|
OR CABLE 2X8 AND EXTENSION (SC-4108)
|
Facility
|
IP
|
$2,035.00
|
|
| Hospital Charge Code |
4472058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,322.75 |
| Max. Negotiated Rate |
$1,322.75 |
| Rate for Payer: Cash Price |
$1,526.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,322.75
|
|
|
OR CABLE 2X8 AND EXTENSION (SC-4108)
|
Facility
|
OP
|
$2,035.00
|
|
| Hospital Charge Code |
4472058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$691.90 |
| Max. Negotiated Rate |
$1,638.18 |
| Rate for Payer: Aetna of NY Commercial |
$1,424.50
|
| Rate for Payer: Aetna of NY Medicare |
$936.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,526.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,526.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$752.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,017.50
|
| Rate for Payer: Cash Price |
$1,526.25
|
| Rate for Payer: CDPHP Commercial |
$1,638.18
|
| Rate for Payer: CDPHP Medicare |
$752.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,628.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,628.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,628.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,628.00
|
| Rate for Payer: EmblemHealth Medicare |
$691.90
|
| Rate for Payer: EmblemHealth Select Care |
$1,465.20
|
| Rate for Payer: Fidelis Medicare |
$775.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,322.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$752.95
|
| Rate for Payer: Humana Medicare |
$752.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,424.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$936.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,526.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,145.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$790.60
|
| Rate for Payer: United Healthcare Medicare |
$752.95
|
| Rate for Payer: WellCare Medicare |
$1,119.25
|
|
|
ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Facility
|
OP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
4002051
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$7,968.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,553.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,662.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: CDPHP Commercial |
$7,968.70
|
| Rate for Payer: CDPHP Medicare |
$3,662.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,365.66
|
| Rate for Payer: EmblemHealth Select Care |
$7,127.28
|
| Rate for Payer: Fidelis Medicare |
$3,772.51
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,662.63
|
| Rate for Payer: Humana Medicare |
$3,662.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,553.54
|
| Rate for Payer: Multiplan Commercial |
$7,919.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,424.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,573.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,845.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,296.34
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,662.63
|
| Rate for Payer: WellCare Medicare |
$5,444.45
|
|
|
ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Facility
|
IP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
4002051
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,434.35 |
| Max. Negotiated Rate |
$6,434.35 |
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
|
|
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
4002050
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
4002050
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR
|
Facility
|
OP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
4002053
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$7,968.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,553.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,662.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: CDPHP Commercial |
$7,968.70
|
| Rate for Payer: CDPHP Medicare |
$3,662.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,919.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,919.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,365.66
|
| Rate for Payer: EmblemHealth Select Care |
$7,127.28
|
| Rate for Payer: Fidelis Medicare |
$3,772.51
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,662.63
|
| Rate for Payer: Humana Medicare |
$3,662.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,553.54
|
| Rate for Payer: Multiplan Commercial |
$7,919.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,424.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,573.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,845.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,296.34
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,662.63
|
| Rate for Payer: WellCare Medicare |
$5,444.45
|
|
|
ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR
|
Facility
|
IP
|
$9,899.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
4002053
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,434.35 |
| Max. Negotiated Rate |
$6,434.35 |
| Rate for Payer: Cash Price |
$7,424.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,434.35
|
|
|
ORGANISM ID MOLD
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
4300594
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Aetna of NY Commercial |
$76.05
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$58.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Commercial |
$94.18
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: EmblemHealth Select Care |
$70.20
|
| Rate for Payer: Fidelis Medicare |
$44.59
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.29
|
| Rate for Payer: Humana Medicare |
$43.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.45
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$87.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.80
|
| Rate for Payer: United Healthcare Commercial |
$87.75
|
| Rate for Payer: United Healthcare Medicare |
$43.29
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
|
ORGANISM ID MOLD
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
4300594
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
|
|
OR IV TUBING
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4471903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
OR IV TUBING
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4471903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
OR IV TUBING 3 CLAVE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4471539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
OR IV TUBING 3 CLAVE
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4471539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO
|
| Hospital Charge Code |
4690160
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Commercial |
$160.20
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: EmblemHealth Select Care |
$143.28
|
| Rate for Payer: Fidelis Medicare |
$75.84
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.63
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$73.63
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO
|
| Hospital Charge Code |
4690160
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (MOD 59)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,59
|
| Hospital Charge Code |
4690233
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (MOD 59)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,59
|
| Hospital Charge Code |
4690233
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Commercial |
$160.20
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: EmblemHealth Select Care |
$143.28
|
| Rate for Payer: Fidelis Medicare |
$75.84
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.63
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$73.63
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (MOD 59 W KX)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,59,KX
|
| Hospital Charge Code |
4690264
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (MOD 59 W KX)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,59,KX
|
| Hospital Charge Code |
4690264
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Commercial |
$160.20
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: EmblemHealth Select Care |
$143.28
|
| Rate for Payer: Fidelis Medicare |
$75.84
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.63
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$73.63
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (W/ KX)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,KX
|
| Hospital Charge Code |
4690198
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC (W/ KX)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,KX
|
| Hospital Charge Code |
4690198
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Commercial |
$160.20
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: EmblemHealth Select Care |
$143.28
|
| Rate for Payer: Fidelis Medicare |
$75.84
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.63
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$73.63
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHOPOXVIRUS AMP PRB EACH
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
4302027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
ORTHOPOXVIRUS AMP PRB EACH
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
4302027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.82
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP
|
| Hospital Charge Code |
4650027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
