|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,KX
|
| Hospital Charge Code |
4650318
|
|
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 (W/ KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,KX
|
| Hospital Charge Code |
4650318
|
|
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
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
OP
|
$1,720.80
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
4401279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.09 |
| Max. Negotiated Rate |
$1,376.64 |
| Rate for Payer: Aetna of NY Medicare |
$791.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.32
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: CDPHP Medicare |
$636.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,376.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicaid |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicare |
$585.07
|
| Rate for Payer: EmblemHealth Select Care |
$109.09
|
| Rate for Payer: Fidelis Medicare |
$688.32
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.32
|
| Rate for Payer: Humana Medicare |
$688.32
|
| Rate for Payer: Local 1199SEIU Medicare |
$791.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,290.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$968.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$722.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$193.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$258.12
|
| Rate for Payer: United Healthcare Commercial |
$193.68
|
| Rate for Payer: United Healthcare Medicare |
$688.32
|
| Rate for Payer: WellCare Medicare |
$946.44
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
IP
|
$1,720.80
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
4401279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.09 |
| Max. Negotiated Rate |
$1,118.52 |
| Rate for Payer: Aetna of NY Commercial |
$946.44
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.09
|
| Rate for Payer: EmblemHealth Select Care |
$109.09
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$946.44
|
| Rate for Payer: WellCare Medicare |
$946.44
|
|
|
ORTHOWEDGE LARGE
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
4471605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
|
|
ORTHOWEDGE LARGE
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
4471605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna of NY Commercial |
$36.05
|
| Rate for Payer: Aetna of NY Medicare |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.60
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: CDPHP Medicare |
$19.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.20
|
| Rate for Payer: EmblemHealth Medicaid |
$41.20
|
| Rate for Payer: EmblemHealth Medicare |
$17.51
|
| Rate for Payer: EmblemHealth Select Care |
$37.08
|
| Rate for Payer: Fidelis Medicare |
$20.60
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.60
|
| Rate for Payer: Humana Medicare |
$20.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
ORTHOWEDGE MEDIUM
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
4471604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
|
|
ORTHOWEDGE MEDIUM
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
4471604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna of NY Commercial |
$36.05
|
| Rate for Payer: Aetna of NY Medicare |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.60
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: CDPHP Medicare |
$19.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.20
|
| Rate for Payer: EmblemHealth Medicaid |
$41.20
|
| Rate for Payer: EmblemHealth Medicare |
$17.51
|
| Rate for Payer: EmblemHealth Select Care |
$37.08
|
| Rate for Payer: Fidelis Medicare |
$20.60
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.60
|
| Rate for Payer: Humana Medicare |
$20.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
ORTHOWEDGE SMALL
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4471603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
ORTHOWEDGE SMALL
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4471603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
ORTHOWEDGE XL
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4471606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
ORTHOWEDGE XL
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4471606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
OSELTAMIVIR PHOS 75 MG CAPSULE 75 mg, 10 eaches
|
Facility
|
IP
|
$46.38
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
4401315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Galaxy Health Commercial |
$30.15
|
| Rate for Payer: WellCare Medicare |
$25.51
|
|
|
OSELTAMIVIR PHOS 75 MG CAPSULE 75 mg, 10 eaches
|
Facility
|
OP
|
$46.38
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
4401315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$37.10 |
| Rate for Payer: Aetna of NY Commercial |
$32.47
|
| Rate for Payer: Aetna of NY Medicare |
$21.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.55
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: CDPHP Medicare |
$17.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.10
|
| Rate for Payer: EmblemHealth Medicaid |
$37.10
|
| Rate for Payer: EmblemHealth Medicare |
$15.77
|
| Rate for Payer: EmblemHealth Select Care |
$33.39
|
| Rate for Payer: Fidelis Medicare |
$18.55
|
| Rate for Payer: Galaxy Health Commercial |
$30.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.55
|
| Rate for Payer: Humana Medicare |
$18.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$18.55
|
| Rate for Payer: WellCare Medicare |
$25.51
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAPS 10 EA
|
Facility
|
IP
|
$48.67
|
|
|
Service Code
|
NDC 4080085
|
| Hospital Charge Code |
4400744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Galaxy Health Commercial |
$31.64
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAPS 10 EA
|
Facility
|
OP
|
$48.67
|
|
|
Service Code
|
NDC 4080085
|
| Hospital Charge Code |
4400744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of NY Commercial |
$34.07
|
| Rate for Payer: Aetna of NY Medicare |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: CDPHP Medicare |
$18.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.94
|
| Rate for Payer: EmblemHealth Medicaid |
$38.94
|
| Rate for Payer: EmblemHealth Medicare |
$16.55
|
| Rate for Payer: EmblemHealth Select Care |
$35.04
|
| Rate for Payer: Fidelis Medicare |
$19.47
|
| Rate for Payer: Galaxy Health Commercial |
$31.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.47
|
| Rate for Payer: Humana Medicare |
$19.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.30
|
| Rate for Payer: United Healthcare Medicare |
$19.47
|
| Rate for Payer: WellCare Medicare |
$26.77
|
|
|
OSMOLALITY-SERUM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
4300597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
OSMOLALITY-SERUM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
4300597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
OSMOLARITY URINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
4300598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
OSMOLARITY URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
4300598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
OSTOMY BAG
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4479205
|
|
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
|
|
|
OSTOMY BAG
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4479205
|
|
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
|
|
|
OT ADL/SELF CARE TR EA 15 M
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4650118
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4650118
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
OT ADL/SELF CARE TR EA 15 M (MOD 59)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59
|
| Hospital Charge Code |
4650398
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
