|
HIV-1 AG W/HIV-1 & HIV-2 AB
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
4305529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
|
|
HIV1 RNA QUANT BY PCR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
4301179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$265.65 |
| Rate for Payer: Aetna of NY Commercial |
$214.50
|
| Rate for Payer: Aetna of NY Medicare |
$151.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$122.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$165.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: CDPHP Commercial |
$265.65
|
| Rate for Payer: CDPHP Medicare |
$122.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$198.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$264.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$264.00
|
| Rate for Payer: EmblemHealth Medicaid |
$264.00
|
| Rate for Payer: EmblemHealth Medicare |
$112.20
|
| Rate for Payer: EmblemHealth Select Care |
$198.00
|
| Rate for Payer: Fidelis Medicare |
$125.76
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$122.10
|
| Rate for Payer: Humana Medicare |
$122.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$214.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$151.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$185.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$128.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$247.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WellCare Medicare |
$181.50
|
|
|
HIV1 RNA QUANT BY PCR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
4301179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
|
|
HOLTER MONITOR - ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
4150500
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
HOLTER MONITOR - ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
4150500
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$237.90
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.18
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
HOMOCYSTEINE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
4301032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna of NY Commercial |
$56.55
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.50
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$52.20
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$65.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.92
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
HOMOCYSTEINE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
4301032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
HOT BIOPSY
|
Facility
|
IP
|
$169.00
|
|
| Hospital Charge Code |
4479187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
|
|
HOT BIOPSY
|
Facility
|
OP
|
$169.00
|
|
| Hospital Charge Code |
4479187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$136.04 |
| Rate for Payer: Aetna of NY Commercial |
$118.30
|
| Rate for Payer: Aetna of NY Medicare |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$126.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$126.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$84.50
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: CDPHP Commercial |
$136.04
|
| Rate for Payer: CDPHP Medicare |
$62.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$135.20
|
| Rate for Payer: EmblemHealth Medicare |
$57.46
|
| Rate for Payer: EmblemHealth Select Care |
$121.68
|
| Rate for Payer: Fidelis Medicare |
$64.41
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.53
|
| Rate for Payer: Humana Medicare |
$62.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$118.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.66
|
| Rate for Payer: United Healthcare Medicare |
$62.53
|
| Rate for Payer: WellCare Medicare |
$92.95
|
|
|
HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,256.00
|
|
| Hospital Charge Code |
4471872
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.04 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna of NY Commercial |
$879.20
|
| Rate for Payer: Aetna of NY Medicare |
$577.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$942.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$942.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$464.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$628.00
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: CDPHP Commercial |
$1,011.08
|
| Rate for Payer: CDPHP Medicare |
$464.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,004.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,004.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,004.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,004.80
|
| Rate for Payer: EmblemHealth Medicare |
$427.04
|
| Rate for Payer: EmblemHealth Select Care |
$904.32
|
| Rate for Payer: Fidelis Medicare |
$478.66
|
| Rate for Payer: Galaxy Health Commercial |
$816.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$464.72
|
| Rate for Payer: Humana Medicare |
$464.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$879.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$577.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$942.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$707.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$487.96
|
| Rate for Payer: United Healthcare Medicare |
$464.72
|
| Rate for Payer: WellCare Medicare |
$690.80
|
|
|
HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,256.00
|
|
| Hospital Charge Code |
4471872
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$816.40 |
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Galaxy Health Commercial |
$816.40
|
|
|
HOT BIOPSY FORCEPS (COOK)
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
4471896
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
HOT BIOPSY FORCEPS (COOK)
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
4471896
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
HOT DISP BIOPSY FORCEPS
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
4471138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna of NY Commercial |
$49.70
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.50
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
HOT DISP BIOPSY FORCEPS
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
4471138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
HOT PACKS
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
HOT PACKS
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
HOT PACKS (MOD 59)
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650365
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
HOT PACKS (MOD 59)
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650365
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
HOT PACKS (MOD 59 W KX)
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650417
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
HOT PACKS (MOD 59 W KX)
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650417
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
HOT PACKS (W/ KX)
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
HOT PACKS (W/ KX)
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
HO W/O JOINTS CF
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
4690166
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.75 |
| Max. Negotiated Rate |
$490.75 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$339.75
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$377.50
|
| Rate for Payer: EmblemHealth Select Care |
$377.50
|
| Rate for Payer: Galaxy Health Commercial |
$490.75
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: WellCare Medicare |
$415.25
|
|
|
HO W/O JOINTS CF
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
4690166
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.70 |
| Max. Negotiated Rate |
$607.78 |
| Rate for Payer: Aetna of NY Commercial |
$528.50
|
| Rate for Payer: Aetna of NY Medicare |
$347.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$279.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$377.50
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: CDPHP Commercial |
$607.78
|
| Rate for Payer: CDPHP Medicare |
$279.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$377.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.00
|
| Rate for Payer: EmblemHealth Medicaid |
$604.00
|
| Rate for Payer: EmblemHealth Medicare |
$256.70
|
| Rate for Payer: EmblemHealth Select Care |
$377.50
|
| Rate for Payer: Fidelis Medicare |
$287.73
|
| Rate for Payer: Galaxy Health Commercial |
$490.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$279.35
|
| Rate for Payer: Humana Medicare |
$279.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$528.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$425.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$293.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$263.38
|
| Rate for Payer: United Healthcare Medicare |
$279.35
|
| Rate for Payer: WellCare Medicare |
$415.25
|
|
