 |
| Max. Negotiated Rate |
$677.81 |
| Rate for Payer: Aetna of NY Commercial |
$589.40
|
| Rate for Payer: Aetna of NY Medicare |
$387.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$631.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$631.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$311.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$421.00
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: CDPHP Commercial |
$677.81
|
| Rate for Payer: CDPHP Medicare |
$311.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$673.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$673.60
|
| Rate for Payer: EmblemHealth Medicaid |
$673.60
|
| Rate for Payer: EmblemHealth Medicare |
$286.28
|
| Rate for Payer: Fidelis Medicare |
$320.89
|
| Rate for Payer: Galaxy Health Commercial |
$547.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$311.54
|
| Rate for Payer: Humana Medicare |
$311.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$589.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$387.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$474.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$327.12
|
| Rate for Payer: United Healthcare Medicare |
$311.54
|
| Rate for Payer: WellCare Medicare |
$463.10
|
|
|
RECOVERY ROOM - FIRST 30 MINS
|
Facility
OP
|
$306.00
|
|
| Hospital Charge Code |
4007610
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$246.33 |
| Rate for Payer: Aetna of NY Commercial |
$214.20
|
| Rate for Payer: Aetna of NY Medicare |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$153.00
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: CDPHP Commercial |
$246.33
|
| Rate for Payer: CDPHP Medicare |
$113.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$244.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$244.80
|
| Rate for Payer: EmblemHealth Medicaid |
$244.80
|
| Rate for Payer: EmblemHealth Medicare |
$104.04
|
| Rate for Payer: Fidelis Medicare |
$116.62
|
| Rate for Payer: Galaxy Health Commercial |
$198.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$113.22
|
| Rate for Payer: Humana Medicare |
$113.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$214.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$140.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$172.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$118.88
|
| Rate for Payer: United Healthcare Medicare |
$113.22
|
| Rate for Payer: WellCare Medicare |
$168.30
|
|
|
RECOVERY ROOM LEVEL 1( 0-3 HRS)
|
Facility
OP
|
$851.00
|
|
| Hospital Charge Code |
4000213
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$289.34 |
| Max. Negotiated Rate |
$685.06 |
| Rate for Payer: Aetna of NY Commercial |
$595.70
|
| Rate for Payer: Aetna of NY Medicare |
$391.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$314.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$425.50
|
| Rate for Payer: Cash Price |
$638.25
|
| Rate for Payer: CDPHP Commercial |
$685.06
|
| Rate for Payer: CDPHP Medicare |
$314.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$680.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$680.80
|
| Rate for Payer: EmblemHealth Medicaid |
$680.80
|
| Rate for Payer: EmblemHealth Medicare |
$289.34
|
| Rate for Payer: Fidelis Medicare |
$324.32
|
| Rate for Payer: Galaxy Health Commercial |
$553.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$314.87
|
| Rate for Payer: Humana Medicare |
$314.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$595.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$391.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$479.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$330.61
|
| Rate for Payer: United Healthcare Medicare |
$314.87
|
| Rate for Payer: WellCare Medicare |
$468.05
|
|
|
RECOVERY ROOM - OVER 180 MINS (3+ HRS)
|
Facility
OP
|
$1,380.00
|
|
| Hospital Charge Code |
4007616
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,110.90 |
| Rate for Payer: Aetna of NY Commercial |
$966.00
|
| Rate for Payer: Aetna of NY Medicare |
$634.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,035.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,035.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$510.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$690.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: CDPHP Commercial |
$1,110.90
|
| Rate for Payer: CDPHP Medicare |
$510.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,104.00
|
| Rate for Payer: EmblemHealth Medicare |
$469.20
|
| Rate for Payer: Fidelis Medicare |
$525.92
|
| Rate for Payer: Galaxy Health Commercial |
$897.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$510.60
|
| Rate for Payer: Humana Medicare |
$510.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$966.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$634.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,035.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$776.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$536.13
|
| Rate for Payer: United Healthcare Medicare |
$510.60
|
| Rate for Payer: WellCare Medicare |
$759.00
|
|
|
RECOVRY ROOM LEVEL2 4-9 HOURS
|
Facility
OP
|
$1,704.00
|
|
| Hospital Charge Code |
4000214
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$579.36 |
| Max. Negotiated Rate |
$1,371.72 |
| Rate for Payer: United Healthcare Medicare |
$630.48
|
| Rate for Payer: Aetna of NY Commercial |
$1,192.80
|
| Rate for Payer: Aetna of NY Medicare |
$783.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,278.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,278.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$630.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$852.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: CDPHP Commercial |
$1,371.72
|
| Rate for Payer: CDPHP Medicare |
$630.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,363.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,363.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,363.20
|
| Rate for Payer: EmblemHealth Medicare |
$579.36
|
| Rate for Payer: Fidelis Medicare |
$649.39
|
| Rate for Payer: Galaxy Health Commercial |
$1,107.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$630.48
|
| Rate for Payer: Humana Medicare |
$630.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,192.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$783.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,278.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$959.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$662.00
|
| Rate for Payer: WellCare Medicare |
$937.20
|
|
|
REFRESH CLASSIC EYE DROPS 1 ea, 50 eaches
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
4401391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
REGADENOSON INJ 0.1 MG
|
Facility
OP
|
$218.66
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
4400436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$176.02 |
| Rate for Payer: Aetna of NY Commercial |
$120.26
|
| Rate for Payer: Aetna of NY Medicare |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$109.33
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: CDPHP Commercial |
$176.02
|
| Rate for Payer: CDPHP Medicare |
$80.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$174.93
|
| Rate for Payer: EmblemHealth Medicaid |
$174.93
|
| Rate for Payer: EmblemHealth Medicare |
$74.34
|
| Rate for Payer: EmblemHealth Select Care |
$7.05
|
| Rate for Payer: Fidelis Medicare |
$83.33
|
| Rate for Payer: Galaxy Health Commercial |
$142.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.90
|
| Rate for Payer: Humana Medicare |
$80.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$100.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$123.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.95
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Commercial |
$102.76
|
| Rate for Payer: United Healthcare Medicare |
$80.90
|
| Rate for Payer: WellCare Medicare |
$120.26
|
|
|
REGENERATIVE TISSUE SKIN GRAFT
|
Facility
OP
|
$5,209.00
|
|
| Hospital Charge Code |
4471641
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,771.06 |
| Max. Negotiated Rate |
$4,193.24 |
| Rate for Payer: Aetna of NY Commercial |
$3,646.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,396.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,906.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,906.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,927.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,604.50
|
| Rate for Payer: Cash Price |
$3,906.75
|
| Rate for Payer: CDPHP Commercial |
$4,193.24
|
| Rate for Payer: CDPHP Medicare |
$1,927.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,167.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,167.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,167.20
|
| Rate for Payer: EmblemHealth Medicaid |
$4,167.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,771.06
|
| Rate for Payer: EmblemHealth Select Care |
$3,750.48
|
| Rate for Payer: Fidelis Medicare |
$1,985.15
|
| Rate for Payer: Galaxy Health Commercial |
$3,385.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,927.33
|
| Rate for Payer: Humana Medicare |
$1,927.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,646.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,396.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,906.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,932.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,023.70
|
| Rate for Payer: United Healthcare Medicare |
$1,927.33
|
| Rate for Payer: WellCare Medicare |
$2,864.95
|
|
|
REM DEEP FB OF FOOT
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
4856714
|
|
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 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: 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
|
|
|
REM FB FOOT; SQ
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
4856713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| 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 |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
REM IMP EAR WAX
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
4602124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 93270
|
| Hospital Charge Code |
4480038
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna of NY Commercial |
$70.20
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$54.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Commercial |
$86.94
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
| Rate for Payer: EmblemHealth Medicaid |
$86.40
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$41.16
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.96
|
| Rate for Payer: Humana Medicare |
$39.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
| Rate for Payer: United Healthcare Medicare |
$39.96
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
OP
|
$918.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
4602238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$422.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$339.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$459.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: CDPHP Commercial |
$738.99
|
| Rate for Payer: CDPHP Medicare |
$339.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Medicare |
$312.12
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$349.85
|
| Rate for Payer: Galaxy Health Commercial |
$596.70
|
| Rate for Payer: Galaxy Health Workers Comp |
$205.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$339.66
|
| Rate for Payer: Humana Medicare |
$339.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$422.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$356.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$339.66
|
| Rate for Payer: WellCare Medicare |
$504.90
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE/TENDON
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
4850166
|
|
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 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: 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
|
|
|
REMOVAL OF NAIL BED
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
4602190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
