|
DOXYCYCLINE HYCLATE 100MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
| Hospital Charge Code |
4400259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4602237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4602237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
4601207
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
4601207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| 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: Cash Price |
$3,796.50
|
| 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 |
$1,206.00
|
| 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 |
$1,085.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
DRAIN/INJ INTER JOINT/BURSA W/US
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
4852004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
DRAIN/INJ INTER JOINT/BURSA W/US
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
4852004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
DRAIN/INJ INTERM JNT/BURSA
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4856668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
DRAIN/INJ INTERM JNT/BURSA
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
4856668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
DRAIN/INJ MAJOR JOINT/BURSA W/US
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
4852003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
DRAIN/INJ MAJOR JOINT/BURSA W/US
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
4852003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
DRAIN/INJ SMALL JOINT/BURSA W/US
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4852005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
DRAIN/INJ SMALL JOINT/BURSA W/US
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4852005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
DRAIN POUCH (COLOSTOMY SUPPLY
|
Facility
|
IP
|
$9.27
|
|
| Hospital Charge Code |
4479197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
|
|
DRAIN POUCH (COLOSTOMY SUPPLY
|
Facility
|
OP
|
$9.27
|
|
| Hospital Charge Code |
4479197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of NY Commercial |
$6.49
|
| Rate for Payer: Aetna of NY Medicare |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: CDPHP Medicare |
$3.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.42
|
| Rate for Payer: EmblemHealth Medicaid |
$7.42
|
| Rate for Payer: EmblemHealth Medicare |
$3.15
|
| Rate for Payer: EmblemHealth Select Care |
$6.67
|
| Rate for Payer: Fidelis Medicare |
$3.71
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.10
|
|
|
DRAW BLOOD OFF VENOUS DEVICE
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4602218
|
|
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
|
|
|
DRAW BLOOD OFF VENOUS DEVICE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4602218
|
|
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
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4853016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4609666
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,206.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$346.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4609666
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4853016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$430.50
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$430.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$346.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
DRESSING ADHESIVE ISLAND NON-ADH PAD STE
|
Facility
|
IP
|
$10.30
|
|
| Hospital Charge Code |
4478188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
|
|
DRESSING ADHESIVE ISLAND NON-ADH PAD STE
|
Facility
|
OP
|
$10.30
|
|
| Hospital Charge Code |
4478188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.12
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
| Rate for Payer: WellCare Medicare |
$5.67
|
|
|
DR EXT EAR ABSCESS/HEMATOMA; SIMPLE
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
4602217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
DR EXT EAR ABSCESS/HEMATOMA; SIMPLE
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
4602217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
