|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Hospital Charge Code |
4201085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Hospital Charge Code |
4201085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76981 TC
|
| Hospital Charge Code |
4201084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76981 TC
|
| Hospital Charge Code |
4201084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
ULTRASOUND THERAPY EA 15 MINS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP
|
| Hospital Charge Code |
4650041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND THERAPY EA 15 MINS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP
|
| Hospital Charge Code |
4650041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59
|
| Hospital Charge Code |
4650378
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59
|
| Hospital Charge Code |
4650378
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59,KX
|
| Hospital Charge Code |
4650430
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59,KX
|
| Hospital Charge Code |
4650430
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
ULTRASOUND THERAPY EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,KX
|
| Hospital Charge Code |
4650323
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
ULTRASOUND THERAPY EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,KX
|
| Hospital Charge Code |
4650323
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 76978 TC
|
| Hospital Charge Code |
4201087
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$341.90 |
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
|
|
ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 76978 TC
|
| Hospital Charge Code |
4201087
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$178.84 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$368.20
|
| Rate for Payer: Aetna of NY Medicare |
$241.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$194.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$263.00
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: CDPHP Commercial |
$423.43
|
| Rate for Payer: CDPHP Medicare |
$194.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$368.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$420.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$420.80
|
| Rate for Payer: EmblemHealth Medicaid |
$420.80
|
| Rate for Payer: EmblemHealth Medicare |
$178.84
|
| Rate for Payer: EmblemHealth Select Care |
$341.90
|
| Rate for Payer: Fidelis Medicare |
$200.46
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$194.62
|
| Rate for Payer: Humana Medicare |
$194.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$368.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$241.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$296.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$204.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$194.62
|
| Rate for Payer: WellCare Medicare |
$289.30
|
|
|
ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 76979 TC
|
| Hospital Charge Code |
4201088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$488.15 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Cash Price |
$563.25
|
| Rate for Payer: Galaxy Health Commercial |
$488.15
|
|
|
ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 76979 TC
|
| Hospital Charge Code |
4201088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.34 |
| Max. Negotiated Rate |
$604.56 |
| Rate for Payer: Aetna of NY Commercial |
$525.70
|
| Rate for Payer: Aetna of NY Medicare |
$345.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$563.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$563.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$277.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$375.50
|
| Rate for Payer: Cash Price |
$563.25
|
| Rate for Payer: Cash Price |
$563.25
|
| Rate for Payer: CDPHP Commercial |
$604.56
|
| Rate for Payer: CDPHP Medicare |
$277.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$525.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$600.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$600.80
|
| Rate for Payer: EmblemHealth Medicaid |
$600.80
|
| Rate for Payer: EmblemHealth Medicare |
$255.34
|
| Rate for Payer: EmblemHealth Select Care |
$488.15
|
| Rate for Payer: Fidelis Medicare |
$286.21
|
| Rate for Payer: Galaxy Health Commercial |
$488.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$277.87
|
| Rate for Payer: Humana Medicare |
$277.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$525.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$422.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$291.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$277.87
|
| Rate for Payer: WellCare Medicare |
$413.05
|
|
|
UNIVERSAL ANKLE BRACE
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
4471168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Aetna of NY Commercial |
$30.80
|
| Rate for Payer: Aetna of NY Medicare |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: CDPHP Commercial |
$35.42
|
| Rate for Payer: CDPHP Medicare |
$16.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.20
|
| Rate for Payer: EmblemHealth Medicaid |
$35.20
|
| Rate for Payer: EmblemHealth Medicare |
$14.96
|
| Rate for Payer: EmblemHealth Select Care |
$31.68
|
| Rate for Payer: Fidelis Medicare |
$16.77
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.28
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.09
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WellCare Medicare |
$24.20
|
|
|
UNIVERSAL ANKLE BRACE
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
4471168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
|
|
UNIVERSAL BLOCK TRAY
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
4473037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
UNIVERSAL BLOCK TRAY
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
4473037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
UNIVERSAL STRYKER SAW BLADE
|
Facility
|
OP
|
$143.00
|
|
| Hospital Charge Code |
4471625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Aetna of NY Commercial |
$100.10
|
| Rate for Payer: Aetna of NY Medicare |
$65.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$71.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: CDPHP Commercial |
$115.12
|
| Rate for Payer: CDPHP Medicare |
$52.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$114.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$114.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.40
|
| Rate for Payer: EmblemHealth Medicaid |
$114.40
|
| Rate for Payer: EmblemHealth Medicare |
$48.62
|
| Rate for Payer: EmblemHealth Select Care |
$102.96
|
| Rate for Payer: Fidelis Medicare |
$54.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.91
|
| Rate for Payer: Humana Medicare |
$52.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.56
|
| Rate for Payer: United Healthcare Medicare |
$52.91
|
| Rate for Payer: WellCare Medicare |
$78.65
|
|
|
UNIVERSAL STRYKER SAW BLADE
|
Facility
|
IP
|
$143.00
|
|
| Hospital Charge Code |
4471625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Galaxy Health Commercial |
$92.95
|
|
|
UNLISTED PROCEDURE ABD PERITONEUM
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
4602231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,088.17 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,193.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$959.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,297.00
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: CDPHP Commercial |
$2,088.17
|
| Rate for Payer: CDPHP Medicare |
$959.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$881.96
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$988.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$959.78
|
| Rate for Payer: Humana Medicare |
$959.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,193.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,007.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$959.78
|
| Rate for Payer: WellCare Medicare |
$1,426.70
|
|
|
UNLISTED PROCEDURE ABD PERITONEUM
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
4602231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.10 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
|
|
UNLISTED PROCEDURE CASTING OR STRAPPING
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
4856725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$363.06 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
