|
STOCKINETTE,IMPERVIOUS,LARGE
|
Facility
|
OP
|
$10.30
|
|
| Hospital Charge Code |
4471165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.12
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
| Rate for Payer: WellCare Medicare |
$5.67
|
|
|
STRAP ANKLE OR FOOT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4856675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
STRAP ANKLE OR FOOT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4856675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
STRAPPING ANKLE
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4600156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
STRAPPING ANKLE
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4600156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| 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 |
$209.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
STRAPPING ELBOW
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
4856662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
STRAPPING ELBOW
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
4856662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
STRAPPING; HAND OR FINGER
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
4852002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
STRAPPING; HAND OR FINGER
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
4852002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
STRAPPING KNEE
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
4852011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
STRAPPING KNEE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
4852011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
STRAPPING OF TOES
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4850251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
STRAPPING OF TOES
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4850251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
STRAPPING; SHOULDER
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4856670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
STRAPPING; SHOULDER
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4856670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
STRAPPING UNNA BOOT CLINIC
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
4856660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
STRAPPING UNNA BOOT CLINIC
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
4856660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
STREP A AG EIA
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
4301213
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
STREP A AG EIA
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
4301213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| 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 |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| 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 |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
STREP SERO GROUP
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
4301094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
STREP SERO GROUP
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
4301094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Aetna of NY Commercial |
$10.40
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$9.60
|
| Rate for Payer: Fidelis Medicare |
$6.40
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.40
|
| Rate for Payer: Humana Medicare |
$6.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$6.40
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
STRESS TTE ONLY
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
4480010
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,088.75 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
|
|
STRESS TTE ONLY
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
4480010
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,088.75
|
| Rate for Payer: Aetna of NY Medicare |
$770.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.00
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: CDPHP Medicare |
$619.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,172.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicare |
$569.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,088.75
|
| Rate for Payer: Fidelis Medicare |
$670.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.00
|
| Rate for Payer: Humana Medicare |
$670.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,088.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$770.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$943.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,256.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$251.25
|
| Rate for Payer: United Healthcare Commercial |
$1,256.25
|
| Rate for Payer: United Healthcare Medicare |
$670.00
|
| Rate for Payer: WellCare Medicare |
$921.25
|
|
|
STRIP IODOFORM PAC 1/2X5YD
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4471650
|
|
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
|
|
|
STRIP IODOFORM PAC 1/2X5YD
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4471650
|
|
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
|
|
