|
APPLY SHORT ARM CAST
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
4856679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$685.60 |
| Rate for Payer: Aetna of NY Commercial |
$599.90
|
| Rate for Payer: Aetna of NY Medicare |
$394.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$342.80
|
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: CDPHP Medicare |
$317.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$685.60
|
| Rate for Payer: EmblemHealth Medicaid |
$685.60
|
| Rate for Payer: EmblemHealth Medicare |
$291.38
|
| Rate for Payer: EmblemHealth Select Care |
$617.04
|
| Rate for Payer: Fidelis Medicare |
$342.80
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$342.80
|
| Rate for Payer: Humana Medicare |
$342.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$599.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$394.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$642.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$482.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$359.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$128.55
|
| Rate for Payer: United Healthcare Medicare |
$342.80
|
| Rate for Payer: WellCare Medicare |
$471.35
|
|
|
APPLY SHORT ARM CAST
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
4856679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$557.05 |
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
|
|
APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4856666
|
|
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
|
|
|
APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4856666
|
|
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
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4856664
|
|
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
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4856664
|
|
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
|
|
|
APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
4852015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna of NY Commercial |
$58.80
|
| Rate for Payer: Aetna of NY Medicare |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$33.60
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: CDPHP Medicare |
$31.08
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$67.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$67.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$67.20
|
| Rate for Payer: EmblemHealth Medicaid |
$67.20
|
| Rate for Payer: EmblemHealth Medicare |
$28.56
|
| Rate for Payer: EmblemHealth Select Care |
$60.48
|
| Rate for Payer: Fidelis Medicare |
$33.60
|
| Rate for Payer: Galaxy Health Commercial |
$54.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$33.60
|
| Rate for Payer: Humana Medicare |
$33.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$58.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.60
|
| Rate for Payer: United Healthcare Medicare |
$33.60
|
| Rate for Payer: WellCare Medicare |
$46.20
|
|
|
APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
4852015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Galaxy Health Commercial |
$54.60
|
|
|
AQUACEL DRESSING
|
Facility
|
OP
|
$24.72
|
|
| Hospital Charge Code |
4479298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.89
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.89
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.71
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
AQUACEL DRESSING
|
Facility
|
IP
|
$24.72
|
|
| Hospital Charge Code |
4479298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
|
|
ARIPiprazole 2 MG TABLET 2 mg, 30 eaches
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 904650904
|
| 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 904650904
|
| Hospital Charge Code |
4401303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$22.40 |
| 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) Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$21.00
|
| 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 |
$11.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$11.20
|
| 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 |
$11.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.20
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
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
|
|
|
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 |
$3.00 |
| Max. Negotiated Rate |
$16.00 |
| 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) Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$15.00
|
| 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 |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| 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 |
$8.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
4300100
|
|
Hospital Revenue Code
|
410
|
| 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
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
4300100
|
|
Hospital Revenue Code
|
410
|
| 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
|
|
|
ARTHREX PUMP TUBING (AR-6410)
|
Facility
|
OP
|
$193.64
|
|
| Hospital Charge Code |
4473028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$154.91 |
| Rate for Payer: Aetna of NY Commercial |
$135.55
|
| Rate for Payer: Aetna of NY Medicare |
$89.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$77.46
|
| Rate for Payer: Cash Price |
$145.23
|
| Rate for Payer: CDPHP Medicare |
$71.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.91
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$154.91
|
| Rate for Payer: EmblemHealth Medicaid |
$154.91
|
| Rate for Payer: EmblemHealth Medicare |
$65.84
|
| Rate for Payer: EmblemHealth Select Care |
$139.42
|
| Rate for Payer: Fidelis Medicare |
$77.46
|
| Rate for Payer: Galaxy Health Commercial |
$125.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$77.46
|
| Rate for Payer: Humana Medicare |
$77.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.23
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.05
|
| Rate for Payer: United Healthcare Medicare |
$77.46
|
| Rate for Payer: WellCare Medicare |
$106.50
|
|
|
ARTHREX PUMP TUBING (AR-6410)
|
Facility
|
IP
|
$193.64
|
|
| Hospital Charge Code |
4473028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.87 |
| Max. Negotiated Rate |
$125.87 |
| Rate for Payer: Cash Price |
$145.23
|
| Rate for Payer: Galaxy Health Commercial |
$125.87
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
4609576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| 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 |
$395.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
4609576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
4850031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
4850031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 20611 26
|
| Hospital Charge Code |
5201090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
4201090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
