|
RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4602227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4853031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: Aetna of NY Commercial |
$536.20
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$551.52
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
4853032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
4853032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: Aetna of NY Commercial |
$536.20
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$551.52
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 78832 26
|
| Hospital Charge Code |
5211263
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
IP
|
$4,476.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
4211263
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,909.40 |
| Max. Negotiated Rate |
$2,909.40 |
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,909.40
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
OP
|
$4,476.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
4211263
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$671.40 |
| Max. Negotiated Rate |
$3,580.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,058.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,790.40
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: CDPHP Medicare |
$1,656.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,133.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,580.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,521.84
|
| Rate for Payer: EmblemHealth Select Care |
$2,909.40
|
| Rate for Payer: Fidelis Medicare |
$1,790.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,909.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,790.40
|
| Rate for Payer: Humana Medicare |
$1,790.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,058.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,357.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,519.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,879.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$671.40
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$1,790.40
|
| Rate for Payer: WellCare Medicare |
$2,461.80
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 78832 26
|
| Hospital Charge Code |
5211263
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$136.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: CDPHP Medicare |
$109.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$236.80
|
| Rate for Payer: EmblemHealth Medicaid |
$236.80
|
| Rate for Payer: EmblemHealth Medicare |
$100.64
|
| Rate for Payer: Fidelis Medicare |
$118.40
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$166.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$124.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.40
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$162.80
|
|
|
R SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471575
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
R SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471575
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
RSV IA W DIR OBSERV-CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
4301171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
RSV IA W DIR OBSERV-CULTURE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
4301171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
RUBELLA ABS IGM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
4300710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
|
|
RUBELLA ABS IGM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
4300710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: Aetna of NY Commercial |
$27.95
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.20
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$25.80
|
| Rate for Payer: Fidelis Medicare |
$17.20
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.20
|
| Rate for Payer: Humana Medicare |
$17.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$32.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.45
|
| Rate for Payer: United Healthcare Commercial |
$32.25
|
| Rate for Payer: United Healthcare Medicare |
$17.20
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
4302013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
4302013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.60
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.60
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.60
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
R XL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471578
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
R XL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471578
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
R XS WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$59.74
|
|
| Hospital Charge Code |
4471574
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
|
|
R XS WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$59.74
|
|
| Hospital Charge Code |
4471574
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$47.79 |
| Rate for Payer: Aetna of NY Commercial |
$41.82
|
| Rate for Payer: Aetna of NY Medicare |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.90
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: CDPHP Medicare |
$22.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.79
|
| Rate for Payer: EmblemHealth Medicaid |
$47.79
|
| Rate for Payer: EmblemHealth Medicare |
$20.31
|
| Rate for Payer: EmblemHealth Select Care |
$43.01
|
| Rate for Payer: Fidelis Medicare |
$23.90
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.90
|
| Rate for Payer: Humana Medicare |
$23.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.82
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.96
|
| Rate for Payer: United Healthcare Medicare |
$23.90
|
| Rate for Payer: WellCare Medicare |
$32.86
|
|
|
SALEM SUMP 10FR
|
Facility
|
IP
|
$1,605.77
|
|
| Hospital Charge Code |
4471333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.60 |
| Max. Negotiated Rate |
$1,124.04 |
| Rate for Payer: Aetna of NY Commercial |
$1,124.04
|
| Rate for Payer: Cash Price |
$1,204.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$802.88
|
| Rate for Payer: EmblemHealth Select Care |
$802.88
|
| Rate for Payer: Galaxy Health Commercial |
$1,043.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,124.04
|
| Rate for Payer: Multiplan Commercial |
$722.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,043.75
|
| Rate for Payer: WellCare Medicare |
$883.17
|
|
|
SALEM SUMP 10FR
|
Facility
|
OP
|
$1,605.77
|
|
| Hospital Charge Code |
4471333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.87 |
| Max. Negotiated Rate |
$1,284.62 |
| Rate for Payer: Aetna of NY Commercial |
$1,124.04
|
| Rate for Payer: Aetna of NY Medicare |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$642.31
|
| Rate for Payer: Cash Price |
$1,204.33
|
| Rate for Payer: CDPHP Medicare |
$594.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$802.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,284.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,284.62
|
| Rate for Payer: EmblemHealth Medicaid |
$1,284.62
|
| Rate for Payer: EmblemHealth Medicare |
$545.96
|
| Rate for Payer: EmblemHealth Select Care |
$802.88
|
| Rate for Payer: Fidelis Medicare |
$642.31
|
| Rate for Payer: Galaxy Health Commercial |
$1,043.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$642.31
|
| Rate for Payer: Humana Medicare |
$642.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,124.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$738.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$674.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$240.87
|
| Rate for Payer: United Healthcare Medicare |
$642.31
|
| Rate for Payer: WellCare Medicare |
$883.17
|
|
|
SALEM SUMP 12FR
|
Facility
|
OP
|
$1,605.77
|
|
| Hospital Charge Code |
4471335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.87 |
| Max. Negotiated Rate |
$1,284.62 |
| Rate for Payer: Aetna of NY Commercial |
$1,124.04
|
| Rate for Payer: Aetna of NY Medicare |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$642.31
|
| Rate for Payer: Cash Price |
$1,204.33
|
| Rate for Payer: CDPHP Medicare |
$594.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$802.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,284.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,284.62
|
| Rate for Payer: EmblemHealth Medicaid |
$1,284.62
|
| Rate for Payer: EmblemHealth Medicare |
$545.96
|
| Rate for Payer: EmblemHealth Select Care |
$802.88
|
| Rate for Payer: Fidelis Medicare |
$642.31
|
| Rate for Payer: Galaxy Health Commercial |
$1,043.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$642.31
|
| Rate for Payer: Humana Medicare |
$642.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,124.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$738.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$674.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$240.87
|
| Rate for Payer: United Healthcare Medicare |
$642.31
|
| Rate for Payer: WellCare Medicare |
$883.17
|
|
|
SALEM SUMP 12FR
|
Facility
|
IP
|
$1,605.77
|
|
| Hospital Charge Code |
4471335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.60 |
| Max. Negotiated Rate |
$1,124.04 |
| Rate for Payer: Aetna of NY Commercial |
$1,124.04
|
| Rate for Payer: Cash Price |
$1,204.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$802.88
|
| Rate for Payer: EmblemHealth Select Care |
$802.88
|
| Rate for Payer: Galaxy Health Commercial |
$1,043.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,124.04
|
| Rate for Payer: Multiplan Commercial |
$722.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,043.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,043.75
|
| Rate for Payer: WellCare Medicare |
$883.17
|
|
|
SALEM SUMP 14FR
|
Facility
|
IP
|
$6.18
|
|
| Hospital Charge Code |
4471338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.09
|
| Rate for Payer: EmblemHealth Select Care |
$3.09
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
