|
SARS-COV-2 COVID-19 ANTIBODY
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
4300005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
|
|
SCOPOLAMINE PATCH 1MG DAILY/72H
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
NDC 45802058046
|
| Hospital Charge Code |
4409238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
| Rate for Payer: WellCare Medicare |
$37.95
|
|
|
SCOPOLAMINE PATCH 1MG DAILY/72H
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
NDC 45802058046
|
| Hospital Charge Code |
4409238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$55.54 |
| Rate for Payer: Aetna of NY Commercial |
$48.30
|
| Rate for Payer: Aetna of NY Medicare |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.50
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: CDPHP Commercial |
$55.54
|
| Rate for Payer: CDPHP Medicare |
$25.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.20
|
| Rate for Payer: EmblemHealth Medicaid |
$55.20
|
| Rate for Payer: EmblemHealth Medicare |
$23.46
|
| Rate for Payer: EmblemHealth Select Care |
$49.68
|
| Rate for Payer: Fidelis Medicare |
$26.30
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.53
|
| Rate for Payer: Humana Medicare |
$25.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.81
|
| Rate for Payer: United Healthcare Medicare |
$25.53
|
| Rate for Payer: WellCare Medicare |
$37.95
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Hospital Charge Code |
4150403
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$135.80
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.00
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Commercial |
$156.17
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: EmblemHealth Select Care |
$126.10
|
| Rate for Payer: Fidelis Medicare |
$73.93
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.78
|
| Rate for Payer: Humana Medicare |
$71.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Hospital Charge Code |
4150403
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Hospital Charge Code |
4150402
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$300.95 |
| Max. Negotiated Rate |
$300.95 |
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: Galaxy Health Commercial |
$300.95
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Hospital Charge Code |
4150402
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$324.10
|
| Rate for Payer: Aetna of NY Medicare |
$212.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$347.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$347.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$171.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$231.50
|
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: CDPHP Commercial |
$372.72
|
| Rate for Payer: CDPHP Medicare |
$171.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$324.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$370.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$370.40
|
| Rate for Payer: EmblemHealth Medicaid |
$370.40
|
| Rate for Payer: EmblemHealth Medicare |
$157.42
|
| Rate for Payer: EmblemHealth Select Care |
$300.95
|
| Rate for Payer: Fidelis Medicare |
$176.45
|
| Rate for Payer: Galaxy Health Commercial |
$300.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$171.31
|
| Rate for Payer: Humana Medicare |
$171.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$324.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$212.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$260.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$179.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: WellCare Medicare |
$254.65
|
|
|
SCROTOPLASTY COMPLICATED
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 55180
|
| Hospital Charge Code |
4002061
|
|
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
|
|
|
SCROTOPLASTY COMPLICATED
|
Facility
|
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 55180
|
| Hospital Charge Code |
4002061
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| 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 |
$1,266.00
|
| 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 |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
SCROTOPLASTY SIMPLE
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 55175
|
| Hospital Charge Code |
4402060
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| 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 |
$1,353.00
|
| 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
|
|
|
SCROTOPLASTY SIMPLE
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 55175
|
| Hospital Charge Code |
4402060
|
|
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
|
|
|
SEAL COHESIVE WAFFER (COLOSTOMY SUPPLY)
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4479196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
SEAL COHESIVE WAFFER (COLOSTOMY SUPPLY)
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4479196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
SECONDARY IV TUBING
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
4471919
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
|
|
SECONDARY IV TUBING
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
4471919
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$2.10
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$2.16
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM<
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
4650112
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM<
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
4650112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| 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 |
$108.00
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| 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 |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,59
|
| Hospital Charge Code |
4650397
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,59
|
| Hospital Charge Code |
4650397
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| 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 |
$108.00
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| 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 |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59 W KX)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,59,KX
|
| Hospital Charge Code |
4650449
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| 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 |
$108.00
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| 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 |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59 W KX)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,59,KX
|
| Hospital Charge Code |
4650449
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (W/ KX)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,KX
|
| Hospital Charge Code |
4650345
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (W/ KX)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597 GP,KX
|
| Hospital Charge Code |
4650345
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| 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 |
$108.00
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| 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 |
$222.61
|
| 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 |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SELF CARE TRAINING 15 MIN HOME MGMT
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650036
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna of NY Commercial |
$66.50
|
| Rate for Payer: Aetna of NY Medicare |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$47.50
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$31.52
|
| Rate for Payer: CDPHP Commercial |
$76.48
|
| Rate for Payer: CDPHP Essential Plan |
$70.92
|
| Rate for Payer: CDPHP Medicare |
$35.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$76.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.52
|
| Rate for Payer: EmblemHealth Medicaid |
$31.52
|
| Rate for Payer: EmblemHealth Medicare |
$32.30
|
| Rate for Payer: EmblemHealth Select Care |
$68.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$70.92
|
| Rate for Payer: Fidelis Medicare |
$36.20
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$46.33
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,152.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.15
|
| Rate for Payer: Humana Medicare |
$35.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$66.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,152.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$71.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.52
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$33.10
|
| Rate for Payer: WellCare Medicare |
$52.25
|
|
|
SELF CARE TRAINING 15 MIN HOME MGMT
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650036
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
|
