|
MEDICAL NUTRITION THERAPY, GROUP (2 OR MORE), EA 30 MINS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
4853015
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
|
|
MEDICAL NUTRITION THERAPY, INITIAL, EA 15 MINS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
4853013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
MEDICAL NUTRITION THERAPY, INITIAL, EA 15 MINS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
4853013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna of NY Commercial |
$83.30
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.01
|
| Rate for Payer: EmblemHealth Medicaid |
$30.01
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$29.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$30.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$83.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$31.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$64.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$64.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$67.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$89.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$89.25
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$31.51
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
MEDICAL NUTRITION THERAPY, RE-ASSESS, EA 15 MINS
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
4853014
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna of NY Commercial |
$72.10
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41.20
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.01
|
| Rate for Payer: EmblemHealth Medicaid |
$30.01
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| Rate for Payer: EmblemHealth Select Care |
$74.16
|
| Rate for Payer: Fidelis Medicare |
$41.20
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Galaxy Health Workers Comp |
$29.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$30.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$41.20
|
| Rate for Payer: Humana Medicare |
$41.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$31.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$64.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$64.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$43.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$77.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.45
|
| Rate for Payer: United Healthcare Commercial |
$77.25
|
| Rate for Payer: United Healthcare Medicare |
$41.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$31.51
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
MEDICAL NUTRITION THERAPY, RE-ASSESS, EA 15 MINS
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
4853014
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
|
|
MEDIHONEY TOPICAL APPLICATION GEL/JELLY
|
Facility
|
IP
|
$168.92
|
|
| Hospital Charge Code |
4479285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.91 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Galaxy Health Commercial |
$109.80
|
| Rate for Payer: WellCare Medicare |
$92.91
|
|
|
MEDIHONEY TOPICAL APPLICATION GEL/JELLY
|
Facility
|
OP
|
$168.92
|
|
| Hospital Charge Code |
4479285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Aetna of NY Commercial |
$118.24
|
| Rate for Payer: Aetna of NY Medicare |
$77.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.57
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: CDPHP Medicare |
$62.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.14
|
| Rate for Payer: EmblemHealth Medicaid |
$135.14
|
| Rate for Payer: EmblemHealth Medicare |
$57.43
|
| Rate for Payer: EmblemHealth Select Care |
$121.62
|
| Rate for Payer: Fidelis Medicare |
$67.57
|
| Rate for Payer: Galaxy Health Commercial |
$109.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.57
|
| Rate for Payer: Humana Medicare |
$67.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$118.24
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.34
|
| Rate for Payer: United Healthcare Medicare |
$67.57
|
| Rate for Payer: WellCare Medicare |
$92.91
|
|
|
MEDIUM JOINT/BURSA INJ OR ASPIR
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4850030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
MEDIUM JOINT/BURSA INJ OR ASPIR
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4609575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| 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 |
$395.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
MEDIUM JOINT/BURSA INJ OR ASPIR
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4609575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
MEDIUM JOINT/BURSA INJ OR ASPIR
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4850030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
MEDIUM LEFT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.81
|
|
| Hospital Charge Code |
4471571
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of NY Commercial |
$19.47
|
| Rate for Payer: Aetna of NY Medicare |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: CDPHP Medicare |
$10.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.25
|
| Rate for Payer: EmblemHealth Medicaid |
$22.25
|
| Rate for Payer: EmblemHealth Medicare |
$9.46
|
| Rate for Payer: EmblemHealth Select Care |
$20.02
|
| Rate for Payer: Fidelis Medicare |
$11.12
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.12
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: WellCare Medicare |
$15.30
|
|
|
MEDIUM LEFT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.81
|
|
| Hospital Charge Code |
4471571
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
|
|
MED RIGHT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.81
|
|
| Hospital Charge Code |
4471566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
|
|
MED RIGHT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.81
|
|
| Hospital Charge Code |
4471566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of NY Commercial |
$19.47
|
| Rate for Payer: Aetna of NY Medicare |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: CDPHP Medicare |
$10.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.25
|
| Rate for Payer: EmblemHealth Medicaid |
$22.25
|
| Rate for Payer: EmblemHealth Medicare |
$9.46
|
| Rate for Payer: EmblemHealth Select Care |
$20.02
|
| Rate for Payer: Fidelis Medicare |
$11.12
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.12
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: WellCare Medicare |
$15.30
|
|
|
MEDROL 4 MG DOSEPAK 4 mg, 21 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4401462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MEDROL 4 MG DOSEPAK 4 mg, 21 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4401462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MED SPECIALTY ARM SLING
|
Facility
|
IP
|
$14.42
|
|
|
Service Code
|
HCPCS A4566
|
| Hospital Charge Code |
4471557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
|
|
MED SPECIALTY ARM SLING
|
Facility
|
OP
|
$14.42
|
|
|
Service Code
|
HCPCS A4566
|
| Hospital Charge Code |
4471557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.77
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.77
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$5.77
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
MED STOCKING ANTI-EMB THIGH
|
Facility
|
OP
|
$42.23
|
|
| Hospital Charge Code |
4471182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: Aetna of NY Commercial |
$29.56
|
| Rate for Payer: Aetna of NY Medicare |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: CDPHP Medicare |
$15.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.78
|
| Rate for Payer: EmblemHealth Medicaid |
$33.78
|
| Rate for Payer: EmblemHealth Medicare |
$14.36
|
| Rate for Payer: EmblemHealth Select Care |
$30.41
|
| Rate for Payer: Fidelis Medicare |
$16.89
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.89
|
| Rate for Payer: Humana Medicare |
$16.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$16.89
|
| Rate for Payer: WellCare Medicare |
$23.23
|
|
|
MED STOCKING ANTI-EMB THIGH
|
Facility
|
IP
|
$42.23
|
|
| Hospital Charge Code |
4471182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
|
|
MEDTRONIC ACESSORY KIT 377860
|
Facility
|
OP
|
$10,474.07
|
|
| Hospital Charge Code |
4479089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.11 |
| Max. Negotiated Rate |
$8,379.26 |
| Rate for Payer: Aetna of NY Commercial |
$7,331.85
|
| Rate for Payer: Aetna of NY Medicare |
$4,818.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,189.63
|
| Rate for Payer: Cash Price |
$7,855.55
|
| Rate for Payer: CDPHP Medicare |
$3,875.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,237.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,379.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,379.26
|
| Rate for Payer: EmblemHealth Medicaid |
$8,379.26
|
| Rate for Payer: EmblemHealth Medicare |
$3,561.18
|
| Rate for Payer: EmblemHealth Select Care |
$5,237.03
|
| Rate for Payer: Fidelis Medicare |
$4,189.63
|
| Rate for Payer: Galaxy Health Commercial |
$6,808.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,189.63
|
| Rate for Payer: Humana Medicare |
$4,189.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,331.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,818.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,808.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,808.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,399.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,571.11
|
| Rate for Payer: United Healthcare Medicare |
$4,189.63
|
| Rate for Payer: WellCare Medicare |
$5,760.74
|
|
|
MEDTRONIC ACESSORY KIT 377860
|
Facility
|
IP
|
$10,474.07
|
|
| Hospital Charge Code |
4479089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,713.33 |
| Max. Negotiated Rate |
$7,331.85 |
| Rate for Payer: Aetna of NY Commercial |
$7,331.85
|
| Rate for Payer: Cash Price |
$7,855.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,237.03
|
| Rate for Payer: EmblemHealth Select Care |
$5,237.03
|
| Rate for Payer: Galaxy Health Commercial |
$6,808.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,331.85
|
| Rate for Payer: Multiplan Commercial |
$4,713.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,808.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,808.15
|
| Rate for Payer: WellCare Medicare |
$5,760.74
|
|
|
MEDTRONIC IMPLANT LEAD KIT
|
Facility
|
IP
|
$9,215.41
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,146.93 |
| Max. Negotiated Rate |
$6,450.79 |
| Rate for Payer: Aetna of NY Commercial |
$6,450.79
|
| Rate for Payer: Cash Price |
$6,911.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,607.70
|
| Rate for Payer: EmblemHealth Select Care |
$4,607.70
|
| Rate for Payer: Galaxy Health Commercial |
$5,990.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,450.79
|
| Rate for Payer: Multiplan Commercial |
$4,146.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,990.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,990.02
|
| Rate for Payer: WellCare Medicare |
$5,068.48
|
|
|
MEDTRONIC IMPLANT LEAD KIT
|
Facility
|
OP
|
$9,215.41
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.31 |
| Max. Negotiated Rate |
$7,372.33 |
| Rate for Payer: Aetna of NY Commercial |
$6,450.79
|
| Rate for Payer: Aetna of NY Medicare |
$4,239.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,686.16
|
| Rate for Payer: Cash Price |
$6,911.56
|
| Rate for Payer: CDPHP Medicare |
$3,409.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,607.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,372.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,372.33
|
| Rate for Payer: EmblemHealth Medicaid |
$7,372.33
|
| Rate for Payer: EmblemHealth Medicare |
$3,133.24
|
| Rate for Payer: EmblemHealth Select Care |
$4,607.70
|
| Rate for Payer: Fidelis Medicare |
$3,686.16
|
| Rate for Payer: Galaxy Health Commercial |
$5,990.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,686.16
|
| Rate for Payer: Humana Medicare |
$3,686.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,450.79
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,239.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,990.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,990.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,870.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,382.31
|
| Rate for Payer: United Healthcare Medicare |
$3,686.16
|
| Rate for Payer: WellCare Medicare |
$5,068.48
|
|
