|
SALEM SUMP 14FR
|
Facility
|
OP
|
$6.18
|
|
| Hospital Charge Code |
4471338
|
|
Hospital Revenue Code
|
278
|
| 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 |
$3.09
|
| 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 |
$3.09
|
| 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 |
$4.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.02
|
| 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
|
|
|
SALEM SUMP 16FR
|
Facility
|
OP
|
$5.15
|
|
| Hospital Charge Code |
4471339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna of NY Commercial |
$3.60
|
| Rate for Payer: Aetna of NY Medicare |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.06
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: CDPHP Medicare |
$1.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.12
|
| Rate for Payer: EmblemHealth Medicaid |
$4.12
|
| Rate for Payer: EmblemHealth Medicare |
$1.75
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$2.06
|
| Rate for Payer: Galaxy Health Commercial |
$3.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.06
|
| Rate for Payer: Humana Medicare |
$2.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$2.06
|
| Rate for Payer: WellCare Medicare |
$2.83
|
|
|
SALEM SUMP 16FR
|
Facility
|
IP
|
$5.15
|
|
| Hospital Charge Code |
4471339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of NY Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$3.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.35
|
| Rate for Payer: WellCare Medicare |
$2.83
|
|
|
SALEM SUMP 18FR
|
Facility
|
OP
|
$6.18
|
|
| Hospital Charge Code |
4471340
|
|
Hospital Revenue Code
|
278
|
| 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 |
$3.09
|
| 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 |
$3.09
|
| 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 |
$4.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.02
|
| 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
|
|
|
SALEM SUMP 18FR
|
Facility
|
IP
|
$6.18
|
|
| Hospital Charge Code |
4471340
|
|
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
|
|
|
SALICYLATE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
4300716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of NY Commercial |
$234.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: CDPHP Medicare |
$133.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$216.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
| Rate for Payer: EmblemHealth Medicaid |
$288.00
|
| Rate for Payer: EmblemHealth Medicare |
$122.40
|
| Rate for Payer: EmblemHealth Select Care |
$216.00
|
| Rate for Payer: Fidelis Medicare |
$144.00
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$234.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$151.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$270.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$270.00
|
| Rate for Payer: United Healthcare Medicare |
$144.00
|
| Rate for Payer: WellCare Medicare |
$198.00
|
|
|
SALICYLATE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
4300716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
|
|
SARS-COV-2 COVID-19 ANTIBODY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
4300005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Galaxy Health Commercial |
$81.90
|
|
|
SARS-COV-2 COVID-19 ANTIBODY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
4300005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of NY Commercial |
$81.90
|
| Rate for Payer: Aetna of NY Medicare |
$57.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.40
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: CDPHP Medicare |
$46.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.80
|
| Rate for Payer: EmblemHealth Medicaid |
$100.80
|
| Rate for Payer: EmblemHealth Medicare |
$42.84
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$50.40
|
| Rate for Payer: Galaxy Health Commercial |
$81.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.40
|
| Rate for Payer: Humana Medicare |
$50.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$81.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$94.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Medicare |
$50.40
|
| Rate for Payer: WellCare Medicare |
$69.30
|
|
|
SCOPOLAMINE PATCH 1MG DAILY/72H
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
NDC 45802058046
|
| Hospital Charge Code |
4409238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
| Rate for Payer: WellCare Medicare |
$37.95
|
|
|
SCOPOLAMINE PATCH 1MG DAILY/72H
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
NDC 45802058046
|
| Hospital Charge Code |
4409238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna of NY Commercial |
$48.30
|
| Rate for Payer: Aetna of NY Medicare |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.60
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: CDPHP Medicare |
$25.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.20
|
| Rate for Payer: EmblemHealth Medicaid |
$55.20
|
| Rate for Payer: EmblemHealth Medicare |
$23.46
|
| Rate for Payer: EmblemHealth Select Care |
$49.68
|
| Rate for Payer: Fidelis Medicare |
$27.60
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.60
|
| Rate for Payer: Humana Medicare |
$27.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.35
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
| Rate for Payer: WellCare Medicare |
$37.95
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 77063 26
|
| Hospital Charge Code |
5150403
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Aetna of NY Commercial |
$62.30
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: Fidelis Medicare |
$35.60
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.60
|
| Rate for Payer: Humana Medicare |
$35.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$35.60
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 77063 26
|
| Hospital Charge Code |
5150403
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Hospital Charge Code |
4150403
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
|
|
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Hospital Charge Code |
4150403
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$135.80
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$77.60
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: EmblemHealth Select Care |
$126.10
|
| Rate for Payer: Fidelis Medicare |
$77.60
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$77.60
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.10
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Hospital Charge Code |
4150402
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$300.95 |
| Max. Negotiated Rate |
$300.95 |
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: Galaxy Health Commercial |
$300.95
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 77067 26
|
| Hospital Charge Code |
5150402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 77067 26
|
| Hospital Charge Code |
5150402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna of NY Commercial |
$79.10
|
| Rate for Payer: Aetna of NY Medicare |
$51.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.20
|
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: CDPHP Medicare |
$41.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$90.40
|
| Rate for Payer: EmblemHealth Medicaid |
$90.40
|
| Rate for Payer: EmblemHealth Medicare |
$38.42
|
| Rate for Payer: Fidelis Medicare |
$45.20
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.20
|
| Rate for Payer: Humana Medicare |
$45.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$51.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$63.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.95
|
| Rate for Payer: United Healthcare Medicare |
$45.20
|
| Rate for Payer: WellCare Medicare |
$62.15
|
|
|
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Hospital Charge Code |
4150402
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$69.45 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$324.10
|
| Rate for Payer: Aetna of NY Medicare |
$212.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.20
|
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: Cash Price |
$347.25
|
| Rate for Payer: CDPHP Medicare |
$171.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$324.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$370.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$370.40
|
| Rate for Payer: EmblemHealth Medicaid |
$370.40
|
| Rate for Payer: EmblemHealth Medicare |
$157.42
|
| Rate for Payer: EmblemHealth Select Care |
$300.95
|
| Rate for Payer: Fidelis Medicare |
$185.20
|
| Rate for Payer: Galaxy Health Commercial |
$300.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$185.20
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$324.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$212.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$260.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$194.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$69.45
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$185.20
|
| Rate for Payer: WellCare Medicare |
$254.65
|
|
|
SCROTOPLASTY COMPLICATED
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 55180
|
| Hospital Charge Code |
4002061
|
|
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 |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
SCROTOPLASTY COMPLICATED
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 55180
|
| Hospital Charge Code |
4002061
|
|
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
|
|
|
SCROTOPLASTY SIMPLE
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 55175
|
| Hospital Charge Code |
4402060
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,022.60 |
| Max. Negotiated Rate |
$7,022.60 |
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
|
|
SCROTOPLASTY SIMPLE
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 55175
|
| Hospital Charge Code |
4402060
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,620.60 |
| Max. Negotiated Rate |
$8,643.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,969.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,321.60
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: CDPHP Medicare |
$3,997.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,673.36
|
| Rate for Payer: EmblemHealth Select Care |
$7,778.88
|
| Rate for Payer: Fidelis Medicare |
$4,321.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,321.60
|
| Rate for Payer: Humana Medicare |
$4,321.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,969.84
|
| Rate for Payer: Multiplan Commercial |
$8,643.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,103.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,082.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,537.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,620.60
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,321.60
|
| Rate for Payer: WellCare Medicare |
$5,942.20
|
|
|
SEAL COHESIVE WAFFER (COLOSTOMY SUPPLY)
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4479196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
SEAL COHESIVE WAFFER (COLOSTOMY SUPPLY)
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4479196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
