|
SINERGY SYSTEM 17GX150 SIK-17-150-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
SINGERY KIT (CERVICOOL) SIK-17-75-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
SINGERY KIT (CERVICOOL) SIK-17-75-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
SINGLE LUMEN CENTRAL VENOUS CA
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
4471812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Galaxy Health Commercial |
$89.70
|
|
|
SINGLE LUMEN CENTRAL VENOUS CA
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
4471812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$111.09 |
| Rate for Payer: Aetna of NY Commercial |
$96.60
|
| Rate for Payer: Aetna of NY Medicare |
$63.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$51.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$69.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: CDPHP Commercial |
$111.09
|
| Rate for Payer: CDPHP Medicare |
$51.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: EmblemHealth Medicare |
$46.92
|
| Rate for Payer: EmblemHealth Select Care |
$99.36
|
| Rate for Payer: Fidelis Medicare |
$52.59
|
| Rate for Payer: Galaxy Health Commercial |
$89.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$51.06
|
| Rate for Payer: Humana Medicare |
$51.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$96.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.61
|
| Rate for Payer: United Healthcare Medicare |
$51.06
|
| Rate for Payer: WellCare Medicare |
$75.90
|
|
|
SINGLE NAIL AVULSION
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4609570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SINGLE NAIL AVULSION
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4609570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SINUS RELIEF 1% NASAL SPRAY 1 ea, 30 mL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 70000013201
|
| Hospital Charge Code |
4401399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$8.40
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
SINUS RELIEF 1% NASAL SPRAY 1 ea, 30 mL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 70000013201
|
| Hospital Charge Code |
4401399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
SIZE 15/2 BALLOONS
|
Facility
|
OP
|
$1,871.00
|
|
| Hospital Charge Code |
4471961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.14 |
| Max. Negotiated Rate |
$1,506.16 |
| Rate for Payer: Aetna of NY Commercial |
$1,309.70
|
| Rate for Payer: Aetna of NY Medicare |
$860.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,403.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,403.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$692.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$935.50
|
| Rate for Payer: Cash Price |
$1,403.25
|
| Rate for Payer: CDPHP Commercial |
$1,506.16
|
| Rate for Payer: CDPHP Medicare |
$692.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,496.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,496.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,496.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,496.80
|
| Rate for Payer: EmblemHealth Medicare |
$636.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,347.12
|
| Rate for Payer: Fidelis Medicare |
$713.04
|
| Rate for Payer: Galaxy Health Commercial |
$1,216.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$692.27
|
| Rate for Payer: Humana Medicare |
$692.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,309.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$860.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,403.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,053.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$726.88
|
| Rate for Payer: United Healthcare Medicare |
$692.27
|
| Rate for Payer: WellCare Medicare |
$1,029.05
|
|
|
SIZE 15/2 BALLOONS
|
Facility
|
IP
|
$1,871.00
|
|
| Hospital Charge Code |
4471961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,216.15 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Cash Price |
$1,403.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,216.15
|
|
|
SIZE 2 BONE BIOPSY DEVICE
|
Facility
|
OP
|
$530.00
|
|
| Hospital Charge Code |
4471869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$426.65 |
| Rate for Payer: Aetna of NY Commercial |
$371.00
|
| Rate for Payer: Aetna of NY Medicare |
$243.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$196.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$265.00
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: CDPHP Commercial |
$426.65
|
| Rate for Payer: CDPHP Medicare |
$196.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$265.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$424.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$424.00
|
| Rate for Payer: EmblemHealth Medicaid |
$424.00
|
| Rate for Payer: EmblemHealth Medicare |
$180.20
|
| Rate for Payer: EmblemHealth Select Care |
$265.00
|
| Rate for Payer: Fidelis Medicare |
$201.98
|
| Rate for Payer: Galaxy Health Commercial |
$344.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$196.10
|
| Rate for Payer: Humana Medicare |
$196.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$371.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$243.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$344.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$344.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$205.90
|
| Rate for Payer: United Healthcare Medicare |
$196.10
|
| Rate for Payer: WellCare Medicare |
$291.50
|
|
|
SIZE 2 BONE BIOPSY DEVICE
|
Facility
|
IP
|
$530.00
|
|
| Hospital Charge Code |
4471869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna of NY Commercial |
$371.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$265.00
|
| Rate for Payer: EmblemHealth Select Care |
$265.00
|
| Rate for Payer: Galaxy Health Commercial |
$344.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$371.00
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$344.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$344.50
|
| Rate for Payer: WellCare Medicare |
$291.50
|
|
|
SIZE 3 BIOPSY
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
4471868
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
SIZE 3 BIOPSY
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
4471868
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
SIZE 4 SHILEY
|
Facility
|
IP
|
$342.00
|
|
| Hospital Charge Code |
4479142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Galaxy Health Commercial |
$222.30
|
|
|
SIZE 4 SHILEY
|
Facility
|
OP
|
$342.00
|
|
| Hospital Charge Code |
4479142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.28 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna of NY Commercial |
$239.40
|
| Rate for Payer: Aetna of NY Medicare |
$157.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$171.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: CDPHP Commercial |
$275.31
|
| Rate for Payer: CDPHP Medicare |
$126.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$273.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$273.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$273.60
|
| Rate for Payer: EmblemHealth Medicaid |
$273.60
|
| Rate for Payer: EmblemHealth Medicare |
$116.28
|
| Rate for Payer: EmblemHealth Select Care |
$246.24
|
| Rate for Payer: Fidelis Medicare |
$130.34
|
| Rate for Payer: Galaxy Health Commercial |
$222.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.54
|
| Rate for Payer: Humana Medicare |
$126.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$239.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$157.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$192.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.87
|
| Rate for Payer: United Healthcare Medicare |
$126.54
|
| Rate for Payer: WellCare Medicare |
$188.10
|
|
|
SIZE 6 SHILEY
|
Facility
|
IP
|
$342.00
|
|
| Hospital Charge Code |
4479143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Galaxy Health Commercial |
$222.30
|
|
|
SIZE 6 SHILEY
|
Facility
|
OP
|
$342.00
|
|
| Hospital Charge Code |
4479143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.28 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna of NY Commercial |
$239.40
|
| Rate for Payer: Aetna of NY Medicare |
$157.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$171.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: CDPHP Commercial |
$275.31
|
| Rate for Payer: CDPHP Medicare |
$126.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$273.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$273.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$273.60
|
| Rate for Payer: EmblemHealth Medicaid |
$273.60
|
| Rate for Payer: EmblemHealth Medicare |
$116.28
|
| Rate for Payer: EmblemHealth Select Care |
$246.24
|
| Rate for Payer: Fidelis Medicare |
$130.34
|
| Rate for Payer: Galaxy Health Commercial |
$222.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.54
|
| Rate for Payer: Humana Medicare |
$126.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$239.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$157.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$192.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.87
|
| Rate for Payer: United Healthcare Medicare |
$126.54
|
| Rate for Payer: WellCare Medicare |
$188.10
|
|
|
SKIN BARRIER (COLOSTOMY SUPPLY)
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
4479195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
SKIN BARRIER (COLOSTOMY SUPPLY)
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
4479195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.50
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Commercial |
$28.18
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$13.34
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.95
|
| Rate for Payer: Humana Medicare |
$12.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.60
|
| Rate for Payer: United Healthcare Medicare |
$12.95
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
|
SKIN SUB GRAFT FACE/NK/HF/G
|
Facility
|
IP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
4852007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,391.70 |
| Max. Negotiated Rate |
$3,391.70 |
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
|
|
SKIN SUB GRAFT FACE/NK/HF/G
|
Facility
|
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
4852007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,737.53 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$3,652.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,609.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: EmblemHealth Select Care |
$3,756.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,652.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
4850303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,391.70 |
| Max. Negotiated Rate |
$3,391.70 |
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
4850303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,737.53 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$3,652.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,609.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: EmblemHealth Select Care |
$3,756.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,652.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
