|
UNLISTED PROCEDURE CASTING OR STRAPPING
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
4856725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
|
|
UNLISTED PROCEDURE FEMUR/KNEE
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
4853042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
UNLISTED PROCEDURE FEMUR/KNEE
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
4853042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$543.38 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$486.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
UNLISTED PROCEDURE, FOOT OR TOES
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 28899
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
UNLISTED PROCEDURE, NERVOUS SYSTEM
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 64999
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
UNLISTED REHAB MODALITY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 97039 GO
|
| Hospital Charge Code |
4690268
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Galaxy Health Commercial |
$78.00
|
|
|
UNLISTED REHAB MODALITY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 97039 GO
|
| Hospital Charge Code |
4690268
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: CDPHP Commercial |
$96.60
|
| Rate for Payer: CDPHP Medicare |
$44.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$96.00
|
| Rate for Payer: EmblemHealth Medicaid |
$96.00
|
| Rate for Payer: EmblemHealth Medicare |
$40.80
|
| Rate for Payer: EmblemHealth Select Care |
$86.40
|
| Rate for Payer: Fidelis Medicare |
$45.73
|
| Rate for Payer: Galaxy Health Commercial |
$78.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.40
|
| Rate for Payer: Humana Medicare |
$44.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$55.20
|
| 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 |
$46.62
|
| 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 |
$44.40
|
| Rate for Payer: WellCare Medicare |
$66.00
|
|
|
UNNA BOOT STRAPPING
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29580 GP
|
| Hospital Charge Code |
4650284
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$363.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| 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 |
$108.00
|
| Rate for Payer: Cash Price |
$338.25
|
| 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 |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| 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 |
$175.21
|
| 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 |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
UNNA BOOT STRAPPING
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29580 GP
|
| Hospital Charge Code |
4650284
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
|
|
UNNA BOOT STRAPPING
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
4855440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| 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 |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| 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: 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
|
|
|
UNNA BOOT STRAPPING
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
4855440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
|
|
UNNA BOOT WITH CALAMINE 4"
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
4471478
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
UNNA BOOT WITH CALAMINE 4"
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
4471478
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$13.30
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$13.68
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
UPPER EXTREMITY PACK
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
4479183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$90.96 |
| 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) Blue Access/Small Group |
$84.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$84.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$56.50
|
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: CDPHP Commercial |
$90.96
|
| Rate for Payer: CDPHP Medicare |
$41.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$90.40
|
| 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: EmblemHealth Select Care |
$81.36
|
| Rate for Payer: Fidelis Medicare |
$43.06
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$41.81
|
| Rate for Payer: Humana Medicare |
$41.81
|
| 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 |
$43.90
|
| Rate for Payer: United Healthcare Medicare |
$41.81
|
| Rate for Payer: WellCare Medicare |
$62.15
|
|
|
UPPER EXTREMITY PACK
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
4479183
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
UPR/LXTR ART STDY 3+ LVLS
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
4201052
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$290.55
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$223.50
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$312.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$290.55
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$290.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$72.72
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
UPR/LXTR ART STDY 3+ LVLS
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
4201052
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
4201051
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$237.90
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$72.72
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
4201051
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
UREA NITROGEN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
4300804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
UREA NITROGEN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
4300804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.95
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 53450
|
| Hospital Charge Code |
4002039
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 53450
|
| Hospital Charge Code |
4002039
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
URIC ACID; BLOOD
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
4301202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.52
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
URIC ACID; BLOOD
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
4301202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
