|
RM & BED-SEMI PRIVATE
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
1000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$683.15 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna of NY Commercial |
$4,918.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,943.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,928.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,484.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,993.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,990.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,577.00
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,993.18
|
| Rate for Payer: CDPHP Commercial |
$3,562.00
|
| Rate for Payer: CDPHP Essential Plan |
$4,484.66
|
| Rate for Payer: CDPHP Medicare |
$1,990.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,729.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,391.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,255.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,825.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$683.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,587.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,993.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,990.70
|
| Rate for Payer: Humana Medicare |
$1,990.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,918.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,993.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,284.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,213.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,090.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,124.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
| Rate for Payer: United Healthcare Commercial |
$4,124.00
|
| Rate for Payer: United Healthcare Medicare |
$1,990.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,993.18
|
| Rate for Payer: WellCare Medicare |
$2,189.77
|
|
|
RM & BED-SWING
|
Facility
|
IP
|
$1,035.00
|
|
| Hospital Charge Code |
1050001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$672.75 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna of NY Commercial |
$4,918.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,943.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,928.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,484.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,993.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,990.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,577.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,993.18
|
| Rate for Payer: CDPHP Commercial |
$3,562.00
|
| Rate for Payer: CDPHP Essential Plan |
$4,484.66
|
| Rate for Payer: CDPHP Medicare |
$1,990.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,729.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,391.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,255.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,825.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$672.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,587.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,993.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,990.70
|
| Rate for Payer: Humana Medicare |
$1,990.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,918.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,993.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,284.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,213.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,090.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,124.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
| Rate for Payer: United Healthcare Commercial |
$4,124.00
|
| Rate for Payer: United Healthcare Medicare |
$1,990.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,993.18
|
| Rate for Payer: WellCare Medicare |
$2,189.77
|
|
|
R MED WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4471576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
R MED WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4471576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
IP
|
$3,377.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4601197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,195.05 |
| Max. Negotiated Rate |
$2,195.05 |
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,195.05
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
OP
|
$3,377.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4601197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,718.48 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,553.42
|
| 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 |
$1,249.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,688.50
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: CDPHP Commercial |
$2,718.48
|
| Rate for Payer: CDPHP Medicare |
$1,249.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,148.18
|
| 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 |
$1,286.97
|
| Rate for Payer: Galaxy Health Commercial |
$2,195.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,249.49
|
| Rate for Payer: Humana Medicare |
$1,249.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,553.42
|
| 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 |
$1,311.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,249.49
|
| Rate for Payer: WellCare Medicare |
$1,857.35
|
|
|
RMVL IMPACTED EARWAX USING IRRI/LAVAGE,U
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
4602748
|
|
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
|
|
|
RMVL IMPACTED EARWAX USING IRRI/LAVAGE,U
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
4602748
|
|
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
|
|
|
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
4002068
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
4002068
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Facility
|
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
4002069
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: EmblemHealth Select Care |
$41,557.68
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Facility
|
IP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
4002069
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$37,517.35 |
| Max. Negotiated Rate |
$37,517.35 |
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
|
|
RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Facility
|
IP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 53447
|
| Hospital Charge Code |
4002072
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$37,517.35 |
| Max. Negotiated Rate |
$37,517.35 |
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
|
|
RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Facility
|
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 53447
|
| Hospital Charge Code |
4002072
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: EmblemHealth Select Care |
$41,557.68
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
ROCURONIUM BROMIDE 10MG/ML MDV 10X10ML
|
Facility
|
IP
|
$29.83
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
4400684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Galaxy Health Commercial |
$19.39
|
| Rate for Payer: WellCare Medicare |
$16.41
|
|
|
ROCURONIUM BROMIDE 10MG/ML MDV 10X10ML
|
Facility
|
OP
|
$29.83
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
4400684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Aetna of NY Commercial |
$20.88
|
| Rate for Payer: Aetna of NY Medicare |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.92
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: CDPHP Commercial |
$24.01
|
| Rate for Payer: CDPHP Medicare |
$11.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.86
|
| Rate for Payer: EmblemHealth Medicaid |
$23.86
|
| Rate for Payer: EmblemHealth Medicare |
$10.14
|
| Rate for Payer: EmblemHealth Select Care |
$21.48
|
| Rate for Payer: Fidelis Medicare |
$11.37
|
| Rate for Payer: Galaxy Health Commercial |
$19.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.04
|
| Rate for Payer: Humana Medicare |
$11.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.88
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$11.04
|
| Rate for Payer: WellCare Medicare |
$16.41
|
|
|
ROM HAND MEASUREMENTS REPORT
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP
|
| Hospital Charge Code |
4650034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
ROM HAND MEASUREMENTS REPORT
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP
|
| Hospital Charge Code |
4650034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ROM HAND MEASUREMENTS REPORT (MOD 59)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,59
|
| Hospital Charge Code |
4650375
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ROM HAND MEASUREMENTS REPORT (MOD 59)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,59
|
| Hospital Charge Code |
4650375
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
ROM HAND MEASUREMENTS REPORT (MOD 59 W KX)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,59,KX
|
| Hospital Charge Code |
4650427
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ROM HAND MEASUREMENTS REPORT (MOD 59 W KX)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,59,KX
|
| Hospital Charge Code |
4650427
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
ROM HAND MEASUREMENTS REPORT (W/ KX)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,KX
|
| Hospital Charge Code |
4650320
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ROM HAND MEASUREMENTS REPORT (W/ KX)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 95852 GP,KX
|
| Hospital Charge Code |
4650320
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
ROPINEROLE 1 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
4401271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
