|
EXC BLES S/N/EX G; 0.5CM/<
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
4856674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXC BLES S/N/EX G; 0.5CM/<
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
4856674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXC BLES S/N/EX G; 0.6-1.0CMC
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
4856696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,562.40
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
EXC BLES S/N/EX G; 0.6-1.0CMC
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
4856696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
EXC BLES S/N/EX G; 1.1-2.0CM
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
4856697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXC BLES S/N/EX G; 1.1-2.0CM
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
4856697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXC BLES S/N/EX G; 2.1-3.0CM
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
4856698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXC BLES S/N/EX G; 2.1-3.0CM
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
4856698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXC BLES S/N/EX G; 3.1-4.0CM
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
4856699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXC BLES S/N/EX G; 3.1-4.0CM
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
4856699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXC BLES S/N/EX G; > 4.0CM
|
Facility
|
IP
|
$8,903.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
4856700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,786.95 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Cash Price |
$6,677.25
|
| Rate for Payer: Galaxy Health Commercial |
$5,786.95
|
|
|
EXC BLES S/N/EX G; > 4.0CM
|
Facility
|
OP
|
$8,903.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
4856700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,335.45 |
| Max. Negotiated Rate |
$7,122.40 |
| Rate for Payer: Aetna of NY Commercial |
$6,232.10
|
| Rate for Payer: Aetna of NY Medicare |
$4,095.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,561.20
|
| Rate for Payer: Cash Price |
$6,677.25
|
| Rate for Payer: CDPHP Medicare |
$3,294.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,122.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$7,122.40
|
| Rate for Payer: EmblemHealth Medicare |
$3,027.02
|
| Rate for Payer: EmblemHealth Select Care |
$6,410.16
|
| Rate for Payer: Fidelis Medicare |
$3,561.20
|
| Rate for Payer: Galaxy Health Commercial |
$5,786.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,561.20
|
| Rate for Payer: Humana Medicare |
$3,561.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,232.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,095.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,677.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,012.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,739.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,335.45
|
| Rate for Payer: United Healthcare Medicare |
$3,561.20
|
| Rate for Payer: WellCare Medicare |
$4,896.65
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
4601088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
4601088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
4852008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
4852008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXCISION HYDROCELE BILATERAL
|
Facility
|
OP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 55041
|
| Hospital Charge Code |
4002059
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,646.10 |
| Max. Negotiated Rate |
$8,779.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,048.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,389.60
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: CDPHP Medicare |
$4,060.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,731.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,901.28
|
| Rate for Payer: Fidelis Medicare |
$4,389.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,389.60
|
| Rate for Payer: Humana Medicare |
$4,389.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,048.04
|
| Rate for Payer: Multiplan Commercial |
$8,779.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,230.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,178.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,609.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,646.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,389.60
|
| Rate for Payer: WellCare Medicare |
$6,035.70
|
|
|
EXCISION HYDROCELE BILATERAL
|
Facility
|
IP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 55041
|
| Hospital Charge Code |
4002059
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,133.10 |
| Max. Negotiated Rate |
$7,133.10 |
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Facility
|
OP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
4002058
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,646.10 |
| Max. Negotiated Rate |
$8,779.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,048.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,389.60
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: CDPHP Medicare |
$4,060.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,731.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,901.28
|
| Rate for Payer: Fidelis Medicare |
$4,389.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,389.60
|
| Rate for Payer: Humana Medicare |
$4,389.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,048.04
|
| Rate for Payer: Multiplan Commercial |
$8,779.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,230.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,178.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,609.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,646.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,389.60
|
| Rate for Payer: WellCare Medicare |
$6,035.70
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Facility
|
IP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
4002058
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,133.10 |
| Max. Negotiated Rate |
$7,133.10 |
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
4002056
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
4002056
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
4853043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
4853043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
4002034
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
