|
COLONOSCOPY FLEX ; DX
|
Facility
OP
|
$2,615.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
4851916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$870.81 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,830.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,202.90
|
| 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 |
$967.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.50
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: CDPHP Commercial |
$2,105.08
|
| Rate for Payer: CDPHP Medicare |
$967.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,092.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicare |
$889.10
|
| Rate for Payer: Fidelis Medicare |
$996.58
|
| Rate for Payer: Galaxy Health Commercial |
$1,699.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$967.55
|
| Rate for Payer: Humana Medicare |
$967.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,830.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,202.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,961.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,472.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,015.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$870.81
|
| Rate for Payer: United Healthcare Medicare |
$967.55
|
| Rate for Payer: WellCare Medicare |
$1,438.25
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$870.81 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$870.81
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
OP
|
$2,675.24
|
|
|
Service Code
|
CPT 45390
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,675.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,675.24
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
COLONOSCOPY FLEX W REM LESION BY SNARE
|
Facility
OP
|
$3,377.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
4000359
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,718.48 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,553.42
|
| 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 |
$1,249.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: Cash Price |
$2,532.75
|
| Rate for Payer: CDPHP Commercial |
$2,718.48
|
| Rate for Payer: CDPHP Medicare |
$1,249.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,148.18
|
| Rate for Payer: Fidelis Medicare |
$1,286.97
|
| Rate for Payer: Galaxy Health Commercial |
$2,195.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,249.49
|
| Rate for Payer: Humana Medicare |
$1,249.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,553.42
|
| Rate for Payer: Multiplan Commercial |
$2,701.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,532.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,901.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,311.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,249.49
|
| Rate for Payer: WellCare Medicare |
$1,857.35
|
|
|
COMBIVENT RESPIMAT INHALER (MD
|
Facility
OP
|
$1,184.24
|
|
| Hospital Charge Code |
4409134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$402.64 |
| Max. Negotiated Rate |
$953.31 |
| Rate for Payer: Aetna of NY Commercial |
$828.97
|
| Rate for Payer: Aetna of NY Medicare |
$544.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$888.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$888.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$438.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$592.12
|
| Rate for Payer: Cash Price |
$888.18
|
| Rate for Payer: CDPHP Commercial |
$953.31
|
| Rate for Payer: CDPHP Medicare |
$438.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$947.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$947.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$947.39
|
| Rate for Payer: EmblemHealth Medicaid |
$947.39
|
| Rate for Payer: EmblemHealth Medicare |
$402.64
|
| Rate for Payer: EmblemHealth Select Care |
$852.65
|
| Rate for Payer: Fidelis Medicare |
$451.31
|
| Rate for Payer: Galaxy Health Commercial |
$769.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$438.17
|
| Rate for Payer: Humana Medicare |
$438.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$828.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$544.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$888.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$666.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$460.08
|
| Rate for Payer: United Healthcare Medicare |
$438.17
|
| Rate for Payer: WellCare Medicare |
$651.33
|
|
|
COMPATIBILITY TEST EACH UNIT
|
Facility
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
4300200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$317.85
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$317.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$366.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$162.74
|
| Rate for Payer: United Healthcare Commercial |
$366.75
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
COMPL AUTOM CBC W PLT
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
4300160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Facility
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
4480111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$536.86 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
4856715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.75 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| 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 |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
4300204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CONNECTOR OXYGEN TUBING CONN
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4472140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP
|
| Hospital Charge Code |
4650005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59)
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59
|
| Hospital Charge Code |
4650361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59 W KX)
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59,KX
|
| Hospital Charge Code |
4650413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (W/ KX)
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,KX
|
| Hospital Charge Code |
4650306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
COOLED INTRODUCER (GENERIC) BOX OF 2
|
Facility
OP
|
$203.00
|
|
| Hospital Charge Code |
4479220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna of NY Commercial |
$142.10
|
| Rate for Payer: Aetna of NY Medicare |
$93.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.50
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: CDPHP Commercial |
$163.42
|
| Rate for Payer: CDPHP Medicare |
$75.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$162.40
|
| Rate for Payer: EmblemHealth Medicaid |
$162.40
|
| Rate for Payer: EmblemHealth Medicare |
$69.02
|
| Rate for Payer: EmblemHealth Select Care |
$146.16
|
| Rate for Payer: Fidelis Medicare |
$77.36
|
| Rate for Payer: Galaxy Health Commercial |
$131.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.11
|
| Rate for Payer: Humana Medicare |
$75.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.87
|
| Rate for Payer: United Healthcare Medicare |
$75.11
|
| Rate for Payer: WellCare Medicare |
$111.65
|
|
|
COOLED LUMBAR PROBE LUP-17-100-4
|
Facility
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
COOLIEF RADIOFREQUENCY KIT 75MM
|
Facility
OP
|
$2,313.00
|
|
| Hospital Charge Code |
4473036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$786.42 |
| Max. Negotiated Rate |
$1,861.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,619.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,734.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,734.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$855.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,156.50
|
| Rate for Payer: Cash Price |
$1,734.75
|
| Rate for Payer: CDPHP Commercial |
$1,861.96
|
| Rate for Payer: CDPHP Medicare |
$855.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,850.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,850.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,850.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,850.40
|
| Rate for Payer: EmblemHealth Medicare |
$786.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,665.36
|
| Rate for Payer: Fidelis Medicare |
$881.48
|
| Rate for Payer: Galaxy Health Commercial |
$1,503.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$855.81
|
| Rate for Payer: Humana Medicare |
$855.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,619.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,063.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,734.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,302.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$898.60
|
| Rate for Payer: United Healthcare Medicare |
$855.81
|
| Rate for Payer: WellCare Medicare |
$1,272.15
|
|
|
COOMBS DIRECT
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
4300207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$113.75
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$131.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.74
|
| Rate for Payer: United Healthcare Commercial |
$131.25
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
CORRECTION OF HALLUX VALGUS
|
Facility
OP
|
$9,262.00
|
|
|
Service Code
|
HCPCS 28292
|
| Hospital Charge Code |
4853008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,017.33 |
| Max. Negotiated Rate |
$7,455.91 |
| Rate for Payer: Aetna of NY Commercial |
$6,483.40
|
| Rate for Payer: Aetna of NY Medicare |
$4,260.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,426.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,631.00
|
| Rate for Payer: Cash Price |
$6,946.50
|
| Rate for Payer: Cash Price |
$6,946.50
|
| Rate for Payer: Cash Price |
$6,946.50
|
| Rate for Payer: CDPHP Commercial |
$7,455.91
|
| Rate for Payer: CDPHP Medicare |
$3,426.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,409.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,409.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,409.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,149.08
|
| Rate for Payer: Fidelis Medicare |
$3,529.75
|
| Rate for Payer: Galaxy Health Commercial |
$6,020.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,426.94
|
| Rate for Payer: Humana Medicare |
$3,426.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,483.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,260.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,946.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,214.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,598.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,084.03
|
| Rate for Payer: United Healthcare Medicare |
$3,426.94
|
| Rate for Payer: WellCare Medicare |
$5,094.10
|
|
|
CORTISOL SERUM-PLASMA
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
4300209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$50.72 |
| 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) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| 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: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| 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 |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$47.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$47.25
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
COTTON STOCKINET 3""
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
4471785
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
COTTON STOCKINET 4""
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4471786
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
