|
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
4002050
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,620.60 |
| Max. Negotiated Rate |
$8,643.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,969.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,321.60
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: CDPHP Medicare |
$3,997.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,673.36
|
| Rate for Payer: EmblemHealth Select Care |
$7,778.88
|
| Rate for Payer: Fidelis Medicare |
$4,321.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,321.60
|
| Rate for Payer: Humana Medicare |
$4,321.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,969.84
|
| Rate for Payer: Multiplan Commercial |
$8,643.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,103.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,082.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,537.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,620.60
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,321.60
|
| Rate for Payer: WellCare Medicare |
$5,942.20
|
|
|
ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR
|
Facility
|
OP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
4002053
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,646.10 |
| Max. Negotiated Rate |
$8,779.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,048.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,389.60
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: CDPHP Medicare |
$4,060.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,731.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,901.28
|
| Rate for Payer: Fidelis Medicare |
$4,389.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,389.60
|
| Rate for Payer: Humana Medicare |
$4,389.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,048.04
|
| Rate for Payer: Multiplan Commercial |
$8,779.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,230.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,178.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,609.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,646.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,389.60
|
| Rate for Payer: WellCare Medicare |
$6,035.70
|
|
|
ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR
|
Facility
|
IP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
4002053
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,133.10 |
| Max. Negotiated Rate |
$7,133.10 |
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
|
|
ORGANISM ID MOLD
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
4300594
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$20.15
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$18.60
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$23.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$23.25
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
ORGANISM ID MOLD
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
4300594
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
OR IV TUBING
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4471903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
OR IV TUBING
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4471903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
OR IV TUBING 3 CLAVE
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4471539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
|
OR IV TUBING 3 CLAVE
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4471539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
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
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO
|
| Hospital Charge Code |
4690160
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| 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 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 |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
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 |
$29.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| 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 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 |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
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 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 |
$29.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| 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 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 |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| 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 |
$29.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| 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 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 |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHOPOXVIRUS AMP PRB EACH
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
4302027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: Aetna of NY Commercial |
$100.10
|
| Rate for Payer: Aetna of NY Medicare |
$70.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.60
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: CDPHP Medicare |
$56.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$123.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$123.20
|
| Rate for Payer: EmblemHealth Medicaid |
$123.20
|
| Rate for Payer: EmblemHealth Medicare |
$52.36
|
| Rate for Payer: EmblemHealth Select Care |
$92.40
|
| Rate for Payer: Fidelis Medicare |
$61.60
|
| Rate for Payer: Galaxy Health Commercial |
$100.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.60
|
| Rate for Payer: Humana Medicare |
$61.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$115.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$115.50
|
| Rate for Payer: United Healthcare Medicare |
$61.60
|
| Rate for Payer: WellCare Medicare |
$84.70
|
|
|
ORTHOPOXVIRUS AMP PRB EACH
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
4302027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Galaxy Health Commercial |
$100.10
|
|
|
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 |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| 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 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 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP
|
| Hospital Charge Code |
4650027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59
|
| Hospital Charge Code |
4650373
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59
|
| Hospital Charge Code |
4650373
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| 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 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 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59,KX
|
| Hospital Charge Code |
4650425
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59,KX
|
| Hospital Charge Code |
4650425
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| 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 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 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
