|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4002005
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4002005
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$509.04
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
4602225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$542.10 |
| Max. Negotiated Rate |
$542.10 |
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Galaxy Health Commercial |
$542.10
|
|
|
BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
4602225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$383.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$308.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$417.00
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: CDPHP Commercial |
$671.37
|
| Rate for Payer: CDPHP Medicare |
$308.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$667.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$667.20
|
| Rate for Payer: EmblemHealth Medicaid |
$667.20
|
| Rate for Payer: EmblemHealth Medicare |
$283.56
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$317.84
|
| Rate for Payer: Galaxy Health Commercial |
$542.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$308.58
|
| Rate for Payer: Humana Medicare |
$308.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$383.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$324.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$277.56
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$308.58
|
| Rate for Payer: WellCare Medicare |
$458.70
|
|
|
BLOOD DRAW FROM PORT
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4304863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$219.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$219.60
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
BLOOD DRAW FROM PORT
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4304863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
BLOOD GAS ANALYSIS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4300131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
BLOOD GAS ANALYSIS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4300131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of NY Commercial |
$65.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Commercial |
$80.50
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: EmblemHealth Select Care |
$60.00
|
| Rate for Payer: Fidelis Medicare |
$38.11
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.00
|
| Rate for Payer: Humana Medicare |
$37.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.85
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$75.00
|
| Rate for Payer: United Healthcare Medicare |
$37.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
BLOOD GAS MIXED WO O2 SAT
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
BLOOD GAS MIXED WO O2 SAT
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of NY Commercial |
$65.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Commercial |
$80.50
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: EmblemHealth Select Care |
$60.00
|
| Rate for Payer: Fidelis Medicare |
$38.11
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.00
|
| Rate for Payer: Humana Medicare |
$37.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.85
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$75.00
|
| Rate for Payer: United Healthcare Medicare |
$37.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
BLOOD TRANSFUSION
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4602028
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
BLOOD TRANSFUSION
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4602028
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
BONE AND/OR JOINT IMAGING LIMITED
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4210004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
BONE AND/OR JOINT IMAGING LIMITED
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4210004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
BONE CEMENT AND MIXER PACK
|
Facility
|
OP
|
$1,152.00
|
|
| Hospital Charge Code |
4478251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.68 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna of NY Commercial |
$806.40
|
| Rate for Payer: Aetna of NY Medicare |
$529.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$426.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$576.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: CDPHP Commercial |
$927.36
|
| Rate for Payer: CDPHP Medicare |
$426.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$576.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$921.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$921.60
|
| Rate for Payer: EmblemHealth Medicaid |
$921.60
|
| Rate for Payer: EmblemHealth Medicare |
$391.68
|
| Rate for Payer: EmblemHealth Select Care |
$576.00
|
| Rate for Payer: Fidelis Medicare |
$439.03
|
| Rate for Payer: Galaxy Health Commercial |
$748.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$426.24
|
| Rate for Payer: Humana Medicare |
$426.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$806.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$529.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$748.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$447.55
|
| Rate for Payer: United Healthcare Medicare |
$426.24
|
| Rate for Payer: WellCare Medicare |
$633.60
|
|
|
BONE CEMENT AND MIXER PACK
|
Facility
|
IP
|
$1,152.00
|
|
| Hospital Charge Code |
4478251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.40 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of NY Commercial |
$806.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$518.40
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$576.00
|
| Rate for Payer: EmblemHealth Select Care |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$748.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$806.40
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$748.80
|
| Rate for Payer: WellCare Medicare |
$633.60
|
|
|
BONE CEMENT PLUS MIXER
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
4471760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.08 |
| Max. Negotiated Rate |
$975.66 |
| Rate for Payer: Aetna of NY Commercial |
$848.40
|
| Rate for Payer: Aetna of NY Medicare |
$557.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$448.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$606.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: CDPHP Commercial |
$975.66
|
| Rate for Payer: CDPHP Medicare |
$448.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$606.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$969.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$969.60
|
| Rate for Payer: EmblemHealth Medicaid |
$969.60
|
| Rate for Payer: EmblemHealth Medicare |
$412.08
|
| Rate for Payer: EmblemHealth Select Care |
$606.00
|
| Rate for Payer: Fidelis Medicare |
$461.89
|
| Rate for Payer: Galaxy Health Commercial |
$787.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$448.44
|
| Rate for Payer: Humana Medicare |
$448.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$848.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$557.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$787.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$787.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$470.86
|
| Rate for Payer: United Healthcare Medicare |
$448.44
|
| Rate for Payer: WellCare Medicare |
$666.60
|
|
|
BONE CEMENT PLUS MIXER
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
4471760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.40 |
| Max. Negotiated Rate |
$848.40 |
| Rate for Payer: Aetna of NY Commercial |
$848.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$545.40
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$606.00
|
| Rate for Payer: EmblemHealth Select Care |
$606.00
|
| Rate for Payer: Galaxy Health Commercial |
$787.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$848.40
|
| Rate for Payer: Multiplan Commercial |
$545.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$787.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$787.80
|
| Rate for Payer: WellCare Medicare |
$666.60
|
|
|
BONE CEMENT W/MIXER KYPHX HV-R
|
Facility
|
IP
|
$767.00
|
|
| Hospital Charge Code |
4471777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.15 |
| Max. Negotiated Rate |
$536.90 |
| Rate for Payer: Aetna of NY Commercial |
$536.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$345.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$345.15
|
| Rate for Payer: Cash Price |
$575.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$383.50
|
| Rate for Payer: EmblemHealth Select Care |
$383.50
|
| Rate for Payer: Galaxy Health Commercial |
$498.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.90
|
| Rate for Payer: Multiplan Commercial |
$345.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$498.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$498.55
|
| Rate for Payer: WellCare Medicare |
$421.85
|
|
|
BONE CEMENT W/MIXER KYPHX HV-R
|
Facility
|
OP
|
$767.00
|
|
| Hospital Charge Code |
4471777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$617.44 |
| Rate for Payer: Aetna of NY Commercial |
$536.90
|
| Rate for Payer: Aetna of NY Medicare |
$352.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$345.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$345.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$283.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$383.50
|
| Rate for Payer: Cash Price |
$575.25
|
| Rate for Payer: CDPHP Commercial |
$617.44
|
| Rate for Payer: CDPHP Medicare |
$283.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$383.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$613.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$613.60
|
| Rate for Payer: EmblemHealth Medicaid |
$613.60
|
| Rate for Payer: EmblemHealth Medicare |
$260.78
|
| Rate for Payer: EmblemHealth Select Care |
$383.50
|
| Rate for Payer: Fidelis Medicare |
$292.30
|
| Rate for Payer: Galaxy Health Commercial |
$498.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$283.79
|
| Rate for Payer: Humana Medicare |
$283.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$498.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$498.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$297.98
|
| Rate for Payer: United Healthcare Medicare |
$283.79
|
| Rate for Payer: WellCare Medicare |
$421.85
|
|
|
BONE FILLER DEVICE - SIZE 2
|
Facility
|
OP
|
$452.00
|
|
| Hospital Charge Code |
4478253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.68 |
| Max. Negotiated Rate |
$363.86 |
| Rate for Payer: Aetna of NY Commercial |
$316.40
|
| Rate for Payer: Aetna of NY Medicare |
$207.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$167.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$226.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: CDPHP Commercial |
$363.86
|
| Rate for Payer: CDPHP Medicare |
$167.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$361.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$361.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$361.60
|
| Rate for Payer: EmblemHealth Medicaid |
$361.60
|
| Rate for Payer: EmblemHealth Medicare |
$153.68
|
| Rate for Payer: EmblemHealth Select Care |
$325.44
|
| Rate for Payer: Fidelis Medicare |
$172.26
|
| Rate for Payer: Galaxy Health Commercial |
$293.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$167.24
|
| Rate for Payer: Humana Medicare |
$167.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$316.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$254.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.60
|
| Rate for Payer: United Healthcare Medicare |
$167.24
|
| Rate for Payer: WellCare Medicare |
$248.60
|
|
|
BONE FILLER DEVICE - SIZE 2
|
Facility
|
IP
|
$452.00
|
|
| Hospital Charge Code |
4478253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Galaxy Health Commercial |
$293.80
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
4210005
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
4210005
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
BORDER STATUS ROOM AND BED SEMI PRIVATE
|
Facility
|
IP
|
$487.00
|
|
| Hospital Charge Code |
1000110
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$316.55 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna of NY Commercial |
$4,918.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,943.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,928.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,484.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,993.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,990.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,577.00
|
| Rate for Payer: Cash Price |
$365.25
|
| Rate for Payer: Cash Price |
$365.25
|
| Rate for Payer: Cash Price |
$365.25
|
| Rate for Payer: Cash Price |
$365.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,993.18
|
| Rate for Payer: CDPHP Commercial |
$3,562.00
|
| Rate for Payer: CDPHP Essential Plan |
$4,484.66
|
| Rate for Payer: CDPHP Medicare |
$1,990.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,729.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,391.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,993.18
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,255.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,825.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$316.55
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,587.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,993.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,990.70
|
| Rate for Payer: Humana Medicare |
$1,990.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,918.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,993.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,284.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,285.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,213.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,090.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,124.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
| Rate for Payer: United Healthcare Commercial |
$4,124.00
|
| Rate for Payer: United Healthcare Medicare |
$1,990.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,993.18
|
| Rate for Payer: WellCare Medicare |
$2,189.77
|
|
