|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4650035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/<
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
4650079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/<
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
4650079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: CDPHP Medicare |
$57.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.80
|
| Rate for Payer: EmblemHealth Medicaid |
$124.80
|
| Rate for Payer: EmblemHealth Medicare |
$53.04
|
| Rate for Payer: EmblemHealth Select Care |
$112.32
|
| Rate for Payer: Fidelis Medicare |
$62.40
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.40
|
| Rate for Payer: Humana Medicare |
$62.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$62.40
|
| Rate for Payer: WellCare Medicare |
$85.80
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59)
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,59
|
| Hospital Charge Code |
4650394
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,59
|
| Hospital Charge Code |
4650394
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: CDPHP Medicare |
$57.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.80
|
| Rate for Payer: EmblemHealth Medicaid |
$124.80
|
| Rate for Payer: EmblemHealth Medicare |
$53.04
|
| Rate for Payer: EmblemHealth Select Care |
$112.32
|
| Rate for Payer: Fidelis Medicare |
$62.40
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.40
|
| Rate for Payer: Humana Medicare |
$62.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$62.40
|
| Rate for Payer: WellCare Medicare |
$85.80
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59 W KX)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,59,KX
|
| Hospital Charge Code |
4650446
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: CDPHP Medicare |
$57.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.80
|
| Rate for Payer: EmblemHealth Medicaid |
$124.80
|
| Rate for Payer: EmblemHealth Medicare |
$53.04
|
| Rate for Payer: EmblemHealth Select Care |
$112.32
|
| Rate for Payer: Fidelis Medicare |
$62.40
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.40
|
| Rate for Payer: Humana Medicare |
$62.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$62.40
|
| Rate for Payer: WellCare Medicare |
$85.80
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (MOD 59 W KX)
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,59,KX
|
| Hospital Charge Code |
4650446
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (W/ KX)
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,KX
|
| Hospital Charge Code |
4650342
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
|
|
SLCTV WND DEBRIDEM ADDL 20 CM/< (W/ KX)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 97598 GP,KX
|
| Hospital Charge Code |
4650342
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: CDPHP Medicare |
$57.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.80
|
| Rate for Payer: EmblemHealth Medicaid |
$124.80
|
| Rate for Payer: EmblemHealth Medicare |
$53.04
|
| Rate for Payer: EmblemHealth Select Care |
$112.32
|
| Rate for Payer: Fidelis Medicare |
$62.40
|
| Rate for Payer: Galaxy Health Commercial |
$101.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.40
|
| Rate for Payer: Humana Medicare |
$62.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$62.40
|
| Rate for Payer: WellCare Medicare |
$85.80
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
4002040
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,965.80 |
| Max. Negotiated Rate |
$9,965.80 |
| Rate for Payer: Cash Price |
$11,499.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,965.80
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
4002040
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$12,265.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,052.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,132.80
|
| Rate for Payer: Cash Price |
$11,499.00
|
| Rate for Payer: Cash Price |
$11,499.00
|
| Rate for Payer: CDPHP Medicare |
$5,672.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12,265.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,265.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,265.60
|
| Rate for Payer: EmblemHealth Medicaid |
$12,265.60
|
| Rate for Payer: EmblemHealth Medicare |
$5,212.88
|
| Rate for Payer: EmblemHealth Select Care |
$11,039.04
|
| Rate for Payer: Fidelis Medicare |
$6,132.80
|
| Rate for Payer: Galaxy Health Commercial |
$9,965.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,132.80
|
| Rate for Payer: Humana Medicare |
$6,132.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,052.72
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,499.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,631.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,439.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,299.80
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,132.80
|
| Rate for Payer: WellCare Medicare |
$8,432.60
|
|
|
SLING QUICK RELEASE ARM ENVELOPE LARGE
|
Facility
|
IP
|
$11.33
|
|
| Hospital Charge Code |
4478233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
|
|
SLING QUICK RELEASE ARM ENVELOPE LARGE
|
Facility
|
OP
|
$11.33
|
|
| Hospital Charge Code |
4478233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of NY Commercial |
$7.93
|
| Rate for Payer: Aetna of NY Medicare |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.53
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: CDPHP Medicare |
$4.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.06
|
| Rate for Payer: EmblemHealth Medicaid |
$9.06
|
| Rate for Payer: EmblemHealth Medicare |
$3.85
|
| Rate for Payer: EmblemHealth Select Care |
$8.16
|
| Rate for Payer: Fidelis Medicare |
$4.53
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.53
|
| Rate for Payer: Humana Medicare |
$4.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.70
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WellCare Medicare |
$6.23
|
|
|
SLING QUICK RELEASE ARM ENVELOPE MEDIUM
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4478232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
SLING QUICK RELEASE ARM ENVELOPE MEDIUM
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4478232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
4002042
|
|
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
|
|
|
SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
4002042
|
|
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
|
|
|
SM 153 LEXIDRONAM =< 150 MCI THERA
|
Facility
|
OP
|
$51,780.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
4210084
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$7,767.00 |
| Max. Negotiated Rate |
$41,424.00 |
| Rate for Payer: Aetna of NY Commercial |
$36,246.00
|
| Rate for Payer: Aetna of NY Medicare |
$23,818.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20,712.00
|
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: CDPHP Medicare |
$19,158.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41,424.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41,424.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41,424.00
|
| Rate for Payer: EmblemHealth Medicaid |
$41,424.00
|
| Rate for Payer: EmblemHealth Medicare |
$17,605.20
|
| Rate for Payer: EmblemHealth Select Care |
$37,281.60
|
| Rate for Payer: Fidelis Medicare |
$20,712.00
|
| Rate for Payer: Galaxy Health Commercial |
$33,657.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$20,712.00
|
| Rate for Payer: Humana Medicare |
$20,712.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36,246.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23,818.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38,835.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29,152.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21,747.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28,478.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7,767.00
|
| Rate for Payer: United Healthcare Commercial |
$28,478.75
|
| Rate for Payer: United Healthcare Medicare |
$20,712.00
|
| Rate for Payer: WellCare Medicare |
$28,479.00
|
|
|
SM 153 LEXIDRONAM =< 150 MCI THERA
|
Facility
|
IP
|
$51,780.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
4210084
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$33,657.00 |
| Max. Negotiated Rate |
$33,657.00 |
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: Galaxy Health Commercial |
$33,657.00
|
|
|
SMALL JOINT/BURSA INJ OR ASPIR
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4850029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
SMALL JOINT/BURSA INJ OR ASPIR
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4850029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
SMALL JOINT INJECTION/ASPIRATION
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4609574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| 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 |
$395.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
SMALL JOINT INJECTION/ASPIRATION
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4609574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
SMALL LEFT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.81
|
|
| Hospital Charge Code |
4471570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of NY Commercial |
$19.47
|
| Rate for Payer: Aetna of NY Medicare |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: CDPHP Medicare |
$10.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.25
|
| Rate for Payer: EmblemHealth Medicaid |
$22.25
|
| Rate for Payer: EmblemHealth Medicare |
$9.46
|
| Rate for Payer: EmblemHealth Select Care |
$20.02
|
| Rate for Payer: Fidelis Medicare |
$11.12
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.12
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: WellCare Medicare |
$15.30
|
|
|
SMALL LEFT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.81
|
|
| Hospital Charge Code |
4471570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
|
