|
REMOVAL OF NAIL BED LEFT
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 LT
|
| Hospital Charge Code |
4856658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.94 |
| Max. Negotiated Rate |
$918.50 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$855.75
|
| 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: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| 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: 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 |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
REMOVAL OF NAIL BED RIGHT
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 RT
|
| Hospital Charge Code |
4856657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.94 |
| Max. Negotiated Rate |
$918.50 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$855.75
|
| 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: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| 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: 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 |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 63661
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,839.63
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4853045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$103.84 |
| Rate for Payer: Aetna of NY Commercial |
$90.30
|
| Rate for Payer: Aetna of NY Medicare |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.50
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: CDPHP Commercial |
$103.84
|
| Rate for Payer: CDPHP Medicare |
$47.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.20
|
| Rate for Payer: EmblemHealth Medicaid |
$103.20
|
| Rate for Payer: EmblemHealth Medicare |
$43.86
|
| Rate for Payer: Fidelis Medicare |
$49.16
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.73
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$90.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$72.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
| Rate for Payer: WellCare Medicare |
$70.95
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4602240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.34
|
| 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 |
$47.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.50
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: CDPHP Commercial |
$103.84
|
| Rate for Payer: CDPHP Medicare |
$47.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.20
|
| Rate for Payer: EmblemHealth Medicaid |
$103.20
|
| Rate for Payer: EmblemHealth Medicare |
$43.86
|
| 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 |
$49.16
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.73
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.34
|
| 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 |
$50.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
| Rate for Payer: WellCare Medicare |
$70.95
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4602239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| 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 |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| 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 |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| 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 |
$40.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.65
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4853044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$82.92 |
| Rate for Payer: Aetna of NY Commercial |
$72.10
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| Rate for Payer: Fidelis Medicare |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.65
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
REMOVE FULL ARM OR LEG CAST
|
Facility
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
4850161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| 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 |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
REMOVE SKIN TAGS ADD-ON =<10 LESIONS
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
4856690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| 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 |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
REMOVE TNL CV CATH
|
Facility
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
4450114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.55 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,258.60
|
| Rate for Payer: Aetna of NY Medicare |
$827.08
|
| 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 |
$665.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$899.00
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: CDPHP Commercial |
$1,447.39
|
| Rate for Payer: CDPHP Medicare |
$665.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,438.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicare |
$611.32
|
| Rate for Payer: Fidelis Medicare |
$685.22
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.26
|
| Rate for Payer: Humana Medicare |
$665.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,258.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$827.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,012.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.55
|
| Rate for Payer: United Healthcare Medicare |
$665.26
|
| Rate for Payer: WellCare Medicare |
$988.90
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4856689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| 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 |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4602226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| 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 |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| 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 |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
REM SUTURES BY MD, DIFF THAN ORIG MD
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS S0630
|
| Hospital Charge Code |
4850302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$39.20
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 53446
|
| Hospital Charge Code |
4002071
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| 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 |
$1,353.00
|
| 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 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: 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 |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
RENAL FUNCTION PANEL
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
4300692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$34.62 |
| Rate for Payer: Aetna of NY Commercial |
$27.95
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.50
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Commercial |
$34.62
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: Fidelis Medicare |
$16.39
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.91
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$32.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$32.25
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
RENAL SCAN W AND W/O
|
Facility
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
4210033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.04
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
RENAL SCAN W/O DRUG
|
Facility
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
4210017
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$95.95 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$95.95
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
RENFLEXIS 100 MG VIAL 10 mg, 1 each
|
Facility
OP
|
$271.50
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
4401379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$218.56 |
| Rate for Payer: Aetna of NY Commercial |
$149.32
|
| Rate for Payer: Aetna of NY Medicare |
$124.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$135.75
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: CDPHP Commercial |
$218.56
|
| Rate for Payer: CDPHP Medicare |
$100.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$217.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.20
|
| Rate for Payer: EmblemHealth Medicaid |
$217.20
|
| Rate for Payer: EmblemHealth Medicare |
$92.31
|
| Rate for Payer: EmblemHealth Select Care |
$30.58
|
| Rate for Payer: Fidelis Medicare |
$103.47
|
| Rate for Payer: Galaxy Health Commercial |
$176.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.46
|
| Rate for Payer: Humana Medicare |
$100.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.32
|
| Rate for Payer: Local 1199SEIU Medicare |
$124.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$152.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$58.66
|
| Rate for Payer: United Healthcare Medicare |
$100.46
|
| Rate for Payer: WellCare Medicare |
$149.32
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
4002048
|
|
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 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: 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
|
|
|
REPAIR KIT 8590-9 AND ANCHOR MEDTRONIC
|
Facility
OP
|
$344.00
|
|
| Hospital Charge Code |
4479123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$240.80
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$240.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$193.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
REPAIR NAIL BED
|
Facility
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4856704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| 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 |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
HCPCS L4205
|
| Hospital Charge Code |
4690266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.64
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
|
Facility
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27696
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
REPLACE NON-TUNNELED CV CATH
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
4450115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| 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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
RESOLUTION CLIP 235CM
|
Facility
OP
|
$860.00
|
|
| Hospital Charge Code |
4471975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$692.30 |
| Rate for Payer: Aetna of NY Commercial |
$602.00
|
| Rate for Payer: Aetna of NY Medicare |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$318.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$430.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: CDPHP Commercial |
$692.30
|
| Rate for Payer: CDPHP Medicare |
$318.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$688.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$688.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$688.00
|
| Rate for Payer: EmblemHealth Medicaid |
$688.00
|
| Rate for Payer: EmblemHealth Medicare |
$292.40
|
| Rate for Payer: EmblemHealth Select Care |
$619.20
|
| Rate for Payer: Fidelis Medicare |
$327.75
|
| Rate for Payer: Galaxy Health Commercial |
$559.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$318.20
|
| Rate for Payer: Humana Medicare |
$318.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$602.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$395.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$645.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$484.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$334.11
|
| Rate for Payer: United Healthcare Medicare |
$318.20
|
| Rate for Payer: WellCare Medicare |
$473.00
|
|
