|
HOMOCYSTEINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
4301032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
HOMOCYSTEINE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
4301032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
5160010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
5160010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
4850010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
4850010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
HOT BIOPSY
|
Facility
|
OP
|
$174.07
|
|
| Hospital Charge Code |
4479187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.11 |
| Max. Negotiated Rate |
$139.26 |
| Rate for Payer: Aetna of NY Commercial |
$121.85
|
| Rate for Payer: Aetna of NY Medicare |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.63
|
| Rate for Payer: Cash Price |
$130.55
|
| Rate for Payer: CDPHP Medicare |
$64.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.26
|
| Rate for Payer: EmblemHealth Medicaid |
$139.26
|
| Rate for Payer: EmblemHealth Medicare |
$59.18
|
| Rate for Payer: EmblemHealth Select Care |
$125.33
|
| Rate for Payer: Fidelis Medicare |
$69.63
|
| Rate for Payer: Galaxy Health Commercial |
$113.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.63
|
| Rate for Payer: Humana Medicare |
$69.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.11
|
| Rate for Payer: United Healthcare Medicare |
$69.63
|
| Rate for Payer: WellCare Medicare |
$95.74
|
|
|
HOT BIOPSY
|
Facility
|
IP
|
$174.07
|
|
| Hospital Charge Code |
4479187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.15 |
| Max. Negotiated Rate |
$113.15 |
| Rate for Payer: Cash Price |
$130.55
|
| Rate for Payer: Galaxy Health Commercial |
$113.15
|
|
|
HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,293.68
|
|
| Hospital Charge Code |
4471872
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$840.89 |
| Max. Negotiated Rate |
$840.89 |
| Rate for Payer: Cash Price |
$970.26
|
| Rate for Payer: Galaxy Health Commercial |
$840.89
|
|
|
HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,293.68
|
|
| Hospital Charge Code |
4471872
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$194.05 |
| Max. Negotiated Rate |
$1,034.94 |
| Rate for Payer: Aetna of NY Commercial |
$905.58
|
| Rate for Payer: Aetna of NY Medicare |
$595.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$517.47
|
| Rate for Payer: Cash Price |
$970.26
|
| Rate for Payer: CDPHP Medicare |
$478.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,034.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,034.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,034.94
|
| Rate for Payer: EmblemHealth Medicaid |
$1,034.94
|
| Rate for Payer: EmblemHealth Medicare |
$439.85
|
| Rate for Payer: EmblemHealth Select Care |
$931.45
|
| Rate for Payer: Fidelis Medicare |
$517.47
|
| Rate for Payer: Galaxy Health Commercial |
$840.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$517.47
|
| Rate for Payer: Humana Medicare |
$517.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$905.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$595.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$728.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$543.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$194.05
|
| Rate for Payer: United Healthcare Medicare |
$517.47
|
| Rate for Payer: WellCare Medicare |
$711.52
|
|
|
HOT BIOPSY FORCEPS (COOK)
|
Facility
|
OP
|
$22.66
|
|
| Hospital Charge Code |
4471896
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.06
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$9.06
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.06
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$9.06
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
HOT BIOPSY FORCEPS (COOK)
|
Facility
|
IP
|
$22.66
|
|
| Hospital Charge Code |
4471896
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
|
|
HOT DISP BIOPSY FORCEPS
|
Facility
|
IP
|
$73.13
|
|
| Hospital Charge Code |
4471138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
|
|
HOT DISP BIOPSY FORCEPS
|
Facility
|
OP
|
$73.13
|
|
| Hospital Charge Code |
4471138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of NY Commercial |
$51.19
|
| Rate for Payer: Aetna of NY Medicare |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.25
|
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: CDPHP Medicare |
$27.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.50
|
| Rate for Payer: EmblemHealth Medicaid |
$58.50
|
| Rate for Payer: EmblemHealth Medicare |
$24.86
|
| Rate for Payer: EmblemHealth Select Care |
$52.65
|
| Rate for Payer: Fidelis Medicare |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.25
|
| Rate for Payer: Humana Medicare |
$29.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.97
|
| Rate for Payer: United Healthcare Medicare |
$29.25
|
| Rate for Payer: WellCare Medicare |
$40.22
|
|
|
HOT PACKS
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
HOT PACKS
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
HOT PACKS (MOD 59)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650365
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
HOT PACKS (MOD 59)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650365
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
HOT PACKS (MOD 59 W KX)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650417
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
HOT PACKS (MOD 59 W KX)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650417
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
HOT PACKS (W/ KX)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
HOT PACKS (W/ KX)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
HO W/O JOINTS CF
|
Facility
|
OP
|
$777.65
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
4690166
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.65 |
| Max. Negotiated Rate |
$622.12 |
| Rate for Payer: Aetna of NY Commercial |
$544.36
|
| Rate for Payer: Aetna of NY Medicare |
$357.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$311.06
|
| Rate for Payer: Cash Price |
$583.24
|
| Rate for Payer: CDPHP Medicare |
$287.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$388.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$622.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$622.12
|
| Rate for Payer: EmblemHealth Medicaid |
$622.12
|
| Rate for Payer: EmblemHealth Medicare |
$264.40
|
| Rate for Payer: EmblemHealth Select Care |
$388.82
|
| Rate for Payer: Fidelis Medicare |
$311.06
|
| Rate for Payer: Galaxy Health Commercial |
$505.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$311.06
|
| Rate for Payer: Humana Medicare |
$311.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$544.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$357.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$437.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$326.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.65
|
| Rate for Payer: United Healthcare Medicare |
$311.06
|
| Rate for Payer: WellCare Medicare |
$427.71
|
|
|
HO W/O JOINTS CF
|
Facility
|
IP
|
$777.65
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
4690166
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.94 |
| Max. Negotiated Rate |
$505.47 |
| Rate for Payer: Cash Price |
$583.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$388.82
|
| Rate for Payer: EmblemHealth Select Care |
$388.82
|
| Rate for Payer: Galaxy Health Commercial |
$505.47
|
| Rate for Payer: Multiplan Commercial |
$349.94
|
| Rate for Payer: WellCare Medicare |
$427.71
|
|
|
HUMALOG INSULIN KWIKPEN 100 UNITS/ML,
|
Facility
|
IP
|
$339.39
|
|
|
Service Code
|
NDC 2879901
|
| Hospital Charge Code |
4409140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.66 |
| Max. Negotiated Rate |
$220.60 |
| Rate for Payer: Cash Price |
$254.54
|
| Rate for Payer: Galaxy Health Commercial |
$220.60
|
| Rate for Payer: WellCare Medicare |
$186.66
|
|
