|
REM SUTURES BY MD, DIFF THAN ORIG MD
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS S0630
|
| Hospital Charge Code |
4850302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 53446
|
| Hospital Charge Code |
4002071
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,623.90 |
| Max. Negotiated Rate |
$9,623.90 |
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
|
|
REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 53446
|
| Hospital Charge Code |
4002071
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$11,918.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,810.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,478.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: CDPHP Commercial |
$11,918.83
|
| Rate for Payer: CDPHP Medicare |
$5,478.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicare |
$5,034.04
|
| Rate for Payer: EmblemHealth Select Care |
$10,660.32
|
| Rate for Payer: Fidelis Medicare |
$5,642.57
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,478.22
|
| Rate for Payer: Humana Medicare |
$5,478.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,810.76
|
| Rate for Payer: Multiplan Commercial |
$11,844.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,104.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,335.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,752.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,930.08
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
4300692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$34.62 |
| Rate for Payer: Aetna of NY Commercial |
$27.95
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.50
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Commercial |
$34.62
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$25.80
|
| Rate for Payer: Fidelis Medicare |
$16.39
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.91
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$32.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$32.25
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
4300692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
4210033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.04
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
4210033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
4210017
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$95.95 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$95.95
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
4210017
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
RENFLEXIS 100 MG VIAL 10 mg, 1 each
|
Facility
|
IP
|
$271.50
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
4401379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$176.48 |
| Rate for Payer: Aetna of NY Commercial |
$149.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.58
|
| Rate for Payer: Cash Price |
$203.63
|
| Rate for Payer: Cash Price |
$203.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.58
|
| Rate for Payer: EmblemHealth Select Care |
$30.58
|
| Rate for Payer: Galaxy Health Commercial |
$176.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.32
|
| Rate for Payer: WellCare Medicare |
$149.32
|
|
|
RENFLEXIS 100 MG VIAL 10 mg, 1 each
|
Facility
|
OP
|
$271.50
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
4401379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$218.56 |
| Rate for Payer: Aetna of NY Commercial |
$149.32
|
| Rate for Payer: Aetna of NY Medicare |
$124.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$135.75
|
| Rate for Payer: Cash Price |
$203.63
|
| Rate for Payer: Cash Price |
$203.63
|
| Rate for Payer: CDPHP Commercial |
$218.56
|
| Rate for Payer: CDPHP Medicare |
$100.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$217.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.20
|
| Rate for Payer: EmblemHealth Medicaid |
$217.20
|
| Rate for Payer: EmblemHealth Medicare |
$92.31
|
| Rate for Payer: EmblemHealth Select Care |
$30.58
|
| Rate for Payer: Fidelis Medicare |
$103.47
|
| Rate for Payer: Galaxy Health Commercial |
$176.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.46
|
| Rate for Payer: Humana Medicare |
$100.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.32
|
| Rate for Payer: Local 1199SEIU Medicare |
$124.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$152.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$58.66
|
| Rate for Payer: United Healthcare Medicare |
$100.46
|
| Rate for Payer: WellCare Medicare |
$149.32
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
4002048
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| 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 |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
4002048
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
REPAIR KIT 8590-9 AND ANCHOR MEDTRONIC
|
Facility
|
IP
|
$344.00
|
|
| Hospital Charge Code |
4479123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
REPAIR KIT 8590-9 AND ANCHOR MEDTRONIC
|
Facility
|
OP
|
$344.00
|
|
| Hospital Charge Code |
4479123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$240.80
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$240.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$193.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
REPAIR NAIL BED
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4856704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| 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 |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,293.84
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
REPAIR NAIL BED
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4856704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.05 |
| Max. Negotiated Rate |
$1,168.05 |
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
|
|
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS L4205
|
| Hospital Charge Code |
4690266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.64
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS L4205
|
| Hospital Charge Code |
4690266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.00
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$24.30
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27696
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$6,816.33 |
| 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 |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| 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 |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
REPLACEMENT PICC SAME VENOUS ACCESS
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
4850260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| 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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$3,299.76
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
REPLACEMENT PICC SAME VENOUS ACCESS
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
4850260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
REPLACE NON-TUNNELED CV CATH
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
4450115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| 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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$3,299.76
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
REPLACE NON-TUNNELED CV CATH
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
4450115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
RESOLUTION CLIP 235CM
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
4471975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Galaxy Health Commercial |
$559.00
|
|
