|
OR 1 HOUR OPERATION
|
Facility
|
IP
|
$3,240.00
|
|
| Hospital Charge Code |
4000106
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,106.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,106.00
|
|
|
OR 2 1/2 HOUR OPERATION
|
Facility
|
IP
|
$6,968.00
|
|
| Hospital Charge Code |
4000112
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,529.20 |
| Max. Negotiated Rate |
$4,529.20 |
| Rate for Payer: Cash Price |
$5,226.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,529.20
|
|
|
OR 2 1/2 HOUR OPERATION
|
Facility
|
OP
|
$6,968.00
|
|
| Hospital Charge Code |
4000112
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$5,574.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,205.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,787.20
|
| Rate for Payer: Cash Price |
$5,226.00
|
| Rate for Payer: Cash Price |
$5,226.00
|
| Rate for Payer: CDPHP Medicare |
$2,578.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,574.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,574.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,574.40
|
| Rate for Payer: EmblemHealth Medicaid |
$5,574.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,369.12
|
| Rate for Payer: EmblemHealth Select Care |
$5,016.96
|
| Rate for Payer: Fidelis Medicare |
$2,787.20
|
| Rate for Payer: Galaxy Health Commercial |
$4,529.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,787.20
|
| Rate for Payer: Humana Medicare |
$2,787.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,226.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,922.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,926.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,045.20
|
| Rate for Payer: United Healthcare Medicare |
$2,787.20
|
| Rate for Payer: WellCare Medicare |
$3,832.40
|
|
|
OR 2 1/4 HOUR OPERATION
|
Facility
|
IP
|
$6,346.00
|
|
| Hospital Charge Code |
4000111
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,124.90 |
| Max. Negotiated Rate |
$4,124.90 |
| Rate for Payer: Cash Price |
$4,759.50
|
| Rate for Payer: Galaxy Health Commercial |
$4,124.90
|
|
|
OR 2 1/4 HOUR OPERATION
|
Facility
|
OP
|
$6,346.00
|
|
| Hospital Charge Code |
4000111
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$951.90 |
| Max. Negotiated Rate |
$5,076.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,919.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,538.40
|
| Rate for Payer: Cash Price |
$4,759.50
|
| Rate for Payer: Cash Price |
$4,759.50
|
| Rate for Payer: CDPHP Medicare |
$2,348.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,076.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,076.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,076.80
|
| Rate for Payer: EmblemHealth Medicaid |
$5,076.80
|
| Rate for Payer: EmblemHealth Medicare |
$2,157.64
|
| Rate for Payer: EmblemHealth Select Care |
$4,569.12
|
| Rate for Payer: Fidelis Medicare |
$2,538.40
|
| Rate for Payer: Galaxy Health Commercial |
$4,124.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,538.40
|
| Rate for Payer: Humana Medicare |
$2,538.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,919.16
|
| Rate for Payer: Multiplan Commercial |
$5,076.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,759.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,572.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,665.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$951.90
|
| Rate for Payer: United Healthcare Medicare |
$2,538.40
|
| Rate for Payer: WellCare Medicare |
$3,490.30
|
|
|
OR 2 3/4 HOUR OPERATION
|
Facility
|
IP
|
$7,589.00
|
|
| Hospital Charge Code |
4000113
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,932.85 |
| Max. Negotiated Rate |
$4,932.85 |
| Rate for Payer: Cash Price |
$5,691.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,932.85
|
|
|
OR 2 3/4 HOUR OPERATION
|
Facility
|
OP
|
$7,589.00
|
|
| Hospital Charge Code |
4000113
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,138.35 |
| Max. Negotiated Rate |
$6,071.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,490.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,035.60
|
| Rate for Payer: Cash Price |
$5,691.75
|
| Rate for Payer: Cash Price |
$5,691.75
|
| Rate for Payer: CDPHP Medicare |
$2,807.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6,071.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,071.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,071.20
|
| Rate for Payer: EmblemHealth Medicaid |
$6,071.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,580.26
|
| Rate for Payer: EmblemHealth Select Care |
$5,464.08
|
| Rate for Payer: Fidelis Medicare |
$3,035.60
|
| Rate for Payer: Galaxy Health Commercial |
$4,932.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,035.60
|
| Rate for Payer: Humana Medicare |
$3,035.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,490.94
|
| Rate for Payer: Multiplan Commercial |
$6,071.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,691.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,272.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,187.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,138.35
|
| Rate for Payer: United Healthcare Medicare |
$3,035.60
|
| Rate for Payer: WellCare Medicare |
$4,173.95
|
|
|
OR 2 HOUR OPERATION
|
Facility
|
IP
|
$5,726.00
|
|
| Hospital Charge Code |
4000110
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,721.90 |
| Max. Negotiated Rate |
$3,721.90 |
| Rate for Payer: Cash Price |
$4,294.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,721.90
|
|
|
OR 2 HOUR OPERATION
|
Facility
|
OP
|
$5,726.00
|
|
| Hospital Charge Code |
4000110
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$858.90 |
| Max. Negotiated Rate |
$4,580.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,633.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,290.40
|
| Rate for Payer: Cash Price |
$4,294.50
|
| Rate for Payer: Cash Price |
$4,294.50
|
| Rate for Payer: CDPHP Medicare |
$2,118.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,580.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4,580.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,946.84
|
| Rate for Payer: EmblemHealth Select Care |
$4,122.72
|
| Rate for Payer: Fidelis Medicare |
$2,290.40
|
| Rate for Payer: Galaxy Health Commercial |
$3,721.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,290.40
|
| Rate for Payer: Humana Medicare |
$2,290.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,633.96
|
| Rate for Payer: Multiplan Commercial |
$4,580.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,294.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,223.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,404.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$858.90
|
| Rate for Payer: United Healthcare Medicare |
$2,290.40
|
| Rate for Payer: WellCare Medicare |
$3,149.30
|
|
|
OR 3 1/2 HOUR OPERATION
|
Facility
|
OP
|
$9,454.00
|
|
| Hospital Charge Code |
4000116
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,418.10 |
| Max. Negotiated Rate |
$7,563.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,348.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,781.60
|
| Rate for Payer: Cash Price |
$7,090.50
|
| Rate for Payer: Cash Price |
$7,090.50
|
| Rate for Payer: CDPHP Medicare |
$3,497.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,563.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,214.36
|
| Rate for Payer: EmblemHealth Select Care |
$6,806.88
|
| Rate for Payer: Fidelis Medicare |
$3,781.60
|
| Rate for Payer: Galaxy Health Commercial |
$6,145.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,781.60
|
| Rate for Payer: Humana Medicare |
$3,781.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,348.84
|
| Rate for Payer: Multiplan Commercial |
$7,563.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,090.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,970.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,418.10
|
| Rate for Payer: United Healthcare Medicare |
$3,781.60
|
| Rate for Payer: WellCare Medicare |
$5,199.70
|
|
|
OR 3 1/2 HOUR OPERATION
|
Facility
|
IP
|
$9,454.00
|
|
| Hospital Charge Code |
4000116
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,145.10 |
| Max. Negotiated Rate |
$6,145.10 |
| Rate for Payer: Cash Price |
$7,090.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,145.10
|
|
|
OR 3 1/4 HOUR OPERATION
|
Facility
|
OP
|
$8,834.00
|
|
| Hospital Charge Code |
4000115
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$7,067.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,063.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,533.60
|
| Rate for Payer: Cash Price |
$6,625.50
|
| Rate for Payer: Cash Price |
$6,625.50
|
| Rate for Payer: CDPHP Medicare |
$3,268.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,067.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,067.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,067.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,067.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,003.56
|
| Rate for Payer: EmblemHealth Select Care |
$6,360.48
|
| Rate for Payer: Fidelis Medicare |
$3,533.60
|
| Rate for Payer: Galaxy Health Commercial |
$5,742.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,533.60
|
| Rate for Payer: Humana Medicare |
$3,533.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,063.64
|
| Rate for Payer: Multiplan Commercial |
$7,067.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,625.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,973.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,710.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,325.10
|
| Rate for Payer: United Healthcare Medicare |
$3,533.60
|
| Rate for Payer: WellCare Medicare |
$4,858.70
|
|
|
OR 3 1/4 HOUR OPERATION
|
Facility
|
IP
|
$8,834.00
|
|
| Hospital Charge Code |
4000115
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$5,742.10 |
| Max. Negotiated Rate |
$5,742.10 |
| Rate for Payer: Cash Price |
$6,625.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,742.10
|
|
|
OR 3 3/4 HOUR OPERATION
|
Facility
|
OP
|
$10,076.00
|
|
| Hospital Charge Code |
4000117
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,511.40 |
| Max. Negotiated Rate |
$8,060.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,634.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,030.40
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: CDPHP Medicare |
$3,728.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,060.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,060.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,060.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8,060.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,425.84
|
| Rate for Payer: EmblemHealth Select Care |
$7,254.72
|
| Rate for Payer: Fidelis Medicare |
$4,030.40
|
| Rate for Payer: Galaxy Health Commercial |
$6,549.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,030.40
|
| Rate for Payer: Humana Medicare |
$4,030.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,634.96
|
| Rate for Payer: Multiplan Commercial |
$8,060.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,557.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,672.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,231.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,511.40
|
| Rate for Payer: United Healthcare Medicare |
$4,030.40
|
| Rate for Payer: WellCare Medicare |
$5,541.80
|
|
|
OR 3 3/4 HOUR OPERATION
|
Facility
|
IP
|
$10,076.00
|
|
| Hospital Charge Code |
4000117
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,549.40 |
| Max. Negotiated Rate |
$6,549.40 |
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Galaxy Health Commercial |
$6,549.40
|
|
|
OR 3/4 HOUR OPERATION
|
Facility
|
IP
|
$2,620.00
|
|
| Hospital Charge Code |
4000105
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$1,703.00 |
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
|
|
OR 3/4 HOUR OPERATION
|
Facility
|
OP
|
$2,620.00
|
|
| Hospital Charge Code |
4000105
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,096.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,205.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,048.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: CDPHP Medicare |
$969.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,096.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,096.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicare |
$890.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,886.40
|
| Rate for Payer: Fidelis Medicare |
$1,048.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,048.00
|
| Rate for Payer: Humana Medicare |
$1,048.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,205.20
|
| Rate for Payer: Multiplan Commercial |
$2,096.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,965.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,475.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,100.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$393.00
|
| Rate for Payer: United Healthcare Medicare |
$1,048.00
|
| Rate for Payer: WellCare Medicare |
$1,441.00
|
|
|
OR 3 HOUR OPERATION
|
Facility
|
IP
|
$8,210.00
|
|
| Hospital Charge Code |
4000114
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$5,336.50 |
| Max. Negotiated Rate |
$5,336.50 |
| Rate for Payer: Cash Price |
$6,157.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,336.50
|
|
|
OR 3 HOUR OPERATION
|
Facility
|
OP
|
$8,210.00
|
|
| Hospital Charge Code |
4000114
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,231.50 |
| Max. Negotiated Rate |
$6,568.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,776.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,284.00
|
| Rate for Payer: Cash Price |
$6,157.50
|
| Rate for Payer: Cash Price |
$6,157.50
|
| Rate for Payer: CDPHP Medicare |
$3,037.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6,568.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,568.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,568.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6,568.00
|
| Rate for Payer: EmblemHealth Medicare |
$2,791.40
|
| Rate for Payer: EmblemHealth Select Care |
$5,911.20
|
| Rate for Payer: Fidelis Medicare |
$3,284.00
|
| Rate for Payer: Galaxy Health Commercial |
$5,336.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,284.00
|
| Rate for Payer: Humana Medicare |
$3,284.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,776.60
|
| Rate for Payer: Multiplan Commercial |
$6,568.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,157.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,622.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,448.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,231.50
|
| Rate for Payer: United Healthcare Medicare |
$3,284.00
|
| Rate for Payer: WellCare Medicare |
$4,515.50
|
|
|
OR 4 1/2HOURS OPERATION
|
Facility
|
IP
|
$11,940.00
|
|
| Hospital Charge Code |
4000120
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,761.00 |
| Max. Negotiated Rate |
$7,761.00 |
| Rate for Payer: Cash Price |
$8,955.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,761.00
|
|
|
OR 4 1/2HOURS OPERATION
|
Facility
|
OP
|
$11,940.00
|
|
| Hospital Charge Code |
4000120
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,791.00 |
| Max. Negotiated Rate |
$9,552.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,492.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,776.00
|
| Rate for Payer: Cash Price |
$8,955.00
|
| Rate for Payer: Cash Price |
$8,955.00
|
| Rate for Payer: CDPHP Medicare |
$4,417.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,552.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,552.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,552.00
|
| Rate for Payer: EmblemHealth Medicaid |
$9,552.00
|
| Rate for Payer: EmblemHealth Medicare |
$4,059.60
|
| Rate for Payer: EmblemHealth Select Care |
$8,596.80
|
| Rate for Payer: Fidelis Medicare |
$4,776.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,761.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,776.00
|
| Rate for Payer: Humana Medicare |
$4,776.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,492.40
|
| Rate for Payer: Multiplan Commercial |
$9,552.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,955.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,722.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,014.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,791.00
|
| Rate for Payer: United Healthcare Medicare |
$4,776.00
|
| Rate for Payer: WellCare Medicare |
$6,567.00
|
|
|
OR 4 1/4 HOURS OPERATION
|
Facility
|
IP
|
$11,318.00
|
|
| Hospital Charge Code |
4000119
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,356.70 |
| Max. Negotiated Rate |
$7,356.70 |
| Rate for Payer: Cash Price |
$8,488.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,356.70
|
|
|
OR 4 1/4 HOURS OPERATION
|
Facility
|
OP
|
$11,318.00
|
|
| Hospital Charge Code |
4000119
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,697.70 |
| Max. Negotiated Rate |
$9,054.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,206.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,527.20
|
| Rate for Payer: Cash Price |
$8,488.50
|
| Rate for Payer: Cash Price |
$8,488.50
|
| Rate for Payer: CDPHP Medicare |
$4,187.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,054.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,054.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,054.40
|
| Rate for Payer: EmblemHealth Medicaid |
$9,054.40
|
| Rate for Payer: EmblemHealth Medicare |
$3,848.12
|
| Rate for Payer: EmblemHealth Select Care |
$8,148.96
|
| Rate for Payer: Fidelis Medicare |
$4,527.20
|
| Rate for Payer: Galaxy Health Commercial |
$7,356.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,527.20
|
| Rate for Payer: Humana Medicare |
$4,527.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,206.28
|
| Rate for Payer: Multiplan Commercial |
$9,054.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,488.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,372.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,753.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,697.70
|
| Rate for Payer: United Healthcare Medicare |
$4,527.20
|
| Rate for Payer: WellCare Medicare |
$6,224.90
|
|
|
OR 4 3/4 HOURS OPERATION
|
Facility
|
OP
|
$12,561.00
|
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,884.15 |
| Max. Negotiated Rate |
$10,048.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,778.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,024.40
|
| Rate for Payer: Cash Price |
$9,420.75
|
| Rate for Payer: Cash Price |
$9,420.75
|
| Rate for Payer: CDPHP Medicare |
$4,647.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,048.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10,048.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10,048.80
|
| Rate for Payer: EmblemHealth Medicaid |
$10,048.80
|
| Rate for Payer: EmblemHealth Medicare |
$4,270.74
|
| Rate for Payer: EmblemHealth Select Care |
$9,043.92
|
| Rate for Payer: Fidelis Medicare |
$5,024.40
|
| Rate for Payer: Galaxy Health Commercial |
$8,164.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,024.40
|
| Rate for Payer: Humana Medicare |
$5,024.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,778.06
|
| Rate for Payer: Multiplan Commercial |
$10,048.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,420.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,071.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,275.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,884.15
|
| Rate for Payer: United Healthcare Medicare |
$5,024.40
|
| Rate for Payer: WellCare Medicare |
$6,908.55
|
|
|
OR 4 3/4 HOURS OPERATION
|
Facility
|
IP
|
$12,561.00
|
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$8,164.65 |
| Max. Negotiated Rate |
$8,164.65 |
| Rate for Payer: Cash Price |
$9,420.75
|
| Rate for Payer: Galaxy Health Commercial |
$8,164.65
|
|
