|
SURG PATH LVL 2
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 88302 TC
|
| Hospital Charge Code |
4008302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$68.42 |
| 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) 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: CDPHP Commercial |
$68.42
|
| 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 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$51.00
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| 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 Commercial |
$63.75
|
| 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 Commercial |
$63.75
|
| Rate for Payer: United Healthcare Medicare |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
SUTURE ETHILON 6/0 18IN BLAC
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
4471170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
SUTURE ETHILON 6/0 18IN BLAC
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
4471170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
SUTURELESS CATH
|
Facility
|
OP
|
$2,415.00
|
|
| Hospital Charge Code |
4471642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$821.10 |
| Max. Negotiated Rate |
$1,944.08 |
| Rate for Payer: Aetna of NY Commercial |
$1,690.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,110.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,811.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,811.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$893.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,207.50
|
| Rate for Payer: Cash Price |
$1,811.25
|
| Rate for Payer: CDPHP Commercial |
$1,944.08
|
| Rate for Payer: CDPHP Medicare |
$893.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,932.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,932.00
|
| Rate for Payer: EmblemHealth Medicare |
$821.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,738.80
|
| Rate for Payer: Fidelis Medicare |
$920.36
|
| Rate for Payer: Galaxy Health Commercial |
$1,569.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$893.55
|
| Rate for Payer: Humana Medicare |
$893.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,690.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,110.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,811.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,359.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$938.23
|
| Rate for Payer: United Healthcare Medicare |
$893.55
|
| Rate for Payer: WellCare Medicare |
$1,328.25
|
|
|
SUTURELESS CATH
|
Facility
|
IP
|
$2,415.00
|
|
| Hospital Charge Code |
4471642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,569.75 |
| Max. Negotiated Rate |
$1,569.75 |
| Rate for Payer: Cash Price |
$1,811.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,569.75
|
|
|
SUTURE LOOP GUIDE RODS
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
4471640
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$236.30 |
| Max. Negotiated Rate |
$559.48 |
| Rate for Payer: Aetna of NY Commercial |
$486.50
|
| Rate for Payer: Aetna of NY Medicare |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$521.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$521.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$257.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$347.50
|
| Rate for Payer: Cash Price |
$521.25
|
| Rate for Payer: CDPHP Commercial |
$559.48
|
| Rate for Payer: CDPHP Medicare |
$257.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$556.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$556.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$556.00
|
| Rate for Payer: EmblemHealth Medicaid |
$556.00
|
| Rate for Payer: EmblemHealth Medicare |
$236.30
|
| Rate for Payer: EmblemHealth Select Care |
$500.40
|
| Rate for Payer: Fidelis Medicare |
$264.86
|
| Rate for Payer: Galaxy Health Commercial |
$451.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$257.15
|
| Rate for Payer: Humana Medicare |
$257.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$486.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$319.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$391.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$270.01
|
| Rate for Payer: United Healthcare Medicare |
$257.15
|
| Rate for Payer: WellCare Medicare |
$382.25
|
|
|
SUTURE LOOP GUIDE RODS
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
4471640
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$451.75 |
| Max. Negotiated Rate |
$451.75 |
| Rate for Payer: Cash Price |
$521.25
|
| Rate for Payer: Galaxy Health Commercial |
$451.75
|
|
|
SUTURE POLYSORB 0 6X18IN VIO
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
4471969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
SUTURE POLYSORB 0 6X18IN VIO
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
4471969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
SUTURE/REPAIR TESTICULAR INJURY
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54670
|
| Hospital Charge Code |
4002054
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| 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 |
$1,266.00
|
| 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
|
|
|
SUTURE/REPAIR TESTICULAR INJURY
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54670
|
| Hospital Charge Code |
4002054
|
|
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
|
|
|
SUTURES POLYSORB
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
4472186
|
|
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
|
|
|
SUTURES POLYSORB
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
4472186
|
|
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
|
|
|
SUTURE SURGILON 1 5X18IN BLAC
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
4471183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
SUTURE SURGILON 1 5X18IN BLAC
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
4471183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
SUTURE TRAY ER
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
4609638
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
SUTURE TRAY ER
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
4609638
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
SUTURE VICRYL 0 18IN VIOLET
|
Facility
|
IP
|
$489.00
|
|
| Hospital Charge Code |
4471860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
|
|
SUTURE VICRYL 0 18IN VIOLET
|
Facility
|
OP
|
$489.00
|
|
| Hospital Charge Code |
4471860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$342.30
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: EmblemHealth Select Care |
$352.08
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$342.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
SWALLOWING FCN W CINE/VIDEO
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Hospital Charge Code |
4150350
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.84 |
| Max. Negotiated Rate |
$423.43 |
| Rate for Payer: Aetna of NY Commercial |
$315.60
|
| Rate for Payer: Aetna of NY Medicare |
$241.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$194.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$263.00
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: CDPHP Commercial |
$423.43
|
| Rate for Payer: CDPHP Medicare |
$194.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$368.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$420.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$420.80
|
| Rate for Payer: EmblemHealth Medicaid |
$420.80
|
| Rate for Payer: EmblemHealth Medicare |
$178.84
|
| Rate for Payer: EmblemHealth Select Care |
$341.90
|
| Rate for Payer: Fidelis Medicare |
$200.46
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$194.62
|
| Rate for Payer: Humana Medicare |
$194.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$241.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$296.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$204.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$194.62
|
| Rate for Payer: WellCare Medicare |
$289.30
|
|
|
SWALLOWING FCN W CINE/VIDEO
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Hospital Charge Code |
4150350
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$341.90 |
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
|
|
SYNCHROMED II PUMP
|
Facility
|
IP
|
$41,864.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
4471639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,838.80 |
| Max. Negotiated Rate |
$29,304.80 |
| Rate for Payer: Aetna of NY Commercial |
$29,304.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18,838.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18,838.80
|
| Rate for Payer: Cash Price |
$31,398.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20,932.00
|
| Rate for Payer: EmblemHealth Select Care |
$20,932.00
|
| Rate for Payer: Galaxy Health Commercial |
$27,211.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29,304.80
|
| Rate for Payer: Multiplan Commercial |
$18,838.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27,211.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27,211.60
|
| Rate for Payer: WellCare Medicare |
$23,025.20
|
|
|
SYNCHROMED II PUMP
|
Facility
|
OP
|
$41,864.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
4471639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,233.76 |
| Max. Negotiated Rate |
$33,700.52 |
| Rate for Payer: Aetna of NY Commercial |
$29,304.80
|
| Rate for Payer: Aetna of NY Medicare |
$19,257.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18,838.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18,838.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15,489.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20,932.00
|
| Rate for Payer: Cash Price |
$31,398.00
|
| Rate for Payer: CDPHP Commercial |
$33,700.52
|
| Rate for Payer: CDPHP Medicare |
$15,489.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33,491.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33,491.20
|
| Rate for Payer: EmblemHealth Medicaid |
$33,491.20
|
| Rate for Payer: EmblemHealth Medicare |
$14,233.76
|
| Rate for Payer: EmblemHealth Select Care |
$20,932.00
|
| Rate for Payer: Fidelis Medicare |
$15,954.37
|
| Rate for Payer: Galaxy Health Commercial |
$27,211.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$15,489.68
|
| Rate for Payer: Humana Medicare |
$15,489.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29,304.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$19,257.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27,211.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27,211.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16,264.16
|
| Rate for Payer: United Healthcare Medicare |
$15,489.68
|
| Rate for Payer: WellCare Medicare |
$23,025.20
|
|
|
SYPHLIS (RPR-STS) SCREEN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
4300749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna of NY Commercial |
$19.50
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Commercial |
$24.15
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$11.43
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.10
|
| Rate for Payer: Humana Medicare |
$11.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$22.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
SYPHLIS (RPR-STS) SCREEN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
4300749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
|
