|
DAPTOMYCIN INJ 1 MG
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of NY Commercial |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Galaxy Health Commercial |
$2.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.77
|
| Rate for Payer: WellCare Medicare |
$1.77
|
|
|
DARIFENACIN 7.5MG TABS 30 EA
|
Facility
|
OP
|
$41.72
|
|
|
Service Code
|
NDC 00430017015
|
| Hospital Charge Code |
4400267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of NY Commercial |
$29.20
|
| Rate for Payer: Aetna of NY Medicare |
$19.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.86
|
| Rate for Payer: Cash Price |
$31.29
|
| Rate for Payer: CDPHP Commercial |
$33.58
|
| Rate for Payer: CDPHP Medicare |
$15.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.38
|
| Rate for Payer: EmblemHealth Medicaid |
$33.38
|
| Rate for Payer: EmblemHealth Medicare |
$14.18
|
| Rate for Payer: EmblemHealth Select Care |
$30.04
|
| Rate for Payer: Fidelis Medicare |
$15.90
|
| Rate for Payer: Galaxy Health Commercial |
$27.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.44
|
| Rate for Payer: Humana Medicare |
$15.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.21
|
| Rate for Payer: United Healthcare Medicare |
$15.44
|
| Rate for Payer: WellCare Medicare |
$22.95
|
|
|
DARIFENACIN 7.5MG TABS 30 EA
|
Facility
|
IP
|
$41.72
|
|
|
Service Code
|
NDC 00430017015
|
| Hospital Charge Code |
4400267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$27.12 |
| Rate for Payer: Cash Price |
$31.29
|
| Rate for Payer: Galaxy Health Commercial |
$27.12
|
| Rate for Payer: WellCare Medicare |
$22.95
|
|
|
DBM BONE GRAFT
|
Facility
|
IP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4471391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,542.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,277.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,277.00
|
| Rate for Payer: Cash Price |
$3,795.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,530.00
|
| Rate for Payer: EmblemHealth Select Care |
$2,530.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,289.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,542.00
|
| Rate for Payer: Multiplan Commercial |
$2,277.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,289.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,289.00
|
| Rate for Payer: WellCare Medicare |
$2,783.00
|
|
|
DBM BONE GRAFT
|
Facility
|
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4471391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,720.40 |
| Max. Negotiated Rate |
$4,073.30 |
| Rate for Payer: Aetna of NY Commercial |
$3,542.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,327.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,277.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,277.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,872.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,530.00
|
| Rate for Payer: Cash Price |
$3,795.00
|
| Rate for Payer: CDPHP Commercial |
$4,073.30
|
| Rate for Payer: CDPHP Medicare |
$1,872.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,530.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,048.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,048.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,048.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,720.40
|
| Rate for Payer: EmblemHealth Select Care |
$2,530.00
|
| Rate for Payer: Fidelis Medicare |
$1,928.37
|
| Rate for Payer: Galaxy Health Commercial |
$3,289.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,872.20
|
| Rate for Payer: Humana Medicare |
$1,872.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,542.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,327.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,289.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,289.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,965.81
|
| Rate for Payer: United Healthcare Medicare |
$1,872.20
|
| Rate for Payer: WellCare Medicare |
$2,783.00
|
|
|
DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Facility
|
IP
|
$2,731.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
4002064
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,775.15 |
| Max. Negotiated Rate |
$1,775.15 |
| Rate for Payer: Cash Price |
$2,048.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,775.15
|
|
|
DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Facility
|
OP
|
$2,731.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
4002064
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,256.26
|
| 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 |
$1,010.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,365.50
|
| Rate for Payer: Cash Price |
$2,048.25
|
| Rate for Payer: Cash Price |
$2,048.25
|
| Rate for Payer: Cash Price |
$2,048.25
|
| Rate for Payer: CDPHP Commercial |
$2,198.46
|
| Rate for Payer: CDPHP Medicare |
$1,010.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,184.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,184.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,184.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,184.80
|
| Rate for Payer: EmblemHealth Medicare |
$928.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,966.32
|
| Rate for Payer: Fidelis Medicare |
$1,040.78
|
| Rate for Payer: Galaxy Health Commercial |
$1,775.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,010.47
|
| Rate for Payer: Humana Medicare |
$1,010.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,256.26
|
| Rate for Payer: Multiplan Commercial |
$2,184.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,048.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,537.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,060.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$560.56
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$1,010.47
|
| Rate for Payer: WellCare Medicare |
$1,502.05
|
|
|
D-DIMER
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 85378
|
| Hospital Charge Code |
4300260
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
D-DIMER
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 85378
|
| Hospital Charge Code |
4300260
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
DEB MUSC/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
4850259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.05 |
| Max. Negotiated Rate |
$1,168.05 |
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
|
|
DEB MUSC/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
4856685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| 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 |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,293.84
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
DEB MUSC/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
4856685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.05 |
| Max. Negotiated Rate |
$1,168.05 |
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
|
|
DEB MUSC/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
4850259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| 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 |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,293.84
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4856686
|
|
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
|
|
|
DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4856686
|
|
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
|
|
|
DEBRIDEMENT OF NAIL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
4609569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| 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: 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 |
$1,182.00
|
| 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 |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| 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 |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
DEBRIDEMENT OF NAIL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
4609569
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
4855443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| 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 |
$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: 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 |
$140.00
|
| 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 |
$126.00
|
| 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 |
$122.50
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
4855443
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
4855442
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
4855442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| 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 |
$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: 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 |
$140.00
|
| 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 |
$126.00
|
| 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 |
$122.50
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
4856548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
4856548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
DECALCIFICATION PROCEDURE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 88311 TC
|
| Hospital Charge Code |
4008311
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
|
|
DECALCIFICATION PROCEDURE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 88311 TC
|
| Hospital Charge Code |
4008311
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Aetna of NY Commercial |
$76.05
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$58.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Commercial |
$94.18
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: EmblemHealth Select Care |
$70.20
|
| Rate for Payer: Fidelis Medicare |
$44.59
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.29
|
| Rate for Payer: Humana Medicare |
$43.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.45
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$87.75
|
| Rate for Payer: United Healthcare Medicare |
$43.29
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
