RECOVERY ROOM - FIRST 30 MINS
|
Facility
|
OP
|
$306.00
|
|
Hospital Charge Code |
4007610
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$104.04 |
Max. Negotiated Rate |
$246.33 |
Rate for Payer: Aetna of NY Commercial |
$214.20
|
Rate for Payer: Aetna of NY Medicare |
$140.76
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$229.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$229.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.22
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$153.00
|
Rate for Payer: Cash Price |
$229.50
|
Rate for Payer: CDPHP Commercial |
$246.33
|
Rate for Payer: CDPHP Medicare |
$113.22
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$244.80
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$244.80
|
Rate for Payer: EmblemHealth Medicaid |
$244.80
|
Rate for Payer: EmblemHealth Medicare |
$104.04
|
Rate for Payer: Fidelis Medicare |
$116.62
|
Rate for Payer: Galaxy Health Commercial |
$198.90
|
Rate for Payer: Hamaspik Choice Medicare |
$113.22
|
Rate for Payer: Humana Medicare |
$113.22
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$214.20
|
Rate for Payer: Local 1199SEIU Medicare |
$140.76
|
Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$172.28
|
Rate for Payer: MVP Health Care of NY Medicare |
$118.88
|
Rate for Payer: United Healthcare Medicare |
$113.22
|
Rate for Payer: WellCare Medicare |
$168.30
|
|
RECOVERY ROOM - FIRST 30 MINS
|
Facility
|
IP
|
$306.00
|
|
Hospital Charge Code |
4007610
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$198.90 |
Max. Negotiated Rate |
$198.90 |
Rate for Payer: Cash Price |
$229.50
|
Rate for Payer: Galaxy Health Commercial |
$198.90
|
|
RECOVERY ROOM LEVEL 1( 0-3 HRS)
|
Facility
|
OP
|
$851.00
|
|
Hospital Charge Code |
4000213
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$289.34 |
Max. Negotiated Rate |
$685.06 |
Rate for Payer: Aetna of NY Commercial |
$595.70
|
Rate for Payer: Aetna of NY Medicare |
$391.46
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$314.87
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$425.50
|
Rate for Payer: Cash Price |
$638.25
|
Rate for Payer: CDPHP Commercial |
$685.06
|
Rate for Payer: CDPHP Medicare |
$314.87
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$680.80
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$680.80
|
Rate for Payer: EmblemHealth Medicaid |
$680.80
|
Rate for Payer: EmblemHealth Medicare |
$289.34
|
Rate for Payer: Fidelis Medicare |
$324.32
|
Rate for Payer: Galaxy Health Commercial |
$553.15
|
Rate for Payer: Hamaspik Choice Medicare |
$314.87
|
Rate for Payer: Humana Medicare |
$314.87
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$595.70
|
Rate for Payer: Local 1199SEIU Medicare |
$391.46
|
Rate for Payer: MVP Health Care of NY Commercial |
$638.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$479.11
|
Rate for Payer: MVP Health Care of NY Medicare |
$330.61
|
Rate for Payer: United Healthcare Medicare |
$314.87
|
Rate for Payer: WellCare Medicare |
$468.05
|
|
RECOVERY ROOM LEVEL 1( 0-3 HRS)
|
Facility
|
IP
|
$851.00
|
|
Hospital Charge Code |
4000213
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$553.15 |
Max. Negotiated Rate |
$553.15 |
Rate for Payer: Cash Price |
$638.25
|
Rate for Payer: Galaxy Health Commercial |
$553.15
|
|
RECOVERY ROOM - OVER 180 MINS (3+ HRS)
|
Facility
|
OP
|
$1,380.00
|
|
Hospital Charge Code |
4007616
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$469.20 |
Max. Negotiated Rate |
$1,110.90 |
Rate for Payer: Aetna of NY Commercial |
$966.00
|
Rate for Payer: Aetna of NY Medicare |
$634.80
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,035.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,035.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$510.60
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$690.00
|
Rate for Payer: Cash Price |
$1,035.00
|
Rate for Payer: CDPHP Commercial |
$1,110.90
|
Rate for Payer: CDPHP Medicare |
$510.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,104.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,104.00
|
Rate for Payer: EmblemHealth Medicaid |
$1,104.00
|
Rate for Payer: EmblemHealth Medicare |
$469.20
|
Rate for Payer: Fidelis Medicare |
$525.92
|
Rate for Payer: Galaxy Health Commercial |
$897.00
|
Rate for Payer: Hamaspik Choice Medicare |
$510.60
|
Rate for Payer: Humana Medicare |
$510.60
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$966.00
|
Rate for Payer: Local 1199SEIU Medicare |
$634.80
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,035.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$776.94
|
Rate for Payer: MVP Health Care of NY Medicare |
$536.13
|
Rate for Payer: United Healthcare Medicare |
$510.60
|
Rate for Payer: WellCare Medicare |
$759.00
|
|
RECOVERY ROOM - OVER 180 MINS (3+ HRS)
|
Facility
|
IP
|
$1,380.00
|
|
Hospital Charge Code |
4007616
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$897.00 |
Max. Negotiated Rate |
$897.00 |
Rate for Payer: Cash Price |
$1,035.00
|
Rate for Payer: Galaxy Health Commercial |
$897.00
|
|
RECOVRY ROOM LEVEL2 4-9 HOURS
|
Facility
|
IP
|
$1,704.00
|
|
Hospital Charge Code |
4000214
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$1,107.60 |
Max. Negotiated Rate |
$1,107.60 |
Rate for Payer: Cash Price |
$1,278.00
|
Rate for Payer: Galaxy Health Commercial |
$1,107.60
|
|
RECOVRY ROOM LEVEL2 4-9 HOURS
|
Facility
|
OP
|
$1,704.00
|
|
Hospital Charge Code |
4000214
|
Hospital Revenue Code
|
710
|
Min. Negotiated Rate |
$579.36 |
Max. Negotiated Rate |
$1,371.72 |
Rate for Payer: Aetna of NY Commercial |
$1,192.80
|
Rate for Payer: Aetna of NY Medicare |
$783.84
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,278.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,278.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$630.48
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$852.00
|
Rate for Payer: Cash Price |
$1,278.00
|
Rate for Payer: CDPHP Commercial |
$1,371.72
|
Rate for Payer: CDPHP Medicare |
$630.48
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,363.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,363.20
|
Rate for Payer: EmblemHealth Medicaid |
$1,363.20
|
Rate for Payer: EmblemHealth Medicare |
$579.36
|
Rate for Payer: Fidelis Medicare |
$649.39
|
Rate for Payer: Galaxy Health Commercial |
$1,107.60
|
Rate for Payer: Hamaspik Choice Medicare |
$630.48
|
Rate for Payer: Humana Medicare |
$630.48
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,192.80
|
Rate for Payer: Local 1199SEIU Medicare |
$783.84
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,278.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$959.35
|
Rate for Payer: MVP Health Care of NY Medicare |
$662.00
|
Rate for Payer: United Healthcare Medicare |
$630.48
|
Rate for Payer: WellCare Medicare |
$937.20
|
|
REGADENOSON INJ 0.1 MG
|
Facility
|
IP
|
$218.66
|
|
Service Code
|
HCPCS J2785
|
Hospital Charge Code |
4400436
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$142.13 |
Rate for Payer: Aetna of NY Commercial |
$120.26
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.05
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.05
|
Rate for Payer: Cash Price |
$164.00
|
Rate for Payer: Cash Price |
$164.00
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.05
|
Rate for Payer: EmblemHealth Select Care |
$7.05
|
Rate for Payer: Galaxy Health Commercial |
$142.13
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.26
|
Rate for Payer: WellCare Medicare |
$120.26
|
|
REGADENOSON INJ 0.1 MG
|
Facility
|
OP
|
$218.66
|
|
Service Code
|
HCPCS J2785
|
Hospital Charge Code |
4400436
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$176.02 |
Rate for Payer: Aetna of NY Commercial |
$120.26
|
Rate for Payer: Aetna of NY Medicare |
$100.58
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.05
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.05
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.90
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$109.33
|
Rate for Payer: Cash Price |
$164.00
|
Rate for Payer: Cash Price |
$164.00
|
Rate for Payer: CDPHP Commercial |
$176.02
|
Rate for Payer: CDPHP Medicare |
$80.90
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.05
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.93
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$174.93
|
Rate for Payer: EmblemHealth Medicaid |
$174.93
|
Rate for Payer: EmblemHealth Medicare |
$74.34
|
Rate for Payer: EmblemHealth Select Care |
$7.05
|
Rate for Payer: Fidelis Medicare |
$83.33
|
Rate for Payer: Galaxy Health Commercial |
$142.13
|
Rate for Payer: Hamaspik Choice Medicare |
$80.90
|
Rate for Payer: Humana Medicare |
$80.90
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.26
|
Rate for Payer: Local 1199SEIU Medicare |
$100.58
|
Rate for Payer: MVP Health Care of NY Commercial |
$164.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$123.11
|
Rate for Payer: MVP Health Care of NY Medicare |
$84.95
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.76
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.05
|
Rate for Payer: United Healthcare Commercial |
$102.76
|
Rate for Payer: United Healthcare Medicare |
$80.90
|
Rate for Payer: WellCare Medicare |
$120.26
|
|
REGENERATIVE TISSUE SKIN GRAFT
|
Facility
|
IP
|
$5,209.00
|
|
Hospital Charge Code |
4471641
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$3,385.85 |
Max. Negotiated Rate |
$3,385.85 |
Rate for Payer: Cash Price |
$3,906.75
|
Rate for Payer: Galaxy Health Commercial |
$3,385.85
|
|
REGENERATIVE TISSUE SKIN GRAFT
|
Facility
|
OP
|
$5,209.00
|
|
Hospital Charge Code |
4471641
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,771.06 |
Max. Negotiated Rate |
$4,193.24 |
Rate for Payer: Aetna of NY Commercial |
$3,646.30
|
Rate for Payer: Aetna of NY Medicare |
$2,396.14
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,906.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,906.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,927.33
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,604.50
|
Rate for Payer: Cash Price |
$3,906.75
|
Rate for Payer: CDPHP Commercial |
$4,193.24
|
Rate for Payer: CDPHP Medicare |
$1,927.33
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,167.20
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,167.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,167.20
|
Rate for Payer: EmblemHealth Medicaid |
$4,167.20
|
Rate for Payer: EmblemHealth Medicare |
$1,771.06
|
Rate for Payer: EmblemHealth Select Care |
$3,750.48
|
Rate for Payer: Fidelis Medicare |
$1,985.15
|
Rate for Payer: Galaxy Health Commercial |
$3,385.85
|
Rate for Payer: Hamaspik Choice Medicare |
$1,927.33
|
Rate for Payer: Humana Medicare |
$1,927.33
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,646.30
|
Rate for Payer: Local 1199SEIU Medicare |
$2,396.14
|
Rate for Payer: MVP Health Care of NY Commercial |
$3,906.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,932.67
|
Rate for Payer: MVP Health Care of NY Medicare |
$2,023.70
|
Rate for Payer: United Healthcare Medicare |
$1,927.33
|
Rate for Payer: WellCare Medicare |
$2,864.95
|
|
REM DEEP FB OF FOOT
|
Facility
|
OP
|
$4,639.00
|
|
Service Code
|
HCPCS 28192
|
Hospital Charge Code |
4856714
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,544.75 |
Max. Negotiated Rate |
$3,734.40 |
Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
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 |
$1,716.43
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: CDPHP Commercial |
$3,734.40
|
Rate for Payer: CDPHP Medicare |
$1,716.43
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,711.20
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
Rate for Payer: EmblemHealth Select Care |
$3,340.08
|
Rate for Payer: Fidelis Medicare |
$1,767.92
|
Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
Rate for Payer: Humana Medicare |
$1,716.43
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
Rate for Payer: United Healthcare Medicare |
$1,716.43
|
Rate for Payer: WellCare Medicare |
$2,551.45
|
|
REM DEEP FB OF FOOT
|
Facility
|
IP
|
$4,639.00
|
|
Service Code
|
HCPCS 28192
|
Hospital Charge Code |
4856714
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$3,015.35 |
Max. Negotiated Rate |
$3,015.35 |
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
|
REM FB FOOT; SQ
|
Facility
|
IP
|
$2,013.00
|
|
Service Code
|
HCPCS 28190
|
Hospital Charge Code |
4856713
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,308.45 |
Max. Negotiated Rate |
$1,308.45 |
Rate for Payer: Cash Price |
$1,509.75
|
Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
REM FB FOOT; SQ
|
Facility
|
OP
|
$2,013.00
|
|
Service Code
|
HCPCS 28190
|
Hospital Charge Code |
4856713
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$670.36 |
Max. Negotiated Rate |
$2,521.93 |
Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
Rate for Payer: Aetna of NY Medicare |
$925.98
|
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 |
$744.81
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
Rate for Payer: Cash Price |
$1,509.75
|
Rate for Payer: Cash Price |
$1,509.75
|
Rate for Payer: Cash Price |
$1,509.75
|
Rate for Payer: CDPHP Commercial |
$1,620.46
|
Rate for Payer: CDPHP Medicare |
$744.81
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,610.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
Rate for Payer: EmblemHealth Medicare |
$684.42
|
Rate for Payer: EmblemHealth Select Care |
$1,449.36
|
Rate for Payer: Fidelis Medicare |
$767.15
|
Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
Rate for Payer: Humana Medicare |
$744.81
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
Rate for Payer: United Healthcare Medicare |
$744.81
|
Rate for Payer: WellCare Medicare |
$1,107.15
|
|
REM IMP EAR WAX
|
Facility
|
IP
|
$175.00
|
|
Service Code
|
HCPCS 69210
|
Hospital Charge Code |
4602124
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$113.75 |
Max. Negotiated Rate |
$113.75 |
Rate for Payer: Cash Price |
$131.25
|
Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
REM IMP EAR WAX
|
Facility
|
OP
|
$175.00
|
|
Service Code
|
HCPCS 69210
|
Hospital Charge Code |
4602124
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$58.28 |
Max. Negotiated Rate |
$1,189.18 |
Rate for Payer: Aetna of NY Commercial |
$955.00
|
Rate for Payer: Aetna of NY Medicare |
$80.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
Rate for Payer: Cash Price |
$131.25
|
Rate for Payer: Cash Price |
$131.25
|
Rate for Payer: Cash Price |
$131.25
|
Rate for Payer: Cash Price |
$131.25
|
Rate for Payer: CDPHP Commercial |
$140.88
|
Rate for Payer: CDPHP Medicare |
$64.75
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
Rate for Payer: EmblemHealth Medicaid |
$140.00
|
Rate for Payer: EmblemHealth Medicare |
$59.50
|
Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
Rate for Payer: Fidelis Medicare |
$66.69
|
Rate for Payer: Galaxy Health Commercial |
$113.75
|
Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
Rate for Payer: Humana Medicare |
$64.75
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
Rate for Payer: United Healthcare Commercial |
$980.00
|
Rate for Payer: United Healthcare Medicare |
$64.75
|
Rate for Payer: WellCare Medicare |
$96.25
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
OP
|
$108.00
|
|
Service Code
|
HCPCS 93270
|
Hospital Charge Code |
4480038
|
Hospital Revenue Code
|
731
|
Min. Negotiated Rate |
$9.09 |
Max. Negotiated Rate |
$86.94 |
Rate for Payer: Aetna of NY Commercial |
$70.20
|
Rate for Payer: Aetna of NY Medicare |
$49.68
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$81.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$81.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.96
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$54.00
|
Rate for Payer: Cash Price |
$81.00
|
Rate for Payer: Cash Price |
$81.00
|
Rate for Payer: CDPHP Commercial |
$86.94
|
Rate for Payer: CDPHP Medicare |
$39.96
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
Rate for Payer: EmblemHealth Medicaid |
$86.40
|
Rate for Payer: EmblemHealth Medicare |
$36.72
|
Rate for Payer: EmblemHealth Select Care |
$70.20
|
Rate for Payer: Fidelis Medicare |
$41.16
|
Rate for Payer: Galaxy Health Commercial |
$70.20
|
Rate for Payer: Hamaspik Choice Medicare |
$39.96
|
Rate for Payer: Humana Medicare |
$39.96
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.20
|
Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
Rate for Payer: MVP Health Care of NY Commercial |
$81.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.80
|
Rate for Payer: MVP Health Care of NY Medicare |
$41.96
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
Rate for Payer: United Healthcare Medicare |
$39.96
|
Rate for Payer: WellCare Medicare |
$59.40
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
IP
|
$108.00
|
|
Service Code
|
HCPCS 93270
|
Hospital Charge Code |
4480038
|
Hospital Revenue Code
|
731
|
Min. Negotiated Rate |
$70.20 |
Max. Negotiated Rate |
$70.20 |
Rate for Payer: Cash Price |
$81.00
|
Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$918.00
|
|
Service Code
|
HCPCS 58301
|
Hospital Charge Code |
4602238
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$250.00 |
Max. Negotiated Rate |
$1,189.18 |
Rate for Payer: Aetna of NY Commercial |
$955.00
|
Rate for Payer: Aetna of NY Medicare |
$422.28
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$339.66
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$459.00
|
Rate for Payer: Cash Price |
$688.50
|
Rate for Payer: Cash Price |
$688.50
|
Rate for Payer: Cash Price |
$688.50
|
Rate for Payer: CDPHP Commercial |
$738.99
|
Rate for Payer: CDPHP Medicare |
$339.66
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
Rate for Payer: EmblemHealth Medicare |
$312.12
|
Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
Rate for Payer: Fidelis Medicare |
$349.85
|
Rate for Payer: Galaxy Health Commercial |
$596.70
|
Rate for Payer: Hamaspik Choice Medicare |
$339.66
|
Rate for Payer: Humana Medicare |
$339.66
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
Rate for Payer: Local 1199SEIU Medicare |
$422.28
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$356.64
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
Rate for Payer: United Healthcare Commercial |
$980.00
|
Rate for Payer: United Healthcare Medicare |
$339.66
|
Rate for Payer: WellCare Medicare |
$504.90
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$918.00
|
|
Service Code
|
HCPCS 58301
|
Hospital Charge Code |
4602238
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$596.70 |
Max. Negotiated Rate |
$596.70 |
Rate for Payer: Cash Price |
$688.50
|
Rate for Payer: Galaxy Health Commercial |
$596.70
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE/TENDON
|
Facility
|
IP
|
$4,639.00
|
|
Service Code
|
HCPCS 20520
|
Hospital Charge Code |
4850166
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$3,015.35 |
Max. Negotiated Rate |
$3,015.35 |
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE/TENDON
|
Facility
|
OP
|
$4,639.00
|
|
Service Code
|
HCPCS 20520
|
Hospital Charge Code |
4850166
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,544.75 |
Max. Negotiated Rate |
$3,734.40 |
Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
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 |
$1,716.43
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: Cash Price |
$3,479.25
|
Rate for Payer: CDPHP Commercial |
$3,734.40
|
Rate for Payer: CDPHP Medicare |
$1,716.43
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,711.20
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
Rate for Payer: EmblemHealth Select Care |
$3,340.08
|
Rate for Payer: Fidelis Medicare |
$1,767.92
|
Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
Rate for Payer: Humana Medicare |
$1,716.43
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
Rate for Payer: United Healthcare Medicare |
$1,716.43
|
Rate for Payer: WellCare Medicare |
$2,551.45
|
|
REMOVAL OF NAIL BED
|
Facility
|
IP
|
$1,141.00
|
|
Service Code
|
HCPCS 11750
|
Hospital Charge Code |
4602190
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$741.65 |
Max. Negotiated Rate |
$741.65 |
Rate for Payer: Cash Price |
$855.75
|
Rate for Payer: Galaxy Health Commercial |
$741.65
|
|