|
CO DIFFUSING CAPACITY
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
4530010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna of NY Commercial |
$154.70
|
| Rate for Payer: Aetna of NY Medicare |
$101.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.40
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: CDPHP Medicare |
$81.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$176.80
|
| Rate for Payer: EmblemHealth Medicaid |
$176.80
|
| Rate for Payer: EmblemHealth Medicare |
$75.14
|
| Rate for Payer: EmblemHealth Select Care |
$143.65
|
| Rate for Payer: Fidelis Medicare |
$88.40
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.40
|
| Rate for Payer: Humana Medicare |
$88.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$154.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$101.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$124.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$92.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.15
|
| Rate for Payer: United Healthcare Medicare |
$88.40
|
| Rate for Payer: WellCare Medicare |
$121.55
|
|
|
COLCHICINE 0.6 MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 143301801
|
| Hospital Charge Code |
4401282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
COLCHICINE 0.6 MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 143301801
|
| Hospital Charge Code |
4401282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.50
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
COLD BIOPSY FORCEPS
|
Facility
|
IP
|
$15.45
|
|
| Hospital Charge Code |
4471973
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.04
|
|
|
COLD BIOPSY FORCEPS
|
Facility
|
OP
|
$15.45
|
|
| Hospital Charge Code |
4471973
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$12.36 |
| Rate for Payer: Aetna of NY Commercial |
$10.81
|
| Rate for Payer: Aetna of NY Medicare |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.18
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: CDPHP Medicare |
$5.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.36
|
| Rate for Payer: EmblemHealth Medicaid |
$12.36
|
| Rate for Payer: EmblemHealth Medicare |
$5.25
|
| Rate for Payer: EmblemHealth Select Care |
$11.12
|
| Rate for Payer: Fidelis Medicare |
$6.18
|
| Rate for Payer: Galaxy Health Commercial |
$10.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.18
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$6.18
|
| Rate for Payer: WellCare Medicare |
$8.50
|
|
|
COLD PACK SUPPLY
|
Facility
|
IP
|
$46.35
|
|
| Hospital Charge Code |
4479125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
|
|
COLD PACK SUPPLY
|
Facility
|
OP
|
$46.35
|
|
| Hospital Charge Code |
4479125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Aetna of NY Commercial |
$32.45
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.08
|
| Rate for Payer: EmblemHealth Medicaid |
$37.08
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
COLLAGENASE 250U/GM OINT 30 GM
|
Facility
|
OP
|
$759.37
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
4400688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.91 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of NY Commercial |
$531.56
|
| Rate for Payer: Aetna of NY Medicare |
$349.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$303.75
|
| Rate for Payer: Cash Price |
$569.53
|
| Rate for Payer: CDPHP Medicare |
$280.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$607.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$607.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$607.50
|
| Rate for Payer: EmblemHealth Medicaid |
$607.50
|
| Rate for Payer: EmblemHealth Medicare |
$258.19
|
| Rate for Payer: EmblemHealth Select Care |
$546.75
|
| Rate for Payer: Fidelis Medicare |
$303.75
|
| Rate for Payer: Galaxy Health Commercial |
$493.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$303.75
|
| Rate for Payer: Humana Medicare |
$303.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$531.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$349.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$569.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$427.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$318.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.91
|
| Rate for Payer: United Healthcare Medicare |
$303.75
|
| Rate for Payer: WellCare Medicare |
$417.65
|
|
|
COLLAGENASE 250U/GM OINT 30 GM
|
Facility
|
IP
|
$759.37
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
4400688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$417.65 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Cash Price |
$569.53
|
| Rate for Payer: Galaxy Health Commercial |
$493.59
|
| Rate for Payer: WellCare Medicare |
$417.65
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN LRG
|
Facility
|
OP
|
$55.62
|
|
| Hospital Charge Code |
4479081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN LRG
|
Facility
|
IP
|
$55.62
|
|
| Hospital Charge Code |
4479081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN MED
|
Facility
|
OP
|
$55.62
|
|
| Hospital Charge Code |
4479080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN MED
|
Facility
|
IP
|
$55.62
|
|
| Hospital Charge Code |
4479080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN SM
|
Facility
|
OP
|
$55.62
|
|
| Hospital Charge Code |
4479079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN SM
|
Facility
|
IP
|
$55.62
|
|
| Hospital Charge Code |
4479079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
|
|
COLLECT BLOOD FROM PICC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
4451252
|
|
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
|
|
|
COLLECT BLOOD FROM PICC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
4451252
|
|
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
|
|
|
COLLES(COCK UP) SPLINT
|
Facility
|
OP
|
$20.60
|
|
| Hospital Charge Code |
4472168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of NY Commercial |
$14.42
|
| Rate for Payer: Aetna of NY Medicare |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.24
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Medicare |
$7.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.48
|
| Rate for Payer: EmblemHealth Medicaid |
$16.48
|
| Rate for Payer: EmblemHealth Medicare |
$7.00
|
| Rate for Payer: EmblemHealth Select Care |
$14.83
|
| Rate for Payer: Fidelis Medicare |
$8.24
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.24
|
| Rate for Payer: Humana Medicare |
$8.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
COLLES(COCK UP) SPLINT
|
Facility
|
IP
|
$20.60
|
|
| Hospital Charge Code |
4472168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
|
|
COLONOSCOPY FLEX ; DX
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
4851916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,852.50
|
|
|
COLONOSCOPY FLEX ; DX
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
4851916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,995.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,311.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,140.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: CDPHP Medicare |
$1,054.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,280.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,280.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,280.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,280.00
|
| Rate for Payer: EmblemHealth Medicare |
$969.00
|
| Rate for Payer: EmblemHealth Select Care |
$2,052.00
|
| Rate for Payer: Fidelis Medicare |
$1,140.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,852.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,140.00
|
| Rate for Payer: Humana Medicare |
$1,140.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,995.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,311.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,137.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,604.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,197.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$427.50
|
| Rate for Payer: United Healthcare Medicare |
$1,140.00
|
| Rate for Payer: WellCare Medicare |
$1,567.50
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$870.81 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$870.81
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,124.36 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,124.36 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,124.36
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,675.24
|
|
|
Service Code
|
CPT 45390
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,828.00 |
| Max. Negotiated Rate |
$2,675.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,675.24
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
