|
PROTEIN TOTAL
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
4300666
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
PROTEIN TOTAL
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
4300666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna of NY Commercial |
$7.15
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.60
|
| 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 |
$6.60
|
| Rate for Payer: Fidelis Medicare |
$4.40
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.40
|
| Rate for Payer: Humana Medicare |
$4.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.15
|
| 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 |
$4.62
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.65
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$4.40
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
PROTHROMBIN TIME
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
4300669
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
PROTHROMBIN TIME
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
4300669
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
Protonix 40 MG SUSPENSION 40 mg, 30 eaches
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
NDC 8084401
|
| Hospital Charge Code |
4401407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$45.60 |
| 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) Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$42.75
|
| 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 |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| 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 |
$23.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
Protonix 40 MG SUSPENSION 40 mg, 30 eaches
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
NDC 8084401
|
| Hospital Charge Code |
4401407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
PROXIMAL REVISION KIT
|
Facility
|
IP
|
$1,173.17
|
|
| Hospital Charge Code |
4471636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$762.56 |
| Max. Negotiated Rate |
$762.56 |
| Rate for Payer: Cash Price |
$879.88
|
| Rate for Payer: Galaxy Health Commercial |
$762.56
|
|
|
PROXIMAL REVISION KIT
|
Facility
|
OP
|
$1,173.17
|
|
| Hospital Charge Code |
4471636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$938.54 |
| Rate for Payer: Aetna of NY Commercial |
$821.22
|
| Rate for Payer: Aetna of NY Medicare |
$539.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$469.27
|
| Rate for Payer: Cash Price |
$879.88
|
| Rate for Payer: CDPHP Medicare |
$434.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$938.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$938.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$938.54
|
| Rate for Payer: EmblemHealth Medicaid |
$938.54
|
| Rate for Payer: EmblemHealth Medicare |
$398.88
|
| Rate for Payer: EmblemHealth Select Care |
$844.68
|
| Rate for Payer: Fidelis Medicare |
$469.27
|
| Rate for Payer: Galaxy Health Commercial |
$762.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$469.27
|
| Rate for Payer: Humana Medicare |
$469.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$821.22
|
| Rate for Payer: Local 1199SEIU Medicare |
$539.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$879.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$660.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$492.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$175.98
|
| Rate for Payer: United Healthcare Medicare |
$469.27
|
| Rate for Payer: WellCare Medicare |
$645.24
|
|
|
PSA; FREE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
4301228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
|
|
PSA; FREE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
4301228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of NY Commercial |
$35.75
|
| Rate for Payer: Aetna of NY Medicare |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: CDPHP Medicare |
$20.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.00
|
| 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 |
$33.00
|
| Rate for Payer: Fidelis Medicare |
$22.00
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.00
|
| Rate for Payer: Humana Medicare |
$22.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.75
|
| 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 |
$23.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$41.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.25
|
| Rate for Payer: United Healthcare Commercial |
$41.25
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
PSEUDOEPHEDRINE HCL 30MG TABS 24 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904505324
|
| Hospital Charge Code |
4400725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PSEUDOEPHEDRINE HCL 30MG TABS 24 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904505324
|
| Hospital Charge Code |
4400725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PT COLD PACKS ONLY
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
PT COLD PACKS ONLY
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
PT COLD PACKS ONLY (MOD 59)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
PT COLD PACKS ONLY (MOD 59)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
PT COLD PACKS ONLY (MOD 59 W KX)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
PT COLD PACKS ONLY (MOD 59 W KX)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
PT COLD PACKS ONLY (W/ KX)
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
PT COLD PACKS ONLY (W/ KX)
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59
|
| Hospital Charge Code |
4650362
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59
|
| Hospital Charge Code |
4650362
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59 W KX)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
| Hospital Charge Code |
4650414
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
