|
CT NECK SPINE W/O & W/DYE
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
4220008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,202.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: CDPHP Medicare |
$967.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,830.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,092.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,092.00
|
| Rate for Payer: EmblemHealth Medicare |
$889.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,699.75
|
| Rate for Payer: Fidelis Medicare |
$1,046.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,699.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,046.00
|
| Rate for Payer: Humana Medicare |
$1,046.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,202.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,961.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,472.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,098.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$392.25
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$1,046.00
|
| Rate for Payer: WellCare Medicare |
$1,438.25
|
|
|
CT NECK SPINE W/O & W/DYE
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Hospital Charge Code |
4220008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,699.75 |
| Max. Negotiated Rate |
$1,699.75 |
| Rate for Payer: Cash Price |
$1,961.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,699.75
|
|
|
CT ORBIT/EAR/FOSSA W/ DYE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 70481 26
|
| Hospital Charge Code |
5220037
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: CDPHP Medicare |
$61.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.00
|
| Rate for Payer: EmblemHealth Medicaid |
$132.00
|
| Rate for Payer: EmblemHealth Medicare |
$56.10
|
| Rate for Payer: Fidelis Medicare |
$66.00
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.00
|
| Rate for Payer: Humana Medicare |
$66.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WellCare Medicare |
$90.75
|
|
|
CT ORBIT/EAR/FOSSA W/ DYE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 70481 26
|
| Hospital Charge Code |
5224307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
|
|
CT ORBIT/EAR/FOSSA W/ DYE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 70481 26
|
| Hospital Charge Code |
5224307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: CDPHP Medicare |
$61.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.00
|
| Rate for Payer: EmblemHealth Medicaid |
$132.00
|
| Rate for Payer: EmblemHealth Medicare |
$56.10
|
| Rate for Payer: Fidelis Medicare |
$66.00
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.00
|
| Rate for Payer: Humana Medicare |
$66.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WellCare Medicare |
$90.75
|
|
|
CT ORBIT/EAR/FOSSA W/ DYE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 70481 26
|
| Hospital Charge Code |
5220037
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Galaxy Health Commercial |
$107.25
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4224307
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4224307
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$242.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$423.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: EmblemHealth Select Care |
$393.25
|
| Rate for Payer: Fidelis Medicare |
$242.00
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$242.00
|
| Rate for Payer: Humana Medicare |
$242.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$254.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$242.00
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4220037
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$278.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$242.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: CDPHP Medicare |
$223.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$423.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$484.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$484.00
|
| Rate for Payer: EmblemHealth Medicaid |
$484.00
|
| Rate for Payer: EmblemHealth Medicare |
$205.70
|
| Rate for Payer: EmblemHealth Select Care |
$393.25
|
| Rate for Payer: Fidelis Medicare |
$242.00
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$242.00
|
| Rate for Payer: Humana Medicare |
$242.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$278.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$340.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$254.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$242.00
|
| Rate for Payer: WellCare Medicare |
$332.75
|
|
|
CT ORBIT/EAR/FOSSA W/DYE
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Hospital Charge Code |
4220037
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Galaxy Health Commercial |
$393.25
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 70480 26
|
| Hospital Charge Code |
5224308
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4220038
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$136.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: EmblemHealth Select Care |
$221.00
|
| Rate for Payer: Fidelis Medicare |
$136.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$136.00
|
| Rate for Payer: Humana Medicare |
$136.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$136.00
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 70480 26
|
| Hospital Charge Code |
5220038
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: CDPHP Medicare |
$69.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.40
|
| Rate for Payer: EmblemHealth Medicaid |
$150.40
|
| Rate for Payer: EmblemHealth Medicare |
$63.92
|
| Rate for Payer: Fidelis Medicare |
$75.20
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.20
|
| Rate for Payer: Humana Medicare |
$75.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.20
|
| Rate for Payer: United Healthcare Medicare |
$75.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4224308
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 70480 26
|
| Hospital Charge Code |
5220038
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 70480 26
|
| Hospital Charge Code |
5224308
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: CDPHP Medicare |
$69.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.40
|
| Rate for Payer: EmblemHealth Medicaid |
$150.40
|
| Rate for Payer: EmblemHealth Medicare |
$63.92
|
| Rate for Payer: Fidelis Medicare |
$75.20
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.20
|
| Rate for Payer: Humana Medicare |
$75.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.20
|
| Rate for Payer: United Healthcare Medicare |
$75.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4220038
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
|
|
CT ORBIT/EAR/FOSSA W/O DYE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Hospital Charge Code |
4224308
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$136.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: CDPHP Medicare |
$125.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.00
|
| Rate for Payer: EmblemHealth Medicaid |
$272.00
|
| Rate for Payer: EmblemHealth Medicare |
$115.60
|
| Rate for Payer: EmblemHealth Select Care |
$221.00
|
| Rate for Payer: Fidelis Medicare |
$136.00
|
| Rate for Payer: Galaxy Health Commercial |
$221.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$136.00
|
| Rate for Payer: Humana Medicare |
$136.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$136.00
|
| Rate for Payer: WellCare Medicare |
$187.00
|
|
|
CT ORBIT/EAR/FOSSA W/O & W/ DYE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 70482 26
|
| Hospital Charge Code |
5220039
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.00
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: CDPHP Medicare |
$68.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.00
|
| Rate for Payer: EmblemHealth Medicaid |
$148.00
|
| Rate for Payer: EmblemHealth Medicare |
$62.90
|
| Rate for Payer: Fidelis Medicare |
$74.00
|
| Rate for Payer: Galaxy Health Commercial |
$120.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.00
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$74.00
|
| Rate for Payer: WellCare Medicare |
$101.75
|
|
|
CT ORBIT/EAR/FOSSA W/O & W/ DYE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 70482 26
|
| Hospital Charge Code |
5220039
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Galaxy Health Commercial |
$120.25
|
|
|
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
4220039
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$612.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$532.80
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: CDPHP Medicare |
$492.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$932.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,065.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,065.60
|
| Rate for Payer: EmblemHealth Medicare |
$452.88
|
| Rate for Payer: EmblemHealth Select Care |
$865.80
|
| Rate for Payer: Fidelis Medicare |
$532.80
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$532.80
|
| Rate for Payer: Humana Medicare |
$532.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$612.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$749.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$559.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$199.80
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$532.80
|
| Rate for Payer: WellCare Medicare |
$732.60
|
|
|
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Hospital Charge Code |
4220039
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$865.80 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
|
|
CT PELVIS W/ DYE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 72193 26
|
| Hospital Charge Code |
5220042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
|
|
CT PELVIS W/ DYE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 72193 26
|
| Hospital Charge Code |
5220042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.60
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: CDPHP Medicare |
$62.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$135.20
|
| Rate for Payer: EmblemHealth Medicare |
$57.46
|
| Rate for Payer: Fidelis Medicare |
$67.60
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.60
|
| Rate for Payer: Humana Medicare |
$67.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.35
|
| Rate for Payer: United Healthcare Medicare |
$67.60
|
| Rate for Payer: WellCare Medicare |
$92.95
|
|
|
CT PELVIS W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Hospital Charge Code |
4220042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$1,204.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$602.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,053.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: EmblemHealth Select Care |
$978.25
|
| Rate for Payer: Fidelis Medicare |
$602.00
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$602.00
|
| Rate for Payer: Humana Medicare |
$602.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$632.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$602.00
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
