|
I&D ABSC; COMPL OR MULTI
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
4856706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
I&D ABSC; COMPL OR MULTI
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
4609652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
I & D ABSCESS BARTHOLINS GLAND
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
4600107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$248.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: CDPHP Medicare |
$229.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.00
|
| Rate for Payer: EmblemHealth Medicaid |
$496.00
|
| Rate for Payer: EmblemHealth Medicare |
$210.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$248.00
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$248.00
|
| Rate for Payer: Humana Medicare |
$248.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$260.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$248.00
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
I & D ABSCESS BARTHOLINS GLAND
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
4600107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
|
|
I & D ABSCESS FINGER SIMPLE
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
4600100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
I & D ABSCESS FINGER SIMPLE
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
4600100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
I & D ABSCESS ISCHIO/PERIRECTA
|
Facility
|
IP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4600101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,384.20 |
| Max. Negotiated Rate |
$2,384.20 |
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
|
|
I & D ABSCESS ISCHIO/PERIRECTA
|
Facility
|
OP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4600101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$2,934.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,687.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,467.20
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: CDPHP Medicare |
$1,357.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,934.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,247.12
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,467.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,467.20
|
| Rate for Payer: Humana Medicare |
$1,467.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,687.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,540.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$550.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,467.20
|
| Rate for Payer: WellCare Medicare |
$2,017.40
|
|
|
I & D ABSCESS PERIANAL SUPERFICI
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
4600108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,311.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,140.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: CDPHP Medicare |
$1,054.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,280.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,280.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,280.00
|
| Rate for Payer: EmblemHealth Medicare |
$969.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,140.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,852.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,140.00
|
| Rate for Payer: Humana Medicare |
$1,140.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,311.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,197.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$427.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,140.00
|
| Rate for Payer: WellCare Medicare |
$1,567.50
|
|
|
I & D ABSCESS PERIANAL SUPERFICI
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
4600108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,852.50
|
|
|
I&D ABSCESS; PERITONSILLAR
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
4609605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$333.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: CDPHP Medicare |
$268.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$580.80
|
| Rate for Payer: EmblemHealth Medicare |
$246.84
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$290.40
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.40
|
| Rate for Payer: Humana Medicare |
$290.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WellCare Medicare |
$399.30
|
|
|
I&D ABSCESS; PERITONSILLAR
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
4609605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
|
|
I & D ABSCESS SIMPLE/SINGLE
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4600106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
I & D ABSCESS SIMPLE/SINGLE
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4600106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
I & D ABSCESS VULVA OR PERINEAL
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
4600105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.10 |
| Max. Negotiated Rate |
$607.10 |
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Galaxy Health Commercial |
$607.10
|
|
|
I & D ABSCESS VULVA OR PERINEAL
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
4600105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$429.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$373.60
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: CDPHP Medicare |
$345.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$747.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$747.20
|
| Rate for Payer: EmblemHealth Medicaid |
$747.20
|
| Rate for Payer: EmblemHealth Medicare |
$317.56
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$373.60
|
| Rate for Payer: Galaxy Health Commercial |
$607.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$373.60
|
| Rate for Payer: Humana Medicare |
$373.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$429.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$392.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$140.10
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$373.60
|
| Rate for Payer: WellCare Medicare |
$513.70
|
|
|
I&D ABSC; SMPL OR SGL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4609568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
I&D ABSC; SMPL OR SGL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4609568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
I&D ABSC; SMPL OR SGL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4856655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
I&D ABSC; SMPL OR SGL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4856655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$430.50
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$430.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$346.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
I & D CYST PILONIDAL SIMPLE
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
4600102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
I & D CYST PILONIDAL SIMPLE
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
4600102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
4002055
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
4601205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
4601205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
