|
BORDER STATUS ROOM AND BED SEMI PRIVATE
|
Facility
|
IP
|
$624.00
|
|
| Hospital Charge Code |
1000110
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$4,871.00 |
| Rate for Payer: Aetna of NY Commercial |
$4,200.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,414.28
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: CDPHP Medicare |
$2,414.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,871.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,361.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicaid |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,383.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$405.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,874.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,967.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,414.28
|
| Rate for Payer: Humana Medicare |
$2,414.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,200.00
|
| 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 |
$1,967.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,370.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,277.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,534.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,248.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
| Rate for Payer: United Healthcare Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare Medicare |
$2,414.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,967.85
|
| Rate for Payer: WellCare Medicare |
$2,414.28
|
|
|
BORDETELLA PERTUSSIS NASOPHARYNGEAL CULT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4304871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
BORDETELLA PERTUSSIS NASOPHARYNGEAL CULT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4304871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
BOSTON SCIENTIFIC CHARGING KIT SC64123
|
Facility
|
IP
|
$8,904.35
|
|
| Hospital Charge Code |
4479091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.96 |
| Max. Negotiated Rate |
$6,233.05 |
| Rate for Payer: Aetna of NY Commercial |
$6,233.05
|
| Rate for Payer: Cash Price |
$6,678.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,452.18
|
| Rate for Payer: EmblemHealth Select Care |
$4,452.18
|
| Rate for Payer: Galaxy Health Commercial |
$5,787.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,233.05
|
| Rate for Payer: Multiplan Commercial |
$4,006.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,787.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,787.83
|
| Rate for Payer: WellCare Medicare |
$4,897.39
|
|
|
BOSTON SCIENTIFIC CHARGING KIT SC64123
|
Facility
|
OP
|
$8,904.35
|
|
| Hospital Charge Code |
4479091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.65 |
| Max. Negotiated Rate |
$7,123.48 |
| Rate for Payer: Aetna of NY Commercial |
$6,233.05
|
| Rate for Payer: Aetna of NY Medicare |
$4,096.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,561.74
|
| Rate for Payer: Cash Price |
$6,678.26
|
| Rate for Payer: CDPHP Medicare |
$3,294.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,452.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,123.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,123.48
|
| Rate for Payer: EmblemHealth Medicaid |
$7,123.48
|
| Rate for Payer: EmblemHealth Medicare |
$3,027.48
|
| Rate for Payer: EmblemHealth Select Care |
$4,452.18
|
| Rate for Payer: Fidelis Medicare |
$3,561.74
|
| Rate for Payer: Galaxy Health Commercial |
$5,787.83
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,561.74
|
| Rate for Payer: Humana Medicare |
$3,561.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,233.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,096.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,787.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,787.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,739.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,335.65
|
| Rate for Payer: United Healthcare Medicare |
$3,561.74
|
| Rate for Payer: WellCare Medicare |
$4,897.39
|
|
|
BOTOX 200 UNIT VIAL 200 unit, 1 each
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
4401941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna of NY Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.51
|
| Rate for Payer: EmblemHealth Select Care |
$6.51
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.65
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
BOTOX 200 UNIT VIAL 200 unit, 1 each
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
4401941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$6.51
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$10.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Commercial |
$10.54
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
BOXER SPLINT LRG LT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4479017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BOXER SPLINT LRG LT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4479017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT LRG RT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4470916
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BOXER SPLINT LRG RT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4470916
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT MED LT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4470915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BOXER SPLINT MED LT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4470915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT MED RT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4470914
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BOXER SPLINT MED RT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4470914
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT SMALL LT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4470913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT SMALL LT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4470913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BOXER SPLINT SMALL RT
|
Facility
|
IP
|
$52.53
|
|
| Hospital Charge Code |
4470912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
|
|
BOXER SPLINT SMALL RT
|
Facility
|
OP
|
$52.53
|
|
| Hospital Charge Code |
4470912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna of NY Commercial |
$36.77
|
| Rate for Payer: Aetna of NY Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: CDPHP Medicare |
$19.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.02
|
| Rate for Payer: EmblemHealth Medicaid |
$42.02
|
| Rate for Payer: EmblemHealth Medicare |
$17.86
|
| Rate for Payer: EmblemHealth Select Care |
$37.82
|
| Rate for Payer: Fidelis Medicare |
$21.01
|
| Rate for Payer: Galaxy Health Commercial |
$34.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.01
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$21.01
|
| Rate for Payer: WellCare Medicare |
$28.89
|
|
|
BRAIN IMAGE W/FLOW 4 + VIEWS
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
4210087
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
|
|
BRAIN IMAGE W/FLOW 4 + VIEWS
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
4210087
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,164.80
|
| Rate for Payer: Aetna of NY Medicare |
$765.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$665.60
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: CDPHP Medicare |
$615.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,331.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,331.20
|
| Rate for Payer: EmblemHealth Medicare |
$565.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,081.60
|
| Rate for Payer: Fidelis Medicare |
$665.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,081.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.60
|
| Rate for Payer: Humana Medicare |
$665.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,164.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$765.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,248.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$936.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$665.60
|
| Rate for Payer: WellCare Medicare |
$915.20
|
|
|
BRAIN IMAGE W/FLOW 4+ VIEWS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 78606 26
|
| Hospital Charge Code |
5210087
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: Aetna of NY Commercial |
$65.10
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.20
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: Fidelis Medicare |
$37.20
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.20
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.95
|
| Rate for Payer: United Healthcare Medicare |
$37.20
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
BRAIN IMAGE W/FLOW 4+ VIEWS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 78606 26
|
| Hospital Charge Code |
5210087
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
|
|
BRAIN VASCULAR FLOW ONLY
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 78610 26
|
| Hospital Charge Code |
5210089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: Aetna of NY Commercial |
$30.10
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.20
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: Fidelis Medicare |
$17.20
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.20
|
| Rate for Payer: Humana Medicare |
$17.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.45
|
| Rate for Payer: United Healthcare Medicare |
$17.20
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
BRAIN VASCULAR FLOW ONLY
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 78610 26
|
| Hospital Charge Code |
5210089
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
|
