|
APPLY FINGER CAST
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29086 TC
|
| Hospital Charge Code |
4850126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.34 |
| 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: 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 Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
APPLY FINGER SPLINT; STATIC
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
4650064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$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: 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 |
$292.80
|
| 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 |
$263.52
|
| 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 |
$256.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
APPLY FINGER SPLINT; STATIC
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
4650064
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
APPLY MULTILAYER COMPRESS - LOWER LEG
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29581 GP
|
| Hospital Charge Code |
4650283
|
|
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
|
|
|
APPLY MULTILAYER COMPRESS - LOWER LEG
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29581 GP
|
| Hospital Charge Code |
4650283
|
|
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
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4851926
|
|
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
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4851926
|
|
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
|
|
|
APPLY SH LEG CAST
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
4856677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
|
|
APPLY SH LEG CAST
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
4856677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| 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 |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: EmblemHealth Select Care |
$552.96
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
APPLY SHORT ARM CAST
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
4856679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
|
|
APPLY SHORT ARM CAST
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
4856679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| 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 |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: EmblemHealth Select Care |
$552.96
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4856666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$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: 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 |
$292.80
|
| 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 |
$263.52
|
| 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 |
$256.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4856666
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4856664
|
|
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
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4856664
|
|
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
|
|
|
APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
4852015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
|
|
APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
4852015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$144.20
|
| Rate for Payer: Aetna of NY Medicare |
$94.76
|
| 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 |
$76.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$103.00
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: CDPHP Commercial |
$165.83
|
| Rate for Payer: CDPHP Medicare |
$76.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.80
|
| Rate for Payer: EmblemHealth Medicaid |
$164.80
|
| Rate for Payer: EmblemHealth Medicare |
$70.04
|
| Rate for Payer: EmblemHealth Select Care |
$148.32
|
| Rate for Payer: Fidelis Medicare |
$78.51
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.22
|
| Rate for Payer: Humana Medicare |
$76.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$144.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$115.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.64
|
| Rate for Payer: United Healthcare Medicare |
$76.22
|
| Rate for Payer: WellCare Medicare |
$113.30
|
|
|
AQUACEL DRESSING
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
4479298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
AQUACEL DRESSING
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
4479298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
ARIPiprazole 2 MG TABLET 2 mg, 30 eaches
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 00904650904
|
| Hospital Charge Code |
4401303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
ARIPiprazole 2 MG TABLET 2 mg, 30 eaches
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 00904650904
|
| Hospital Charge Code |
4401303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Commercial |
$22.54
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$20.16
|
| Rate for Payer: Fidelis Medicare |
$10.67
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
| Rate for Payer: Humana Medicare |
$10.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
ARIPiprazole 5 MG TABLET 5 mg, 50 eaches
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 50268008815
|
| Hospital Charge Code |
4401304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.00
|
| 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: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
| 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 |
$14.40
|
| 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 |
$14.00
|
| 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: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
ARIPiprazole 5 MG TABLET 5 mg, 50 eaches
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 50268008815
|
| Hospital Charge Code |
4401304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
4300100
|
|
Hospital Revenue Code
|
410
|
| 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
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
4300100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| 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 |
$292.80
|
| 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 |
$263.52
|
| 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 |
$256.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
