|
COMPL AUTOM CBC W PLT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
4300160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$19.80
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
4480111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$536.86 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,105.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,026.35
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
4480111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
4856715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.75 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: EmblemHealth Select Care |
$3,340.08
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
4856715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,015.35 |
| Max. Negotiated Rate |
$3,015.35 |
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
4300204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
4300204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
CONNECTOR OXYGEN TUBING CONN
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4472140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
CONNECTOR OXYGEN TUBING CONN
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4472140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP
|
| Hospital Charge Code |
4650005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP
|
| Hospital Charge Code |
4650005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59
|
| Hospital Charge Code |
4650361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59
|
| Hospital Charge Code |
4650361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59 W KX)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59,KX
|
| Hospital Charge Code |
4650413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (MOD 59 W KX)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59,KX
|
| Hospital Charge Code |
4650413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (W/ KX)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,KX
|
| Hospital Charge Code |
4650306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CONTRAST BATH APPLICATION PER 15 MINUTES (W/ KX)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,KX
|
| Hospital Charge Code |
4650306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
COOLED INTRODUCER (GENERIC) BOX OF 2
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
4479220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna of NY Commercial |
$142.10
|
| Rate for Payer: Aetna of NY Medicare |
$93.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.50
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: CDPHP Commercial |
$163.42
|
| Rate for Payer: CDPHP Medicare |
$75.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$162.40
|
| Rate for Payer: EmblemHealth Medicaid |
$162.40
|
| Rate for Payer: EmblemHealth Medicare |
$69.02
|
| Rate for Payer: EmblemHealth Select Care |
$146.16
|
| Rate for Payer: Fidelis Medicare |
$77.36
|
| Rate for Payer: Galaxy Health Commercial |
$131.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.11
|
| Rate for Payer: Humana Medicare |
$75.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.87
|
| Rate for Payer: United Healthcare Medicare |
$75.11
|
| Rate for Payer: WellCare Medicare |
$111.65
|
|
|
COOLED INTRODUCER (GENERIC) BOX OF 2
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
4479220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Galaxy Health Commercial |
$131.95
|
|
|
COOLED LUMBAR PROBE LUP-17-100-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
COOLED LUMBAR PROBE LUP-17-100-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
COOLIEF RADIOFREQUENCY KIT 75MM
|
Facility
|
OP
|
$2,313.00
|
|
| Hospital Charge Code |
4473036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$786.42 |
| Max. Negotiated Rate |
$1,861.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,619.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,734.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,734.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$855.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,156.50
|
| Rate for Payer: Cash Price |
$1,734.75
|
| Rate for Payer: CDPHP Commercial |
$1,861.96
|
| Rate for Payer: CDPHP Medicare |
$855.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,850.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,850.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,850.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,850.40
|
| Rate for Payer: EmblemHealth Medicare |
$786.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,665.36
|
| Rate for Payer: Fidelis Medicare |
$881.48
|
| Rate for Payer: Galaxy Health Commercial |
$1,503.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$855.81
|
| Rate for Payer: Humana Medicare |
$855.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,619.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,063.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,734.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,302.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$898.60
|
| Rate for Payer: United Healthcare Medicare |
$855.81
|
| Rate for Payer: WellCare Medicare |
$1,272.15
|
|
|
COOLIEF RADIOFREQUENCY KIT 75MM
|
Facility
|
IP
|
$2,313.00
|
|
| Hospital Charge Code |
4473036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,503.45 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Cash Price |
$1,734.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,503.45
|
|
|
COOMBS DIRECT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
4300207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$113.75
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$105.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$105.00
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$131.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.74
|
| Rate for Payer: United Healthcare Commercial |
$131.25
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
COOMBS DIRECT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
4300207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
