|
WATER STERILE - INJECTION SDV 25X50ML
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 409488750
|
| Hospital Charge Code |
4400811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
WAYNE PNEUMOTHORAX
|
Facility
|
IP
|
$604.61
|
|
| Hospital Charge Code |
4479109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Cash Price |
$453.46
|
| Rate for Payer: Galaxy Health Commercial |
$393.00
|
|
|
WAYNE PNEUMOTHORAX
|
Facility
|
OP
|
$604.61
|
|
| Hospital Charge Code |
4479109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.69 |
| Max. Negotiated Rate |
$483.69 |
| Rate for Payer: Aetna of NY Commercial |
$423.23
|
| Rate for Payer: Aetna of NY Medicare |
$278.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$241.84
|
| Rate for Payer: Cash Price |
$453.46
|
| Rate for Payer: CDPHP Medicare |
$223.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$483.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$483.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$483.69
|
| Rate for Payer: EmblemHealth Medicaid |
$483.69
|
| Rate for Payer: EmblemHealth Medicare |
$205.57
|
| Rate for Payer: EmblemHealth Select Care |
$435.32
|
| Rate for Payer: Fidelis Medicare |
$241.84
|
| Rate for Payer: Galaxy Health Commercial |
$393.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$241.84
|
| Rate for Payer: Humana Medicare |
$241.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$423.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$253.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$90.69
|
| Rate for Payer: United Healthcare Medicare |
$241.84
|
| Rate for Payer: WellCare Medicare |
$332.54
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4609572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| 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 |
$523.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4856705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$996.80 |
| Rate for Payer: Aetna of NY Commercial |
$872.20
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$897.12
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$872.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$934.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$701.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$523.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4856705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4609572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
WEDGING OF CAST NOT CLUBFOOT CAST
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
4850164
|
|
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
|
|
|
WEDGING OF CAST NOT CLUBFOOT CAST
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
4850164
|
|
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
|
|
|
WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
4301197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna of NY Commercial |
$33.15
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$30.60
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
4301197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
WET SKIN PREP TRAY
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4471379
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
WET SKIN PREP TRAY
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4471379
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4650042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4650042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.31
|
| Rate for Payer: EmblemHealth Medicaid |
$42.31
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$41.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$42.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$44.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$44.43
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59
|
| Hospital Charge Code |
4650379
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.31
|
| Rate for Payer: EmblemHealth Medicaid |
$42.31
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$41.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$42.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$44.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$44.43
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59
|
| Hospital Charge Code |
4650379
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59,KX
|
| Hospital Charge Code |
4650431
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59,KX
|
| Hospital Charge Code |
4650431
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.31
|
| Rate for Payer: EmblemHealth Medicaid |
$42.31
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$41.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$42.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$44.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$44.43
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,KX
|
| Hospital Charge Code |
4650324
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.31
|
| Rate for Payer: EmblemHealth Medicaid |
$42.31
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$41.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$42.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$44.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$90.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$44.43
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,KX
|
| Hospital Charge Code |
4650324
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHFO W/JOINT(S) CUSTOM FAB
|
Facility
|
OP
|
$1,300.89
|
|
|
Service Code
|
HCPCS L3806
|
| Hospital Charge Code |
4690163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,040.71 |
| Rate for Payer: Aetna of NY Commercial |
$910.62
|
| Rate for Payer: Aetna of NY Medicare |
$598.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$520.36
|
| Rate for Payer: Cash Price |
$975.67
|
| Rate for Payer: CDPHP Medicare |
$481.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$650.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,040.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,040.71
|
| Rate for Payer: EmblemHealth Medicaid |
$1,040.71
|
| Rate for Payer: EmblemHealth Medicare |
$442.30
|
| Rate for Payer: EmblemHealth Select Care |
$650.45
|
| Rate for Payer: Fidelis Medicare |
$520.36
|
| Rate for Payer: Galaxy Health Commercial |
$845.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$520.36
|
| Rate for Payer: Humana Medicare |
$520.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$910.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$598.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$975.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$732.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$546.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$195.13
|
| Rate for Payer: United Healthcare Medicare |
$520.36
|
| Rate for Payer: WellCare Medicare |
$715.49
|
|
|
WHFO W/JOINT(S) CUSTOM FAB
|
Facility
|
IP
|
$1,300.89
|
|
|
Service Code
|
HCPCS L3806
|
| Hospital Charge Code |
4690163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$585.40 |
| Max. Negotiated Rate |
$845.58 |
| Rate for Payer: Cash Price |
$975.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$650.45
|
| Rate for Payer: EmblemHealth Select Care |
$650.45
|
| Rate for Payer: Galaxy Health Commercial |
$845.58
|
| Rate for Payer: Multiplan Commercial |
$585.40
|
| Rate for Payer: WellCare Medicare |
$715.49
|
|
|
WHFO W/O JOINTS PRE CST
|
Facility
|
IP
|
$717.91
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
4690167
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$323.06 |
| Max. Negotiated Rate |
$466.64 |
| Rate for Payer: Cash Price |
$538.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$358.95
|
| Rate for Payer: EmblemHealth Select Care |
$358.95
|
| Rate for Payer: Galaxy Health Commercial |
$466.64
|
| Rate for Payer: Multiplan Commercial |
$323.06
|
| Rate for Payer: WellCare Medicare |
$394.85
|
|
|
WHFO W/O JOINTS PRE CST
|
Facility
|
OP
|
$717.91
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
4690167
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$574.33 |
| Rate for Payer: Aetna of NY Commercial |
$502.54
|
| Rate for Payer: Aetna of NY Medicare |
$330.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$287.16
|
| Rate for Payer: Cash Price |
$538.43
|
| Rate for Payer: CDPHP Medicare |
$265.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$358.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$574.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$574.33
|
| Rate for Payer: EmblemHealth Medicaid |
$574.33
|
| Rate for Payer: EmblemHealth Medicare |
$244.09
|
| Rate for Payer: EmblemHealth Select Care |
$358.95
|
| Rate for Payer: Fidelis Medicare |
$287.16
|
| Rate for Payer: Galaxy Health Commercial |
$466.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$287.16
|
| Rate for Payer: Humana Medicare |
$287.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$502.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$330.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$404.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$301.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.69
|
| Rate for Payer: United Healthcare Medicare |
$287.16
|
| Rate for Payer: WellCare Medicare |
$394.85
|
|
