|
OR 1 1/4 HOUR OPERATION
|
Facility
|
IP
|
$3,605.00
|
|
| Hospital Charge Code |
4000107
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,343.25 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Cash Price |
$2,703.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,343.25
|
|
|
OR 1 1/4 HOUR OPERATION
|
Facility
|
OP
|
$3,605.00
|
|
| Hospital Charge Code |
4000107
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,225.70 |
| Max. Negotiated Rate |
$2,902.02 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,658.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,703.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,703.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,333.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,802.50
|
| Rate for Payer: Cash Price |
$2,703.75
|
| Rate for Payer: Cash Price |
$2,703.75
|
| Rate for Payer: CDPHP Commercial |
$2,902.02
|
| Rate for Payer: CDPHP Medicare |
$1,333.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,884.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,884.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,884.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,884.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,225.70
|
| Rate for Payer: EmblemHealth Select Care |
$2,595.60
|
| Rate for Payer: Fidelis Medicare |
$1,373.87
|
| Rate for Payer: Galaxy Health Commercial |
$2,343.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,333.85
|
| Rate for Payer: Humana Medicare |
$1,333.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,658.30
|
| Rate for Payer: Multiplan Commercial |
$2,884.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,703.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,029.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,400.54
|
| Rate for Payer: United Healthcare Medicare |
$1,333.85
|
| Rate for Payer: WellCare Medicare |
$1,982.75
|
|
|
OR 1 3/4 HOUR OPERATION
|
Facility
|
OP
|
$4,763.00
|
|
| Hospital Charge Code |
4000109
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,619.42 |
| Max. Negotiated Rate |
$3,834.22 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,190.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,572.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,572.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,762.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,381.50
|
| Rate for Payer: Cash Price |
$3,572.25
|
| Rate for Payer: Cash Price |
$3,572.25
|
| Rate for Payer: CDPHP Commercial |
$3,834.22
|
| Rate for Payer: CDPHP Medicare |
$1,762.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,810.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,810.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,810.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,810.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,619.42
|
| Rate for Payer: EmblemHealth Select Care |
$3,429.36
|
| Rate for Payer: Fidelis Medicare |
$1,815.18
|
| Rate for Payer: Galaxy Health Commercial |
$3,095.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,762.31
|
| Rate for Payer: Humana Medicare |
$1,762.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,190.98
|
| Rate for Payer: Multiplan Commercial |
$3,810.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,572.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,681.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,850.43
|
| Rate for Payer: United Healthcare Medicare |
$1,762.31
|
| Rate for Payer: WellCare Medicare |
$2,619.65
|
|
|
OR 1 3/4 HOUR OPERATION
|
Facility
|
IP
|
$4,763.00
|
|
| Hospital Charge Code |
4000109
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,095.95 |
| Max. Negotiated Rate |
$3,095.95 |
| Rate for Payer: Cash Price |
$3,572.25
|
| Rate for Payer: Galaxy Health Commercial |
$3,095.95
|
|
|
OR 1 HOUR OPERATION
|
Facility
|
IP
|
$3,025.00
|
|
| Hospital Charge Code |
4000106
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,966.25 |
| Max. Negotiated Rate |
$1,966.25 |
| Rate for Payer: Cash Price |
$2,268.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,966.25
|
|
|
OR 1 HOUR OPERATION
|
Facility
|
OP
|
$3,025.00
|
|
| Hospital Charge Code |
4000106
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,028.50 |
| Max. Negotiated Rate |
$2,435.12 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,391.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,268.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,268.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,119.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,512.50
|
| Rate for Payer: Cash Price |
$2,268.75
|
| Rate for Payer: Cash Price |
$2,268.75
|
| Rate for Payer: CDPHP Commercial |
$2,435.12
|
| Rate for Payer: CDPHP Medicare |
$1,119.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,420.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,420.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,420.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,420.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,028.50
|
| Rate for Payer: EmblemHealth Select Care |
$2,178.00
|
| Rate for Payer: Fidelis Medicare |
$1,152.83
|
| Rate for Payer: Galaxy Health Commercial |
$1,966.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,119.25
|
| Rate for Payer: Humana Medicare |
$1,119.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,391.50
|
| Rate for Payer: Multiplan Commercial |
$2,420.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,268.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,703.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,175.21
|
| Rate for Payer: United Healthcare Medicare |
$1,119.25
|
| Rate for Payer: WellCare Medicare |
$1,663.75
|
|
|
OR 2 1/2 HOUR OPERATION
|
Facility
|
IP
|
$6,505.00
|
|
| Hospital Charge Code |
4000112
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,228.25 |
| Max. Negotiated Rate |
$4,228.25 |
| Rate for Payer: Cash Price |
$4,878.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,228.25
|
|
|
OR 2 1/2 HOUR OPERATION
|
Facility
|
OP
|
$6,505.00
|
|
| Hospital Charge Code |
4000112
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$5,236.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,992.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,878.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,878.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,406.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,252.50
|
| Rate for Payer: Cash Price |
$4,878.75
|
| Rate for Payer: Cash Price |
$4,878.75
|
| Rate for Payer: CDPHP Commercial |
$5,236.52
|
| Rate for Payer: CDPHP Medicare |
$2,406.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$5,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$2,211.70
|
| Rate for Payer: EmblemHealth Select Care |
$4,683.60
|
| Rate for Payer: Fidelis Medicare |
$2,479.06
|
| Rate for Payer: Galaxy Health Commercial |
$4,228.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,406.85
|
| Rate for Payer: Humana Medicare |
$2,406.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,992.30
|
| Rate for Payer: Multiplan Commercial |
$5,204.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,878.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,662.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,527.19
|
| Rate for Payer: United Healthcare Medicare |
$2,406.85
|
| Rate for Payer: WellCare Medicare |
$3,577.75
|
|
|
OR 2 1/4 HOUR OPERATION
|
Facility
|
IP
|
$5,924.00
|
|
| Hospital Charge Code |
4000111
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,850.60 |
| Max. Negotiated Rate |
$3,850.60 |
| Rate for Payer: Cash Price |
$4,443.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,850.60
|
|
|
OR 2 1/4 HOUR OPERATION
|
Facility
|
OP
|
$5,924.00
|
|
| Hospital Charge Code |
4000111
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$4,768.82 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,725.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,443.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,443.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,191.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,962.00
|
| Rate for Payer: Cash Price |
$4,443.00
|
| Rate for Payer: Cash Price |
$4,443.00
|
| Rate for Payer: CDPHP Commercial |
$4,768.82
|
| Rate for Payer: CDPHP Medicare |
$2,191.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,739.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,739.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,739.20
|
| Rate for Payer: EmblemHealth Medicaid |
$4,739.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,014.16
|
| Rate for Payer: EmblemHealth Select Care |
$4,265.28
|
| Rate for Payer: Fidelis Medicare |
$2,257.64
|
| Rate for Payer: Galaxy Health Commercial |
$3,850.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,191.88
|
| Rate for Payer: Humana Medicare |
$2,191.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,725.04
|
| Rate for Payer: Multiplan Commercial |
$4,739.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,443.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,335.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,301.47
|
| Rate for Payer: United Healthcare Medicare |
$2,191.88
|
| Rate for Payer: WellCare Medicare |
$3,258.20
|
|
|
OR 2 3/4 HOUR OPERATION
|
Facility
|
IP
|
$7,085.00
|
|
| Hospital Charge Code |
4000113
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,605.25 |
| Max. Negotiated Rate |
$4,605.25 |
| Rate for Payer: Cash Price |
$5,313.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,605.25
|
|
|
OR 2 3/4 HOUR OPERATION
|
Facility
|
OP
|
$7,085.00
|
|
| Hospital Charge Code |
4000113
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$5,703.42 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,259.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5,313.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5,313.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,621.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,542.50
|
| Rate for Payer: Cash Price |
$5,313.75
|
| Rate for Payer: Cash Price |
$5,313.75
|
| Rate for Payer: CDPHP Commercial |
$5,703.42
|
| Rate for Payer: CDPHP Medicare |
$2,621.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,668.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,668.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,668.00
|
| Rate for Payer: EmblemHealth Medicaid |
$5,668.00
|
| Rate for Payer: EmblemHealth Medicare |
$2,408.90
|
| Rate for Payer: EmblemHealth Select Care |
$5,101.20
|
| Rate for Payer: Fidelis Medicare |
$2,700.09
|
| Rate for Payer: Galaxy Health Commercial |
$4,605.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,621.45
|
| Rate for Payer: Humana Medicare |
$2,621.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,259.10
|
| Rate for Payer: Multiplan Commercial |
$5,668.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,313.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,988.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,752.52
|
| Rate for Payer: United Healthcare Medicare |
$2,621.45
|
| Rate for Payer: WellCare Medicare |
$3,896.75
|
|
|
OR 2 HOUR OPERATION
|
Facility
|
OP
|
$5,345.00
|
|
| Hospital Charge Code |
4000110
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,817.30 |
| Max. Negotiated Rate |
$4,302.72 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,458.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,008.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,008.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,977.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,672.50
|
| Rate for Payer: Cash Price |
$4,008.75
|
| Rate for Payer: Cash Price |
$4,008.75
|
| Rate for Payer: CDPHP Commercial |
$4,302.72
|
| Rate for Payer: CDPHP Medicare |
$1,977.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,276.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,276.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,817.30
|
| Rate for Payer: EmblemHealth Select Care |
$3,848.40
|
| Rate for Payer: Fidelis Medicare |
$2,036.98
|
| Rate for Payer: Galaxy Health Commercial |
$3,474.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,977.65
|
| Rate for Payer: Humana Medicare |
$1,977.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,458.70
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,008.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,009.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,076.53
|
| Rate for Payer: United Healthcare Medicare |
$1,977.65
|
| Rate for Payer: WellCare Medicare |
$2,939.75
|
|
|
OR 2 HOUR OPERATION
|
Facility
|
IP
|
$5,345.00
|
|
| Hospital Charge Code |
4000110
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,474.25 |
| Max. Negotiated Rate |
$3,474.25 |
| Rate for Payer: Cash Price |
$4,008.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,474.25
|
|
|
OR 3 1/2 HOUR OPERATION
|
Facility
|
OP
|
$8,826.00
|
|
| Hospital Charge Code |
4000116
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$7,104.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,059.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,619.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,619.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,265.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,413.00
|
| Rate for Payer: Cash Price |
$6,619.50
|
| Rate for Payer: Cash Price |
$6,619.50
|
| Rate for Payer: CDPHP Commercial |
$7,104.93
|
| Rate for Payer: CDPHP Medicare |
$3,265.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,060.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,060.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,060.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,060.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,000.84
|
| Rate for Payer: EmblemHealth Select Care |
$6,354.72
|
| Rate for Payer: Fidelis Medicare |
$3,363.59
|
| Rate for Payer: Galaxy Health Commercial |
$5,736.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,265.62
|
| Rate for Payer: Humana Medicare |
$3,265.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,059.96
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,619.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,969.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,428.90
|
| Rate for Payer: United Healthcare Medicare |
$3,265.62
|
| Rate for Payer: WellCare Medicare |
$4,854.30
|
|
|
OR 3 1/2 HOUR OPERATION
|
Facility
|
IP
|
$8,826.00
|
|
| Hospital Charge Code |
4000116
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$5,736.90 |
| Max. Negotiated Rate |
$5,736.90 |
| Rate for Payer: Cash Price |
$6,619.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,736.90
|
|
|
OR 3 1/4 HOUR OPERATION
|
Facility
|
OP
|
$8,247.00
|
|
| Hospital Charge Code |
4000115
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$6,638.84 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,793.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,185.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,185.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,051.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,123.50
|
| Rate for Payer: Cash Price |
$6,185.25
|
| Rate for Payer: Cash Price |
$6,185.25
|
| Rate for Payer: CDPHP Commercial |
$6,638.84
|
| Rate for Payer: CDPHP Medicare |
$3,051.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6,597.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,597.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,597.60
|
| Rate for Payer: EmblemHealth Medicaid |
$6,597.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,803.98
|
| Rate for Payer: EmblemHealth Select Care |
$5,937.84
|
| Rate for Payer: Fidelis Medicare |
$3,142.93
|
| Rate for Payer: Galaxy Health Commercial |
$5,360.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,051.39
|
| Rate for Payer: Humana Medicare |
$3,051.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,793.62
|
| Rate for Payer: Multiplan Commercial |
$6,597.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,643.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,203.96
|
| Rate for Payer: United Healthcare Medicare |
$3,051.39
|
| Rate for Payer: WellCare Medicare |
$4,535.85
|
|
|
OR 3 1/4 HOUR OPERATION
|
Facility
|
IP
|
$8,247.00
|
|
| Hospital Charge Code |
4000115
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$5,360.55 |
| Max. Negotiated Rate |
$5,360.55 |
| Rate for Payer: Cash Price |
$6,185.25
|
| Rate for Payer: Galaxy Health Commercial |
$5,360.55
|
|
|
OR 3 3/4 HOUR OPERATION
|
Facility
|
OP
|
$9,406.00
|
|
| Hospital Charge Code |
4000117
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$7,571.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,326.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,054.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,054.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,480.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,703.00
|
| Rate for Payer: Cash Price |
$7,054.50
|
| Rate for Payer: Cash Price |
$7,054.50
|
| Rate for Payer: CDPHP Commercial |
$7,571.83
|
| Rate for Payer: CDPHP Medicare |
$3,480.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,524.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,524.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,524.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,524.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,198.04
|
| Rate for Payer: EmblemHealth Select Care |
$6,772.32
|
| Rate for Payer: Fidelis Medicare |
$3,584.63
|
| Rate for Payer: Galaxy Health Commercial |
$6,113.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,480.22
|
| Rate for Payer: Humana Medicare |
$3,480.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,326.76
|
| Rate for Payer: Multiplan Commercial |
$7,524.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,054.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,295.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,654.23
|
| Rate for Payer: United Healthcare Medicare |
$3,480.22
|
| Rate for Payer: WellCare Medicare |
$5,173.30
|
|
|
OR 3 3/4 HOUR OPERATION
|
Facility
|
IP
|
$9,406.00
|
|
| Hospital Charge Code |
4000117
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,113.90 |
| Max. Negotiated Rate |
$6,113.90 |
| Rate for Payer: Cash Price |
$7,054.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,113.90
|
|
|
OR 3/4 HOUR OPERATION
|
Facility
|
IP
|
$2,446.00
|
|
| Hospital Charge Code |
4000105
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,589.90 |
| Max. Negotiated Rate |
$1,589.90 |
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,589.90
|
|
|
OR 3/4 HOUR OPERATION
|
Facility
|
OP
|
$2,446.00
|
|
| Hospital Charge Code |
4000105
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$831.64 |
| Max. Negotiated Rate |
$1,969.03 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,125.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,834.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,834.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$905.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,223.00
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: CDPHP Commercial |
$1,969.03
|
| Rate for Payer: CDPHP Medicare |
$905.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,956.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,956.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,956.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,956.80
|
| Rate for Payer: EmblemHealth Medicare |
$831.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,761.12
|
| Rate for Payer: Fidelis Medicare |
$932.17
|
| Rate for Payer: Galaxy Health Commercial |
$1,589.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$905.02
|
| Rate for Payer: Humana Medicare |
$905.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,125.16
|
| Rate for Payer: Multiplan Commercial |
$1,956.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,834.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,377.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$950.27
|
| Rate for Payer: United Healthcare Medicare |
$905.02
|
| Rate for Payer: WellCare Medicare |
$1,345.30
|
|
|
OR 3 HOUR OPERATION
|
Facility
|
OP
|
$7,664.00
|
|
| Hospital Charge Code |
4000114
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$6,169.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,525.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5,748.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5,748.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,835.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,832.00
|
| Rate for Payer: Cash Price |
$5,748.00
|
| Rate for Payer: Cash Price |
$5,748.00
|
| Rate for Payer: CDPHP Commercial |
$6,169.52
|
| Rate for Payer: CDPHP Medicare |
$2,835.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6,131.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,131.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,131.20
|
| Rate for Payer: EmblemHealth Medicaid |
$6,131.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,605.76
|
| Rate for Payer: EmblemHealth Select Care |
$5,518.08
|
| Rate for Payer: Fidelis Medicare |
$2,920.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,981.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,835.68
|
| Rate for Payer: Humana Medicare |
$2,835.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,525.44
|
| Rate for Payer: Multiplan Commercial |
$6,131.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,748.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,314.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,977.46
|
| Rate for Payer: United Healthcare Medicare |
$2,835.68
|
| Rate for Payer: WellCare Medicare |
$4,215.20
|
|
|
OR 3 HOUR OPERATION
|
Facility
|
IP
|
$7,664.00
|
|
| Hospital Charge Code |
4000114
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,981.60 |
| Max. Negotiated Rate |
$4,981.60 |
| Rate for Payer: Cash Price |
$5,748.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,981.60
|
|
|
OR 4 1/2HOURS OPERATION
|
Facility
|
OP
|
$11,146.00
|
|
| Hospital Charge Code |
4000120
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$8,972.53 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,127.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8,359.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8,359.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,124.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,573.00
|
| Rate for Payer: Cash Price |
$8,359.50
|
| Rate for Payer: Cash Price |
$8,359.50
|
| Rate for Payer: CDPHP Commercial |
$8,972.53
|
| Rate for Payer: CDPHP Medicare |
$4,124.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,916.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,916.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,916.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8,916.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,789.64
|
| Rate for Payer: EmblemHealth Select Care |
$8,025.12
|
| Rate for Payer: Fidelis Medicare |
$4,247.74
|
| Rate for Payer: Galaxy Health Commercial |
$7,244.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,124.02
|
| Rate for Payer: Humana Medicare |
$4,124.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,127.16
|
| Rate for Payer: Multiplan Commercial |
$8,916.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,359.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,275.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,330.22
|
| Rate for Payer: United Healthcare Medicare |
$4,124.02
|
| Rate for Payer: WellCare Medicare |
$6,130.30
|
|
