|
REMOVAL OF NAIL BED
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
4602190
|
|
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 |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| 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 |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
REMOVAL OF NAIL BED LEFT
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 LT
|
| Hospital Charge Code |
4856658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.94 |
| Max. Negotiated Rate |
$918.50 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
REMOVAL OF NAIL BED LEFT
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 LT
|
| Hospital Charge Code |
4856658
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
REMOVAL OF NAIL BED RIGHT
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 RT
|
| Hospital Charge Code |
4856657
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
REMOVAL OF NAIL BED RIGHT
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11750 RT
|
| Hospital Charge Code |
4856657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.94 |
| Max. Negotiated Rate |
$918.50 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$855.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 63661
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,839.63
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4853045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$103.84 |
| Rate for Payer: Aetna of NY Commercial |
$90.30
|
| Rate for Payer: Aetna of NY Medicare |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.50
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: CDPHP Commercial |
$103.84
|
| Rate for Payer: CDPHP Medicare |
$47.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.20
|
| Rate for Payer: EmblemHealth Medicaid |
$103.20
|
| Rate for Payer: EmblemHealth Medicare |
$43.86
|
| Rate for Payer: EmblemHealth Select Care |
$92.88
|
| Rate for Payer: Fidelis Medicare |
$49.16
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.73
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$90.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$72.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
| Rate for Payer: WellCare Medicare |
$70.95
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4853045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4602240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.34
|
| 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 |
$47.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.50
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: CDPHP Commercial |
$103.84
|
| Rate for Payer: CDPHP Medicare |
$47.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.20
|
| Rate for Payer: EmblemHealth Medicaid |
$103.20
|
| Rate for Payer: EmblemHealth Medicare |
$43.86
|
| 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 |
$49.16
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.73
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.34
|
| 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 |
$50.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
| Rate for Payer: WellCare Medicare |
$70.95
|
|
|
REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
4602240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4853044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$82.92 |
| Rate for Payer: Aetna of NY Commercial |
$72.10
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| Rate for Payer: EmblemHealth Select Care |
$74.16
|
| Rate for Payer: Fidelis Medicare |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.65
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4602239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| 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 |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| 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 |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| 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 |
$40.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.65
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4602239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4853044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
|
|
REMOVE FULL ARM OR LEG CAST
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
4850161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
|
|
REMOVE FULL ARM OR LEG CAST
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
4850161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| 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 |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: EmblemHealth Select Care |
$552.96
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
REMOVE SKIN TAGS ADD-ON =<10 LESIONS
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
4856690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
|
|
REMOVE SKIN TAGS ADD-ON =<10 LESIONS
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
4856690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| 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 |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
REMOVE TNL CV CATH
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
4450114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.70 |
| Max. Negotiated Rate |
$1,168.70 |
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
|
|
REMOVE TNL CV CATH
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
4450114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.55 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,258.60
|
| Rate for Payer: Aetna of NY Medicare |
$827.08
|
| 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 |
$665.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$899.00
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: CDPHP Commercial |
$1,447.39
|
| Rate for Payer: CDPHP Medicare |
$665.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,438.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,438.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicare |
$611.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,294.56
|
| Rate for Payer: Fidelis Medicare |
$685.22
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.26
|
| Rate for Payer: Humana Medicare |
$665.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,258.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$827.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,012.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.55
|
| Rate for Payer: United Healthcare Medicare |
$665.26
|
| Rate for Payer: WellCare Medicare |
$988.90
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4602226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| 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 |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| 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 |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4856689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4602226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
REM SKIN TAGS; <=15 LESIONS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
4856689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| 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 |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
REM SUTURES BY MD, DIFF THAN ORIG MD
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS S0630
|
| Hospital Charge Code |
4850302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$39.20
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$40.32
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
