|
ANTI-NUCLEAR ANTIBODY SC
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
4300084
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
ANTI-NUCLEAR ANTIBODY SC
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
4300084
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
ANTISTREPTOLYSIN O TITER
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
4300090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
ANTISTREPTOLYSIN O TITER
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
4300090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna of NY Commercial |
$14.30
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.20
|
| Rate for Payer: Fidelis Medicare |
$8.80
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.80
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$16.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
ANTITHROMBIN III
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
4300092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$19.20
|
| Rate for Payer: Fidelis Medicare |
$12.80
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.80
|
| Rate for Payer: Humana Medicare |
$12.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ANTITHROMBIN III
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
4300092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
ANTI-THROMBIN III ACTIVITY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
4300094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
ANTI-THROMBIN III ACTIVITY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
4300094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
APHASIA ASSESSMENT PER HOUR
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN
|
| Hospital Charge Code |
4670005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$250.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$143.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.20
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: CDPHP Medicare |
$115.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$250.40
|
| Rate for Payer: EmblemHealth Medicare |
$106.42
|
| Rate for Payer: EmblemHealth Select Care |
$225.36
|
| Rate for Payer: Fidelis Medicare |
$125.20
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.20
|
| Rate for Payer: Humana Medicare |
$125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.98
|
| 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 |
$131.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$125.20
|
| Rate for Payer: WellCare Medicare |
$172.15
|
|
|
APHASIA ASSESSMENT PER HOUR
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN
|
| Hospital Charge Code |
4670005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$203.45 |
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59)
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,59
|
| Hospital Charge Code |
4670283
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$203.45 |
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59)
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,59
|
| Hospital Charge Code |
4670283
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$250.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$143.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.20
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: CDPHP Medicare |
$115.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$250.40
|
| Rate for Payer: EmblemHealth Medicare |
$106.42
|
| Rate for Payer: EmblemHealth Select Care |
$225.36
|
| Rate for Payer: Fidelis Medicare |
$125.20
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.20
|
| Rate for Payer: Humana Medicare |
$125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.98
|
| 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 |
$131.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$125.20
|
| Rate for Payer: WellCare Medicare |
$172.15
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59 W KX)
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,59,KX
|
| Hospital Charge Code |
4670299
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$203.45 |
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
|
|
APHASIA ASSESSMENT PER HOUR (MOD 59 W KX)
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,59,KX
|
| Hospital Charge Code |
4670299
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$250.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$143.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.20
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: CDPHP Medicare |
$115.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$250.40
|
| Rate for Payer: EmblemHealth Medicare |
$106.42
|
| Rate for Payer: EmblemHealth Select Care |
$225.36
|
| Rate for Payer: Fidelis Medicare |
$125.20
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.20
|
| Rate for Payer: Humana Medicare |
$125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.98
|
| 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 |
$131.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$125.20
|
| Rate for Payer: WellCare Medicare |
$172.15
|
|
|
APHASIA ASSESSMENT PER HOUR (W/ KX)
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,KX
|
| Hospital Charge Code |
4670261
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$203.45 |
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
|
|
APHASIA ASSESSMENT PER HOUR (W/ KX)
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 96105 GN,KX
|
| Hospital Charge Code |
4670261
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$250.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$143.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.20
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: Cash Price |
$234.75
|
| Rate for Payer: CDPHP Medicare |
$115.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$250.40
|
| Rate for Payer: EmblemHealth Medicare |
$106.42
|
| Rate for Payer: EmblemHealth Select Care |
$225.36
|
| Rate for Payer: Fidelis Medicare |
$125.20
|
| Rate for Payer: Galaxy Health Commercial |
$203.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.20
|
| Rate for Payer: Humana Medicare |
$125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.98
|
| 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 |
$131.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$125.20
|
| Rate for Payer: WellCare Medicare |
$172.15
|
|
|
APOLIPOPROTEIN A-1
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
4300096
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
APOLIPOPROTEIN A-1
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
4300096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of NY Commercial |
$40.95
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.20
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.80
|
| 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 |
$37.80
|
| Rate for Payer: Fidelis Medicare |
$25.20
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$47.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.45
|
| Rate for Payer: United Healthcare Commercial |
$47.25
|
| Rate for Payer: United Healthcare Medicare |
$25.20
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4856663
|
|
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
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4856663
|
|
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
|
|
|
APPLICATION-LONG ARM SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4600028
|
|
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
|
|
|
APPLICATION-LONG ARM SPLINT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4600028
|
|
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
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4600016
|
|
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
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4600016
|
|
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
|
|
|
APPLICATION SHORT LEG SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4600018
|
|
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
|
|
