|
SKIN TEST TUBERCULOSIS INTRADERMAL
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
4300013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of NY Commercial |
$55.25
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$11.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$42.50
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$5.05
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Essential Plan |
$11.36
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.05
|
| Rate for Payer: EmblemHealth Medicaid |
$5.05
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$51.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$11.36
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$7.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$505.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$505.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$10.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$10.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$63.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Commercial |
$63.75
|
| Rate for Payer: United Healthcare Medicare |
$31.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$5.30
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
SKIN TEST TUBERCULOSIS INTRADERMAL
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
4300013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
SKYRIZI 600 MG/10 ML VIAL 600 mg, 10 mL
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
4401545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna of NY Commercial |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.25
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
SKYRIZI 600 MG/10 ML VIAL 600 mg, 10 mL
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
4401545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$44.28 |
| Rate for Payer: Aetna of NY Commercial |
$30.25
|
| Rate for Payer: Aetna of NY Medicare |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.50
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: CDPHP Commercial |
$44.28
|
| Rate for Payer: CDPHP Medicare |
$20.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.00
|
| Rate for Payer: EmblemHealth Medicaid |
$44.00
|
| Rate for Payer: EmblemHealth Medicare |
$18.70
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Fidelis Medicare |
$20.96
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.35
|
| Rate for Payer: Humana Medicare |
$20.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.61
|
| Rate for Payer: United Healthcare Commercial |
$25.61
|
| Rate for Payer: United Healthcare Medicare |
$20.35
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4650035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
4856724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
4856724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4650035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of NY Commercial |
$65.80
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$47.00
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Commercial |
$75.67
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$35.82
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.78
|
| Rate for Payer: Humana Medicare |
$34.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$34.78
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/<
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
4650079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/<
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
4650079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Commercial |
$75.67
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$35.82
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.78
|
| Rate for Payer: Humana Medicare |
$34.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$36.52
|
| 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 |
$34.78
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,59
|
| Hospital Charge Code |
4650394
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,59
|
| Hospital Charge Code |
4650394
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Commercial |
$75.67
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$35.82
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.78
|
| Rate for Payer: Humana Medicare |
$34.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$36.52
|
| 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 |
$34.78
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59 W KX)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,59,KX
|
| Hospital Charge Code |
4650446
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Commercial |
$75.67
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$35.82
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.78
|
| Rate for Payer: Humana Medicare |
$34.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$36.52
|
| 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 |
$34.78
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59 W KX)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,59,KX
|
| Hospital Charge Code |
4650446
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (W/ KX)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,KX
|
| Hospital Charge Code |
4650342
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Commercial |
$75.67
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.20
|
| Rate for Payer: EmblemHealth Medicaid |
$75.20
|
| Rate for Payer: EmblemHealth Medicare |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$35.82
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.78
|
| Rate for Payer: Humana Medicare |
$34.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$36.52
|
| 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 |
$34.78
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (W/ KX)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97598 GP,KX
|
| Hospital Charge Code |
4650342
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Facility
|
IP
|
$14,232.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
4002040
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,250.80 |
| Max. Negotiated Rate |
$9,250.80 |
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,250.80
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Facility
|
OP
|
$14,232.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
4002040
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$11,456.76 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,546.72
|
| 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 |
$5,265.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: CDPHP Commercial |
$11,456.76
|
| Rate for Payer: CDPHP Medicare |
$5,265.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,385.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,385.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,385.60
|
| Rate for Payer: EmblemHealth Medicaid |
$11,385.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,838.88
|
| Rate for Payer: EmblemHealth Select Care |
$10,247.04
|
| Rate for Payer: Fidelis Medicare |
$5,423.82
|
| Rate for Payer: Galaxy Health Commercial |
$9,250.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,265.84
|
| Rate for Payer: Humana Medicare |
$5,265.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,546.72
|
| Rate for Payer: Multiplan Commercial |
$11,385.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,674.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,012.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,529.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,739.10
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,265.84
|
| Rate for Payer: WellCare Medicare |
$7,827.60
|
|
|
SLING QUICK RELEASE ARM ENVELOPE LARGE
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
4478233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
SLING QUICK RELEASE ARM ENVELOPE LARGE
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
4478233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
|
|
SLING QUICK RELEASE ARM ENVELOPE MEDIUM
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4478232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
SLING QUICK RELEASE ARM ENVELOPE MEDIUM
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4478232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
4002042
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
4002042
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
SM 153 LEXIDRONAM =< 150 MCI THERA
|
Facility
|
IP
|
$51,780.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
4210084
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$33,657.00 |
| Max. Negotiated Rate |
$33,657.00 |
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: Galaxy Health Commercial |
$33,657.00
|
|
