|
FLUTICASONE PROPIONATE 110MCG ARIN 12 GM
|
Facility
|
OP
|
$787.95
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
4400300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$267.90 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna of NY Commercial |
$551.56
|
| Rate for Payer: Aetna of NY Medicare |
$362.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$590.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$590.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$291.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$393.98
|
| Rate for Payer: Cash Price |
$590.96
|
| Rate for Payer: CDPHP Commercial |
$634.30
|
| Rate for Payer: CDPHP Medicare |
$291.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$630.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$630.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$630.36
|
| Rate for Payer: EmblemHealth Medicaid |
$630.36
|
| Rate for Payer: EmblemHealth Medicare |
$267.90
|
| Rate for Payer: EmblemHealth Select Care |
$567.32
|
| Rate for Payer: Fidelis Medicare |
$300.29
|
| Rate for Payer: Galaxy Health Commercial |
$512.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$291.54
|
| Rate for Payer: Humana Medicare |
$291.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$551.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$362.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.96
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$443.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$306.12
|
| Rate for Payer: United Healthcare Medicare |
$291.54
|
| Rate for Payer: WellCare Medicare |
$433.37
|
|
|
FLUTICASONE PROPIONATE 50MCG SPIN 16 GM
|
Facility
|
IP
|
$232.52
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
4400306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$151.14 |
| Rate for Payer: Cash Price |
$174.39
|
| Rate for Payer: Galaxy Health Commercial |
$151.14
|
| Rate for Payer: WellCare Medicare |
$127.89
|
|
|
FLUTICASONE PROPIONATE 50MCG SPIN 16 GM
|
Facility
|
OP
|
$232.52
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
4400306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.06 |
| Max. Negotiated Rate |
$187.18 |
| Rate for Payer: Aetna of NY Commercial |
$162.76
|
| Rate for Payer: Aetna of NY Medicare |
$106.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$174.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$174.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$86.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$116.26
|
| Rate for Payer: Cash Price |
$174.39
|
| Rate for Payer: CDPHP Commercial |
$187.18
|
| Rate for Payer: CDPHP Medicare |
$86.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$186.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$186.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$186.02
|
| Rate for Payer: EmblemHealth Medicaid |
$186.02
|
| Rate for Payer: EmblemHealth Medicare |
$79.06
|
| Rate for Payer: EmblemHealth Select Care |
$167.41
|
| Rate for Payer: Fidelis Medicare |
$88.61
|
| Rate for Payer: Galaxy Health Commercial |
$151.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.03
|
| Rate for Payer: Humana Medicare |
$86.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$162.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$106.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$130.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.33
|
| Rate for Payer: United Healthcare Medicare |
$86.03
|
| Rate for Payer: WellCare Medicare |
$127.89
|
|
|
FluZONE HIGH-DOSE QUAD 2022-23 1 ea, 0.7 mL
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
4401456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.62 |
| Max. Negotiated Rate |
$155.36 |
| Rate for Payer: Aetna of NY Commercial |
$106.15
|
| Rate for Payer: Aetna of NY Medicare |
$88.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$96.50
|
| Rate for Payer: Cash Price |
$144.75
|
| Rate for Payer: Cash Price |
$144.75
|
| Rate for Payer: CDPHP Commercial |
$155.36
|
| Rate for Payer: CDPHP Medicare |
$71.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$154.40
|
| Rate for Payer: EmblemHealth Medicaid |
$154.40
|
| Rate for Payer: EmblemHealth Medicare |
$65.62
|
| Rate for Payer: EmblemHealth Select Care |
$73.40
|
| Rate for Payer: Fidelis Medicare |
$73.55
|
| Rate for Payer: Galaxy Health Commercial |
$125.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.41
|
| Rate for Payer: Humana Medicare |
$71.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$106.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$108.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$115.40
|
| Rate for Payer: United Healthcare Commercial |
$115.40
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
| Rate for Payer: WellCare Medicare |
$106.15
|
|
|
FluZONE HIGH-DOSE QUAD 2022-23 1 ea, 0.7 mL
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
4401456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$125.45 |
| Rate for Payer: Aetna of NY Commercial |
$106.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.40
|
| Rate for Payer: Cash Price |
$144.75
|
| Rate for Payer: Cash Price |
$144.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.40
|
| Rate for Payer: EmblemHealth Select Care |
$73.40
|
| Rate for Payer: Galaxy Health Commercial |
$125.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$106.15
|
| Rate for Payer: WellCare Medicare |
$106.15
|
|
|
FML OO
|
Facility
|
OP
|
$450.37
|
|
|
Service Code
|
NDC 00023031604
|
| Hospital Charge Code |
4409008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.13 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Aetna of NY Commercial |
$315.26
|
| Rate for Payer: Aetna of NY Medicare |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$337.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$337.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.18
|
| Rate for Payer: Cash Price |
$337.78
|
| Rate for Payer: CDPHP Commercial |
$362.55
|
| Rate for Payer: CDPHP Medicare |
$166.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.30
|
| Rate for Payer: EmblemHealth Medicaid |
$360.30
|
| Rate for Payer: EmblemHealth Medicare |
$153.13
|
| Rate for Payer: EmblemHealth Select Care |
$324.27
|
| Rate for Payer: Fidelis Medicare |
$171.64
|
| Rate for Payer: Galaxy Health Commercial |
$292.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.64
|
| Rate for Payer: Humana Medicare |
$166.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$174.97
|
| Rate for Payer: United Healthcare Medicare |
$166.64
|
| Rate for Payer: WellCare Medicare |
$247.70
|
|
|
FML OO
|
Facility
|
IP
|
$450.37
|
|
|
Service Code
|
NDC 00023031604
|
| Hospital Charge Code |
4409008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$247.70 |
| Max. Negotiated Rate |
$292.74 |
| Rate for Payer: Cash Price |
$337.78
|
| Rate for Payer: Galaxy Health Commercial |
$292.74
|
| Rate for Payer: WellCare Medicare |
$247.70
|
|
|
FNA BX, W/ CT GUIDE; 1ST LES
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
4853021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| 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 |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,449.36
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
FNA BX, W/ CT GUIDE; 1ST LES
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
4853021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
FNA BX, W/ CT GUIDE; EA ADDL LES
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
4853022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
FNA BX, W/ CT GUIDE; EA ADDL LES
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
4853022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| 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 |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$226.80
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.90
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
4853019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| 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 |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,449.36
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
4853019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
4853020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$150.80 |
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Galaxy Health Commercial |
$150.80
|
|
|
FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
4853020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$162.40
|
| Rate for Payer: Aetna of NY Medicare |
$106.72
|
| 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 |
$85.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$116.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: CDPHP Commercial |
$186.76
|
| Rate for Payer: CDPHP Medicare |
$85.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$185.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$185.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$185.60
|
| Rate for Payer: EmblemHealth Medicaid |
$185.60
|
| Rate for Payer: EmblemHealth Medicare |
$78.88
|
| Rate for Payer: EmblemHealth Select Care |
$167.04
|
| Rate for Payer: Fidelis Medicare |
$88.42
|
| Rate for Payer: Galaxy Health Commercial |
$150.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.84
|
| Rate for Payer: Humana Medicare |
$85.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$162.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$106.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$130.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.60
|
| Rate for Payer: United Healthcare Medicare |
$85.84
|
| Rate for Payer: WellCare Medicare |
$127.60
|
|
|
FNA BX, W/ MR GUIDE; 1ST LES
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10011
|
| Hospital Charge Code |
4853023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
FNA BX, W/ MR GUIDE; 1ST LES
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10011
|
| Hospital Charge Code |
4853023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| 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 |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,449.36
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
FNA BX, W/ MR GUIDE; EA ADDL LES
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 10012
|
| Hospital Charge Code |
4853024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$224.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| 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 |
$118.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$160.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Commercial |
$257.60
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$230.40
|
| Rate for Payer: Fidelis Medicare |
$121.95
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$124.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$184.47
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
FNA BX, W/ MR GUIDE; EA ADDL LES
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 10012
|
| Hospital Charge Code |
4853024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
FNA BX, W/ US GUIDE; 1ST LES
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4853017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| 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 |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,449.36
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
FNA BX, W/ US GUIDE; 1ST LES
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4853017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
FNA BX, W/ US GUIDE; EA ADDL LES
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
4853018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$132.30
|
| Rate for Payer: Aetna of NY Medicare |
$86.94
|
| 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 |
$69.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$94.50
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: CDPHP Commercial |
$152.14
|
| Rate for Payer: CDPHP Medicare |
$69.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$151.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$151.20
|
| Rate for Payer: EmblemHealth Medicaid |
$151.20
|
| Rate for Payer: EmblemHealth Medicare |
$64.26
|
| Rate for Payer: EmblemHealth Select Care |
$136.08
|
| Rate for Payer: Fidelis Medicare |
$72.03
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.93
|
| Rate for Payer: Humana Medicare |
$69.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$132.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$106.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.27
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
| Rate for Payer: WellCare Medicare |
$103.95
|
|
|
FNA BX, W/ US GUIDE; EA ADDL LES
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
4853018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
|
|
FOLEY INSERTION TRAY 10CC
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4471221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
FOLEY INSERTION TRAY 10CC
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4471221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
