|
ANTICARDIOLIPIN AB IGM QN
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
4300067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Aetna of NY Commercial |
$92.95
|
| Rate for Payer: Aetna of NY Medicare |
$65.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$71.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: CDPHP Commercial |
$115.12
|
| Rate for Payer: CDPHP Medicare |
$52.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$114.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.40
|
| Rate for Payer: EmblemHealth Medicaid |
$114.40
|
| Rate for Payer: EmblemHealth Medicare |
$48.62
|
| Rate for Payer: Fidelis Medicare |
$54.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.91
|
| Rate for Payer: Humana Medicare |
$52.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$92.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$107.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$107.25
|
| Rate for Payer: United Healthcare Medicare |
$52.91
|
| Rate for Payer: WellCare Medicare |
$78.65
|
|
|
ANTI-DNA ANTIBODY DBLE S
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
4300072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna of NY Commercial |
$51.35
|
| Rate for Payer: Aetna of NY Medicare |
$36.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: CDPHP Commercial |
$63.60
|
| Rate for Payer: CDPHP Medicare |
$29.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
| Rate for Payer: EmblemHealth Medicaid |
$63.20
|
| Rate for Payer: EmblemHealth Medicare |
$26.86
|
| Rate for Payer: Fidelis Medicare |
$30.11
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$59.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$59.25
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
OP
|
$41.46
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4401273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$33.38 |
| Rate for Payer: Aetna of NY Commercial |
$22.80
|
| Rate for Payer: Aetna of NY Medicare |
$19.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.73
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: CDPHP Commercial |
$33.38
|
| Rate for Payer: CDPHP Medicare |
$15.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.17
|
| Rate for Payer: EmblemHealth Medicaid |
$33.17
|
| Rate for Payer: EmblemHealth Medicare |
$14.10
|
| Rate for Payer: EmblemHealth Select Care |
$29.85
|
| Rate for Payer: Fidelis Medicare |
$15.80
|
| Rate for Payer: Galaxy Health Commercial |
$26.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.34
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.11
|
| Rate for Payer: United Healthcare Medicare |
$15.34
|
| Rate for Payer: WellCare Medicare |
$22.80
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
OP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna of NY Commercial |
$30.02
|
| Rate for Payer: Aetna of NY Medicare |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.30
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: CDPHP Commercial |
$43.94
|
| Rate for Payer: CDPHP Medicare |
$20.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.67
|
| Rate for Payer: EmblemHealth Medicaid |
$43.67
|
| Rate for Payer: EmblemHealth Medicare |
$18.56
|
| Rate for Payer: EmblemHealth Select Care |
$39.30
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$35.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.20
|
| Rate for Payer: Humana Medicare |
$20.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.21
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WellCare Medicare |
$30.02
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
OP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna of NY Commercial |
$30.02
|
| Rate for Payer: Aetna of NY Medicare |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.30
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: CDPHP Commercial |
$43.94
|
| Rate for Payer: CDPHP Medicare |
$20.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.67
|
| Rate for Payer: EmblemHealth Medicaid |
$43.67
|
| Rate for Payer: EmblemHealth Medicare |
$18.56
|
| Rate for Payer: EmblemHealth Select Care |
$39.30
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$35.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.20
|
| Rate for Payer: Humana Medicare |
$20.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.21
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WellCare Medicare |
$30.02
|
|
|
ANTIFUNGAL 2% POWDER 1 ea, 71 g
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
4401411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.50
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Commercial |
$16.90
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: EmblemHealth Select Care |
$15.12
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.16
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
ANTIHEMOPHILIC FACTOR
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
4300081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$172.27 |
| Rate for Payer: Aetna of NY Commercial |
$139.10
|
| Rate for Payer: Aetna of NY Medicare |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$160.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$160.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.00
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: CDPHP Commercial |
$172.27
|
| Rate for Payer: CDPHP Medicare |
$79.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$171.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$171.20
|
| Rate for Payer: EmblemHealth Medicaid |
$171.20
|
| Rate for Payer: EmblemHealth Medicare |
$72.76
|
| Rate for Payer: Fidelis Medicare |
$81.56
|
| Rate for Payer: Galaxy Health Commercial |
$139.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.18
|
| Rate for Payer: Humana Medicare |
$79.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$139.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$120.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$160.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$160.50
|
| Rate for Payer: United Healthcare Medicare |
$79.18
|
| Rate for Payer: WellCare Medicare |
$117.70
|
|
|
ANTI-NUCLEAR ANTIBODY SC
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
4300084
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$50.72 |
| Rate for Payer: Aetna of NY Commercial |
$40.95
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$47.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$47.25
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ANTISTREPTOLYSIN O TITER
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
4300090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ANTITHROMBIN III
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
4300092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna of NY Commercial |
$135.20
|
| Rate for Payer: Aetna of NY Medicare |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$76.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$104.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: CDPHP Commercial |
$167.44
|
| Rate for Payer: CDPHP Medicare |
$76.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$166.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$166.40
|
| Rate for Payer: EmblemHealth Medicaid |
$166.40
|
| Rate for Payer: EmblemHealth Medicare |
$70.72
|
| Rate for Payer: Fidelis Medicare |
$79.27
|
| Rate for Payer: Galaxy Health Commercial |
$135.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.96
|
| Rate for Payer: Humana Medicare |
$76.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$95.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$117.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.81
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$76.96
|
| Rate for Payer: WellCare Medicare |
$114.40
|
|
|
ANTI-THROMBIN III ACTIVITY
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
4300094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna of NY Commercial |
$109.20
|
| Rate for Payer: Aetna of NY Medicare |
$77.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$84.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: CDPHP Commercial |
$135.24
|
| Rate for Payer: CDPHP Medicare |
$62.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$134.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.40
|
| Rate for Payer: EmblemHealth Medicaid |
$134.40
|
| Rate for Payer: EmblemHealth Medicare |
$57.12
|
| Rate for Payer: Fidelis Medicare |
$64.02
|
| Rate for Payer: Galaxy Health Commercial |
$109.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.16
|
| Rate for Payer: Humana Medicare |
$62.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$94.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$126.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Medicare |
$62.16
|
| Rate for Payer: WellCare Medicare |
$92.40
|
|
|
APHASIA ASSESSMENT PER HOUR
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 96105 GN
|
| Hospital Charge Code |
4670005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$335.68 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$154.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: CDPHP Commercial |
$335.68
|
| Rate for Payer: CDPHP Medicare |
$154.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$333.60
|
| Rate for Payer: EmblemHealth Medicaid |
$333.60
|
| Rate for Payer: EmblemHealth Medicare |
$141.78
|
| Rate for Payer: EmblemHealth Select Care |
$300.24
|
| Rate for Payer: Fidelis Medicare |
$158.92
|
| Rate for Payer: Galaxy Health Commercial |
$271.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$154.29
|
| Rate for Payer: Humana Medicare |
$154.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$191.82
|
| 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 |
$162.00
|
| 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 |
$154.29
|
| Rate for Payer: WellCare Medicare |
$229.35
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59)
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 96105 GN,59
|
| Hospital Charge Code |
4670283
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$335.68 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$154.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: CDPHP Commercial |
$335.68
|
| Rate for Payer: CDPHP Medicare |
$154.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$333.60
|
| Rate for Payer: EmblemHealth Medicaid |
$333.60
|
| Rate for Payer: EmblemHealth Medicare |
$141.78
|
| Rate for Payer: EmblemHealth Select Care |
$300.24
|
| Rate for Payer: Fidelis Medicare |
$158.92
|
| Rate for Payer: Galaxy Health Commercial |
$271.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$154.29
|
| Rate for Payer: Humana Medicare |
$154.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$191.82
|
| 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 |
$162.00
|
| 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 |
$154.29
|
| Rate for Payer: WellCare Medicare |
$229.35
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59 W KX)
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 96105 GN,59,KX
|
| Hospital Charge Code |
4670299
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$335.68 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$154.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: CDPHP Commercial |
$335.68
|
| Rate for Payer: CDPHP Medicare |
$154.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$333.60
|
| Rate for Payer: EmblemHealth Medicaid |
$333.60
|
| Rate for Payer: EmblemHealth Medicare |
$141.78
|
| Rate for Payer: EmblemHealth Select Care |
$300.24
|
| Rate for Payer: Fidelis Medicare |
$158.92
|
| Rate for Payer: Galaxy Health Commercial |
$271.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$154.29
|
| Rate for Payer: Humana Medicare |
$154.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$191.82
|
| 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 |
$162.00
|
| 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 |
$154.29
|
| Rate for Payer: WellCare Medicare |
$229.35
|
|
|
APHASIA ASSESSMENT PER HOUR (W/ KX)
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 96105 GN,KX
|
| Hospital Charge Code |
4670261
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$335.68 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$154.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: CDPHP Commercial |
$335.68
|
| Rate for Payer: CDPHP Medicare |
$154.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$333.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$333.60
|
| Rate for Payer: EmblemHealth Medicaid |
$333.60
|
| Rate for Payer: EmblemHealth Medicare |
$141.78
|
| Rate for Payer: EmblemHealth Select Care |
$300.24
|
| Rate for Payer: Fidelis Medicare |
$158.92
|
| Rate for Payer: Galaxy Health Commercial |
$271.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$154.29
|
| Rate for Payer: Humana Medicare |
$154.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$191.82
|
| 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 |
$162.00
|
| 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 |
$154.29
|
| Rate for Payer: WellCare Medicare |
$229.35
|
|
|
APOLIPOPROTEIN A-1
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
4300096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna of NY Commercial |
$52.00
|
| Rate for Payer: Aetna of NY Medicare |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: CDPHP Commercial |
$64.40
|
| Rate for Payer: CDPHP Medicare |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.00
|
| Rate for Payer: EmblemHealth Medicaid |
$64.00
|
| Rate for Payer: EmblemHealth Medicare |
$27.20
|
| Rate for Payer: Fidelis Medicare |
$30.49
|
| Rate for Payer: Galaxy Health Commercial |
$52.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.60
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$60.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$60.00
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: WellCare Medicare |
$44.00
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4856663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION-LONG ARM SPLINT
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4600028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| 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 |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4600016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| 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 |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION SHORT LEG SPLINT
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4600018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| 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 |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION SPLINT- LONG ARM
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4650062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$363.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION SPLINT- SHORT LEG
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4650065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| 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 |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLICATION STATIC SPLINT- SHORT ARM
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 29126 GP
|
| Hospital Charge Code |
4650063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| 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 |
$108.00
|
| Rate for Payer: Cash Price |
$274.50
|
| 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 |
$292.80
|
| 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 |
$263.52
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| 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 |
$142.19
|
| 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 |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
APPLICATOR SEPP CHLORAPREP 0.
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
4471725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of NY Commercial |
$0.70
|
| Rate for Payer: Aetna of NY Medicare |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.50
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: CDPHP Commercial |
$0.81
|
| Rate for Payer: CDPHP Medicare |
$0.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.80
|
| Rate for Payer: EmblemHealth Medicaid |
$0.80
|
| Rate for Payer: EmblemHealth Medicare |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.72
|
| Rate for Payer: Fidelis Medicare |
$0.38
|
| Rate for Payer: Galaxy Health Commercial |
$0.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.39
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WellCare Medicare |
$0.55
|
|
|
APPL MULTLAY COMPRS ARM/HAND
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29584
|
| Hospital Charge Code |
4851986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
