|
REM SUTURES BY MD, DIFF THAN ORIG MD
|
Facility
|
OP
|
$57.68
|
|
|
Service Code
|
HCPCS S0630
|
| Hospital Charge Code |
4850302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$46.14 |
| Rate for Payer: Aetna of NY Commercial |
$40.38
|
| Rate for Payer: Aetna of NY Medicare |
$26.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.07
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: CDPHP Medicare |
$21.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.14
|
| Rate for Payer: EmblemHealth Medicaid |
$46.14
|
| Rate for Payer: EmblemHealth Medicare |
$19.61
|
| Rate for Payer: EmblemHealth Select Care |
$41.53
|
| Rate for Payer: Fidelis Medicare |
$23.07
|
| Rate for Payer: Galaxy Health Commercial |
$37.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.07
|
| Rate for Payer: Humana Medicare |
$23.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.65
|
| Rate for Payer: United Healthcare Medicare |
$23.07
|
| Rate for Payer: WellCare Medicare |
$31.72
|
|
|
REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 53446
|
| Hospital Charge Code |
4002071
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 53446
|
| Hospital Charge Code |
4002071
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,682.10 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
4300692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
4300692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.40
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 78709 26
|
| Hospital Charge Code |
5210033
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: Aetna of NY Commercial |
$139.30
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: Fidelis Medicare |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$139.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 78709 26
|
| Hospital Charge Code |
5210033
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
4210033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,164.80
|
| Rate for Payer: Aetna of NY Medicare |
$765.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$665.60
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: CDPHP Medicare |
$615.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,331.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicare |
$565.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,081.60
|
| Rate for Payer: Fidelis Medicare |
$665.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.60
|
| Rate for Payer: Humana Medicare |
$665.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,164.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$765.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,248.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$936.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$665.60
|
| Rate for Payer: WellCare Medicare |
$915.20
|
|
|
RENAL SCAN W AND W/O
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
4210033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
4210017
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
4210017
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,164.80
|
| Rate for Payer: Aetna of NY Medicare |
$765.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$665.60
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: CDPHP Medicare |
$615.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,331.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicare |
$565.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,081.60
|
| Rate for Payer: Fidelis Medicare |
$665.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.60
|
| Rate for Payer: Humana Medicare |
$665.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,164.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$765.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,248.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$936.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$665.60
|
| Rate for Payer: WellCare Medicare |
$915.20
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 78707 26
|
| Hospital Charge Code |
5210017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Aetna of NY Commercial |
$95.20
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.40
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: Fidelis Medicare |
$54.40
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.40
|
| Rate for Payer: Humana Medicare |
$54.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.40
|
| Rate for Payer: United Healthcare Medicare |
$54.40
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
RENAL SCAN W/O DRUG
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 78707 26
|
| Hospital Charge Code |
5210017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
RENFLEXIS 100 MG VIAL 10 mg, 1 each
|
Facility
|
OP
|
$271.50
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
4401379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$217.20 |
| Rate for Payer: Aetna of NY Medicare |
$124.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$108.60
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: CDPHP Medicare |
$100.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$217.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.20
|
| Rate for Payer: EmblemHealth Medicaid |
$217.20
|
| Rate for Payer: EmblemHealth Medicare |
$92.31
|
| Rate for Payer: EmblemHealth Select Care |
$26.80
|
| Rate for Payer: Fidelis Medicare |
$108.60
|
| Rate for Payer: Galaxy Health Commercial |
$176.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$108.60
|
| Rate for Payer: Humana Medicare |
$108.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$124.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$152.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$114.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$58.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.73
|
| Rate for Payer: United Healthcare Commercial |
$58.66
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
| Rate for Payer: WellCare Medicare |
$149.32
|
|
|
RENFLEXIS 100 MG VIAL 10 mg, 1 each
|
Facility
|
IP
|
$271.50
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
4401379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$176.47 |
| Rate for Payer: Aetna of NY Commercial |
$149.32
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.80
|
| Rate for Payer: EmblemHealth Select Care |
$26.80
|
| Rate for Payer: Galaxy Health Commercial |
$176.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.32
|
| Rate for Payer: WellCare Medicare |
$149.32
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
4002048
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
4002048
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
|
REPAIR KIT 8590-9 AND ANCHOR MEDTRONIC
|
Facility
|
IP
|
$354.32
|
|
| Hospital Charge Code |
4479123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.31 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Cash Price |
$265.74
|
| Rate for Payer: Galaxy Health Commercial |
$230.31
|
|
|
REPAIR KIT 8590-9 AND ANCHOR MEDTRONIC
|
Facility
|
OP
|
$354.32
|
|
| Hospital Charge Code |
4479123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$283.46 |
| Rate for Payer: Aetna of NY Commercial |
$248.02
|
| Rate for Payer: Aetna of NY Medicare |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$141.73
|
| Rate for Payer: Cash Price |
$265.74
|
| Rate for Payer: CDPHP Medicare |
$131.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$283.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$283.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$283.46
|
| Rate for Payer: EmblemHealth Medicaid |
$283.46
|
| Rate for Payer: EmblemHealth Medicare |
$120.47
|
| Rate for Payer: EmblemHealth Select Care |
$255.11
|
| Rate for Payer: Fidelis Medicare |
$141.73
|
| Rate for Payer: Galaxy Health Commercial |
$230.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$141.73
|
| Rate for Payer: Humana Medicare |
$141.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$248.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.74
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$199.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$148.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.15
|
| Rate for Payer: United Healthcare Medicare |
$141.73
|
| Rate for Payer: WellCare Medicare |
$194.88
|
|
|
REPAIR NAIL BED
|
Facility
|
IP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4856704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,472.25 |
| Max. Negotiated Rate |
$1,472.25 |
| Rate for Payer: Cash Price |
$1,698.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,472.25
|
|
|
REPAIR NAIL BED
|
Facility
|
OP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4856704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.75 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,585.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,041.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$906.00
|
| Rate for Payer: Cash Price |
$1,698.75
|
| Rate for Payer: CDPHP Medicare |
$838.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,812.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,812.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,812.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,812.00
|
| Rate for Payer: EmblemHealth Medicare |
$770.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,630.80
|
| Rate for Payer: Fidelis Medicare |
$906.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,472.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$906.00
|
| Rate for Payer: Humana Medicare |
$906.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,585.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,041.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,698.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,275.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$951.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$339.75
|
| Rate for Payer: United Healthcare Medicare |
$906.00
|
| Rate for Payer: WellCare Medicare |
$1,245.75
|
|
|
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
|
Facility
|
OP
|
$55.62
|
|
|
Service Code
|
HCPCS L4205
|
| Hospital Charge Code |
4690266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$27.81
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
HCPCS L4205
|
| Hospital Charge Code |
4690266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.03 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.81
|
| Rate for Payer: EmblemHealth Select Care |
$27.81
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Multiplan Commercial |
$25.03
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27696
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
|
|
REPLACEMENT PICC SAME VENOUS ACCESS
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
4850260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,377.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,474.00
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,377.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,618.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,716.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,026.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
