|
BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
OP
|
$973.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
4602225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.95 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$447.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$389.20
|
| Rate for Payer: Cash Price |
$729.75
|
| Rate for Payer: Cash Price |
$729.75
|
| Rate for Payer: Cash Price |
$729.75
|
| Rate for Payer: CDPHP Medicare |
$360.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$778.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$778.40
|
| Rate for Payer: EmblemHealth Medicaid |
$778.40
|
| Rate for Payer: EmblemHealth Medicare |
$330.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$389.20
|
| Rate for Payer: Galaxy Health Commercial |
$632.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$389.20
|
| Rate for Payer: Humana Medicare |
$389.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$447.58
|
| 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 |
$408.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$145.95
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$389.20
|
| Rate for Payer: WellCare Medicare |
$535.15
|
|
|
BLOOD DRAW FROM PORT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4304863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$244.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$244.80
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$306.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
BLOOD DRAW FROM PORT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4304863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
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 |
$15.00 |
| Max. Negotiated Rate |
$80.00 |
| 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) Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$75.00
|
| 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 |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| 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 |
$42.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$75.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
BLOOD GAS MIXED WO O2 SAT
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Galaxy Health Commercial |
$50.70
|
|
|
BLOOD GAS MIXED WO O2 SAT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna of NY Commercial |
$50.70
|
| Rate for Payer: Aetna of NY Medicare |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.20
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: CDPHP Medicare |
$28.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$62.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$62.40
|
| Rate for Payer: EmblemHealth Medicaid |
$62.40
|
| Rate for Payer: EmblemHealth Medicare |
$26.52
|
| Rate for Payer: EmblemHealth Select Care |
$46.80
|
| Rate for Payer: Fidelis Medicare |
$31.20
|
| Rate for Payer: Galaxy Health Commercial |
$50.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.20
|
| Rate for Payer: Humana Medicare |
$31.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$58.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.70
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
| Rate for Payer: WellCare Medicare |
$42.90
|
|
|
BLOOD TRANSFUSION
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4602028
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Aetna of NY Commercial |
$946.40
|
| Rate for Payer: Aetna of NY Medicare |
$621.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$540.80
|
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: CDPHP Medicare |
$500.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$676.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,081.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,081.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,081.60
|
| Rate for Payer: EmblemHealth Medicare |
$459.68
|
| Rate for Payer: EmblemHealth Select Care |
$676.00
|
| Rate for Payer: Fidelis Medicare |
$540.80
|
| Rate for Payer: Galaxy Health Commercial |
$878.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$540.80
|
| Rate for Payer: Humana Medicare |
$540.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$946.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$621.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,014.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$761.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$567.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,014.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$202.80
|
| Rate for Payer: United Healthcare Commercial |
$1,014.00
|
| Rate for Payer: United Healthcare Medicare |
$540.80
|
| Rate for Payer: WellCare Medicare |
$743.60
|
|
|
BLOOD TRANSFUSION
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4602028
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$878.80 |
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$676.00
|
| Rate for Payer: EmblemHealth Select Care |
$676.00
|
| Rate for Payer: Galaxy Health Commercial |
$878.80
|
| Rate for Payer: WellCare Medicare |
$743.60
|
|
|
BONE AND/OR JOIN IMAGING LIMITED
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 78300 26
|
| Hospital Charge Code |
5210004
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna of NY Commercial |
$63.70
|
| Rate for Payer: Aetna of NY Medicare |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.40
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: CDPHP Medicare |
$33.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.80
|
| Rate for Payer: EmblemHealth Medicaid |
$72.80
|
| Rate for Payer: EmblemHealth Medicare |
$30.94
|
| Rate for Payer: Fidelis Medicare |
$36.40
|
| Rate for Payer: Galaxy Health Commercial |
$59.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.40
|
| Rate for Payer: Humana Medicare |
$36.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.65
|
| Rate for Payer: United Healthcare Medicare |
$36.40
|
| Rate for Payer: WellCare Medicare |
$50.05
|
|
|
BONE AND/OR JOIN IMAGING LIMITED
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 78300 26
|
| Hospital Charge Code |
5210004
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Galaxy Health Commercial |
$59.15
|
|
|
BONE AND/OR JOINT IMAGING LIMITED
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4210004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
BONE AND/OR JOINT IMAGING LIMITED
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4210004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
BONE CEMENT AND MIXER PACK
|
Facility
|
IP
|
$1,186.56
|
|
| Hospital Charge Code |
4478251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.95 |
| Max. Negotiated Rate |
$830.59 |
| Rate for Payer: Aetna of NY Commercial |
$830.59
|
| Rate for Payer: Cash Price |
$889.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$593.28
|
| Rate for Payer: EmblemHealth Select Care |
$593.28
|
| Rate for Payer: Galaxy Health Commercial |
$771.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$830.59
|
| Rate for Payer: Multiplan Commercial |
$533.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$771.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$771.26
|
| Rate for Payer: WellCare Medicare |
$652.61
|
|
|
BONE CEMENT AND MIXER PACK
|
Facility
|
OP
|
$1,186.56
|
|
| Hospital Charge Code |
4478251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.98 |
| Max. Negotiated Rate |
$949.25 |
| Rate for Payer: Aetna of NY Commercial |
$830.59
|
| Rate for Payer: Aetna of NY Medicare |
$545.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$474.62
|
| Rate for Payer: Cash Price |
$889.92
|
| Rate for Payer: CDPHP Medicare |
$439.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$593.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$949.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$949.25
|
| Rate for Payer: EmblemHealth Medicaid |
$949.25
|
| Rate for Payer: EmblemHealth Medicare |
$403.43
|
| Rate for Payer: EmblemHealth Select Care |
$593.28
|
| Rate for Payer: Fidelis Medicare |
$474.62
|
| Rate for Payer: Galaxy Health Commercial |
$771.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$474.62
|
| Rate for Payer: Humana Medicare |
$474.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$830.59
|
| Rate for Payer: Local 1199SEIU Medicare |
$545.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$771.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$771.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$498.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$177.98
|
| Rate for Payer: United Healthcare Medicare |
$474.62
|
| Rate for Payer: WellCare Medicare |
$652.61
|
|
|
BONE CEMENT PLUS MIXER
|
Facility
|
IP
|
$1,248.36
|
|
| Hospital Charge Code |
4471760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.76 |
| Max. Negotiated Rate |
$873.85 |
| Rate for Payer: Aetna of NY Commercial |
$873.85
|
| Rate for Payer: Cash Price |
$936.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$624.18
|
| Rate for Payer: EmblemHealth Select Care |
$624.18
|
| Rate for Payer: Galaxy Health Commercial |
$811.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$873.85
|
| Rate for Payer: Multiplan Commercial |
$561.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$811.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$811.43
|
| Rate for Payer: WellCare Medicare |
$686.60
|
|
|
BONE CEMENT PLUS MIXER
|
Facility
|
OP
|
$1,248.36
|
|
| Hospital Charge Code |
4471760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$998.69 |
| Rate for Payer: Aetna of NY Commercial |
$873.85
|
| Rate for Payer: Aetna of NY Medicare |
$574.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$499.34
|
| Rate for Payer: Cash Price |
$936.27
|
| Rate for Payer: CDPHP Medicare |
$461.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$624.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$998.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$998.69
|
| Rate for Payer: EmblemHealth Medicaid |
$998.69
|
| Rate for Payer: EmblemHealth Medicare |
$424.44
|
| Rate for Payer: EmblemHealth Select Care |
$624.18
|
| Rate for Payer: Fidelis Medicare |
$499.34
|
| Rate for Payer: Galaxy Health Commercial |
$811.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$499.34
|
| Rate for Payer: Humana Medicare |
$499.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$873.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$574.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$811.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$811.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$524.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$187.25
|
| Rate for Payer: United Healthcare Medicare |
$499.34
|
| Rate for Payer: WellCare Medicare |
$686.60
|
|
|
BONE CEMENT W/MIXER KYPHX HV-R
|
Facility
|
OP
|
$790.01
|
|
| Hospital Charge Code |
4471777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$632.01 |
| Rate for Payer: Aetna of NY Commercial |
$553.01
|
| Rate for Payer: Aetna of NY Medicare |
$363.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$316.00
|
| Rate for Payer: Cash Price |
$592.51
|
| Rate for Payer: CDPHP Medicare |
$292.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$395.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$632.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$632.01
|
| Rate for Payer: EmblemHealth Medicaid |
$632.01
|
| Rate for Payer: EmblemHealth Medicare |
$268.60
|
| Rate for Payer: EmblemHealth Select Care |
$395.00
|
| Rate for Payer: Fidelis Medicare |
$316.00
|
| Rate for Payer: Galaxy Health Commercial |
$513.51
|
| Rate for Payer: Hamaspik Choice Medicare |
$316.00
|
| Rate for Payer: Humana Medicare |
$316.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$553.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$363.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$513.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$331.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.50
|
| Rate for Payer: United Healthcare Medicare |
$316.00
|
| Rate for Payer: WellCare Medicare |
$434.51
|
|
|
BONE CEMENT W/MIXER KYPHX HV-R
|
Facility
|
IP
|
$790.01
|
|
| Hospital Charge Code |
4471777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$553.01 |
| Rate for Payer: Aetna of NY Commercial |
$553.01
|
| Rate for Payer: Cash Price |
$592.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$395.00
|
| Rate for Payer: EmblemHealth Select Care |
$395.00
|
| Rate for Payer: Galaxy Health Commercial |
$513.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$553.01
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$513.51
|
| Rate for Payer: WellCare Medicare |
$434.51
|
|
|
BONE FILLER DEVICE - SIZE 2
|
Facility
|
IP
|
$465.56
|
|
| Hospital Charge Code |
4478253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.61 |
| Max. Negotiated Rate |
$302.61 |
| Rate for Payer: Cash Price |
$349.17
|
| Rate for Payer: Galaxy Health Commercial |
$302.61
|
|
|
BONE FILLER DEVICE - SIZE 2
|
Facility
|
OP
|
$465.56
|
|
| Hospital Charge Code |
4478253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna of NY Commercial |
$325.89
|
| Rate for Payer: Aetna of NY Medicare |
$214.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$186.22
|
| Rate for Payer: Cash Price |
$349.17
|
| Rate for Payer: CDPHP Medicare |
$172.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$372.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$372.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$372.45
|
| Rate for Payer: EmblemHealth Medicaid |
$372.45
|
| Rate for Payer: EmblemHealth Medicare |
$158.29
|
| Rate for Payer: EmblemHealth Select Care |
$335.20
|
| Rate for Payer: Fidelis Medicare |
$186.22
|
| Rate for Payer: Galaxy Health Commercial |
$302.61
|
| Rate for Payer: Hamaspik Choice Medicare |
$186.22
|
| Rate for Payer: Humana Medicare |
$186.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$325.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$214.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.17
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$262.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$195.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$69.83
|
| Rate for Payer: United Healthcare Medicare |
$186.22
|
| Rate for Payer: WellCare Medicare |
$256.06
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 78306 26
|
| Hospital Charge Code |
5210005
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$99.20 |
| Rate for Payer: Aetna of NY Commercial |
$86.80
|
| Rate for Payer: Aetna of NY Medicare |
$57.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: CDPHP Medicare |
$45.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$99.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$99.20
|
| Rate for Payer: EmblemHealth Medicaid |
$99.20
|
| Rate for Payer: EmblemHealth Medicare |
$42.16
|
| Rate for Payer: Fidelis Medicare |
$49.60
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.60
|
| Rate for Payer: Humana Medicare |
$49.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$69.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.60
|
| Rate for Payer: United Healthcare Medicare |
$49.60
|
| Rate for Payer: WellCare Medicare |
$68.20
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 78306 26
|
| Hospital Charge Code |
5210005
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
4210005
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
BONE SCAN-WHOLE BODY
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
4210005
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
