|
COLONOSCOPY FLEX W REM LESION BY SNARE
|
Facility
|
OP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
4000359
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$2,934.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,687.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,467.20
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: CDPHP Medicare |
$1,357.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,934.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,934.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,247.12
|
| Rate for Payer: EmblemHealth Select Care |
$2,640.96
|
| Rate for Payer: Fidelis Medicare |
$1,467.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,467.20
|
| Rate for Payer: Humana Medicare |
$1,467.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,687.28
|
| Rate for Payer: Multiplan Commercial |
$2,934.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,751.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,065.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,540.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$550.20
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$1,467.20
|
| Rate for Payer: WellCare Medicare |
$2,017.40
|
|
|
COLONOSCOPY FLEX W REM LESION BY SNARE
|
Facility
|
IP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
4000359
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,384.20 |
| Max. Negotiated Rate |
$2,384.20 |
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
|
|
COMBIVENT RESPIMAT INHALER (MD
|
Facility
|
IP
|
$1,184.24
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
4409134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$651.33 |
| Max. Negotiated Rate |
$769.76 |
| Rate for Payer: Cash Price |
$888.18
|
| Rate for Payer: Galaxy Health Commercial |
$769.76
|
| Rate for Payer: WellCare Medicare |
$651.33
|
|
|
COMBIVENT RESPIMAT INHALER (MD
|
Facility
|
OP
|
$1,184.24
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
4409134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.64 |
| Max. Negotiated Rate |
$947.39 |
| Rate for Payer: Aetna of NY Commercial |
$828.97
|
| Rate for Payer: Aetna of NY Medicare |
$544.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$473.70
|
| Rate for Payer: Cash Price |
$888.18
|
| Rate for Payer: CDPHP Medicare |
$438.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$947.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$947.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$947.39
|
| Rate for Payer: EmblemHealth Medicaid |
$947.39
|
| Rate for Payer: EmblemHealth Medicare |
$402.64
|
| Rate for Payer: EmblemHealth Select Care |
$852.65
|
| Rate for Payer: Fidelis Medicare |
$473.70
|
| Rate for Payer: Galaxy Health Commercial |
$769.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$473.70
|
| Rate for Payer: Humana Medicare |
$473.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$828.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$544.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$888.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$666.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$497.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$177.64
|
| Rate for Payer: United Healthcare Medicare |
$473.70
|
| Rate for Payer: WellCare Medicare |
$651.33
|
|
|
COMPATIBILITY TEST EACH UNIT
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
4300200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of NY Commercial |
$339.30
|
| Rate for Payer: Aetna of NY Medicare |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: CDPHP Medicare |
$193.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$417.60
|
| Rate for Payer: EmblemHealth Medicare |
$177.48
|
| Rate for Payer: EmblemHealth Select Care |
$313.20
|
| Rate for Payer: Fidelis Medicare |
$208.80
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$208.80
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$339.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$240.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$391.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$293.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$391.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WellCare Medicare |
$287.10
|
|
|
COMPATIBILITY TEST EACH UNIT
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
4300200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
|
|
COMPL AUTOM CBC W PLT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
4300160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
COMPL AUTOM CBC W PLT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
4300160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$26.40 |
| 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) Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$24.75
|
| 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 |
$13.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.20
|
| Rate for Payer: Humana Medicare |
$13.20
|
| 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 |
$13.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
4480111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,088.75 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
|
|
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
4480111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,088.75
|
| Rate for Payer: Aetna of NY Medicare |
$770.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.00
|
| Rate for Payer: Cash Price |
$1,256.25
|
| Rate for Payer: CDPHP Medicare |
$619.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,172.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.00
|
| Rate for Payer: EmblemHealth Medicare |
$569.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,088.75
|
| Rate for Payer: Fidelis Medicare |
$670.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,088.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.00
|
| Rate for Payer: Humana Medicare |
$670.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,088.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$770.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$943.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,256.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$251.25
|
| Rate for Payer: United Healthcare Commercial |
$1,256.25
|
| Rate for Payer: United Healthcare Medicare |
$670.00
|
| Rate for Payer: WellCare Medicare |
$921.25
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
4856715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
4856715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
4300204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| 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) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| 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 |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| 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 |
$22.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| 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
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4472140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
CONNECTOR OXYGEN TUBING CONN
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4472140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
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 |
$8.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
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 (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)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GP,59
|
| Hospital Charge Code |
4650361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
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 |
$8.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
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 (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
|
|
|
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 |
$8.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
COOLED INTRODUCER (GENERIC) BOX OF 2
|
Facility
|
OP
|
$209.09
|
|
| Hospital Charge Code |
4479220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$167.27 |
| Rate for Payer: Aetna of NY Commercial |
$146.36
|
| Rate for Payer: Aetna of NY Medicare |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.64
|
| Rate for Payer: Cash Price |
$156.82
|
| Rate for Payer: CDPHP Medicare |
$77.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$167.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$167.27
|
| Rate for Payer: EmblemHealth Medicaid |
$167.27
|
| Rate for Payer: EmblemHealth Medicare |
$71.09
|
| Rate for Payer: EmblemHealth Select Care |
$150.54
|
| Rate for Payer: Fidelis Medicare |
$83.64
|
| Rate for Payer: Galaxy Health Commercial |
$135.91
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.64
|
| Rate for Payer: Humana Medicare |
$83.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$96.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$117.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.36
|
| Rate for Payer: United Healthcare Medicare |
$83.64
|
| Rate for Payer: WellCare Medicare |
$115.00
|
|
