|
I&D HEMATOMA/FLUID
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
4856684
|
|
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
|
|
|
I&D HEMATOMA/FLUID
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
4856684
|
|
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
|
|
|
I & D HEMATOMA SEROMA FLUID
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
4600103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| 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 |
$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 |
$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: 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 |
$1,182.00
|
| 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 |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| 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 |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| 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 |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
I & D HEMATOMA SEROMA FLUID
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
4600103
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
I&D LEG/ANKLE DEEP ABSC/HEMATOMA
|
Facility
|
OP
|
$8,130.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
4602152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$6,544.65 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,739.80
|
| 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 |
$3,008.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,065.00
|
| Rate for Payer: Cash Price |
$6,097.50
|
| Rate for Payer: Cash Price |
$6,097.50
|
| Rate for Payer: Cash Price |
$6,097.50
|
| Rate for Payer: Cash Price |
$6,097.50
|
| Rate for Payer: CDPHP Commercial |
$6,544.65
|
| Rate for Payer: CDPHP Medicare |
$3,008.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,504.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,504.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6,504.00
|
| Rate for Payer: EmblemHealth Medicare |
$2,764.20
|
| 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 |
$3,098.34
|
| Rate for Payer: Galaxy Health Commercial |
$5,284.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,008.10
|
| Rate for Payer: Humana Medicare |
$3,008.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,739.80
|
| 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 |
$3,158.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,707.35
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,008.10
|
| Rate for Payer: WellCare Medicare |
$4,471.50
|
|
|
I&D LEG/ANKLE DEEP ABSC/HEMATOMA
|
Facility
|
IP
|
$8,130.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
4602152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,284.50 |
| Max. Negotiated Rate |
$5,284.50 |
| Rate for Payer: Cash Price |
$6,097.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,284.50
|
|
|
I&D OF PILONIDAL CYST; SIMPLE
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
4850301
|
|
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
|
|
|
I&D OF PILONIDAL CYST; SIMPLE
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
4850301
|
|
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
|
|
|
I&D TRAY ER
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
4609641
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
I&D TRAY ER
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
4609641
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
IGA QUANT CSF
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
4300462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
IGA QUANT CSF
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
4300462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
4201075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| 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 |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| 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: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,409.10
|
| 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 |
$1,308.45
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
4201075
|
|
Hospital Revenue Code
|
402
|
| 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
|
|
|
IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 88342 TC
|
| Hospital Charge Code |
4008342
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$317.85
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$293.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: EmblemHealth Select Care |
$293.40
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$317.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$366.75
|
| Rate for Payer: United Healthcare Commercial |
$366.75
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 88342 TC
|
| Hospital Charge Code |
4008342
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
|
|
IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 88341 TC
|
| Hospital Charge Code |
4008341
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$219.05 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Cash Price |
$252.75
|
| Rate for Payer: Galaxy Health Commercial |
$219.05
|
|
|
IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 88341 TC
|
| Hospital Charge Code |
4008341
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.58 |
| Max. Negotiated Rate |
$271.28 |
| Rate for Payer: Aetna of NY Commercial |
$219.05
|
| Rate for Payer: Aetna of NY Medicare |
$155.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$252.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$252.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$124.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$168.50
|
| Rate for Payer: Cash Price |
$252.75
|
| Rate for Payer: CDPHP Commercial |
$271.28
|
| Rate for Payer: CDPHP Medicare |
$124.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$202.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$269.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$269.60
|
| Rate for Payer: EmblemHealth Medicaid |
$269.60
|
| Rate for Payer: EmblemHealth Medicare |
$114.58
|
| Rate for Payer: EmblemHealth Select Care |
$202.20
|
| Rate for Payer: Fidelis Medicare |
$128.43
|
| Rate for Payer: Galaxy Health Commercial |
$219.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$124.69
|
| Rate for Payer: Humana Medicare |
$124.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$219.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$189.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$130.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$252.75
|
| Rate for Payer: United Healthcare Commercial |
$252.75
|
| Rate for Payer: United Healthcare Medicare |
$124.69
|
| Rate for Payer: WellCare Medicare |
$185.35
|
|
|
IMMUNIZATION ADMIN 1 VACCINE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
4604611
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$162.61 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$161.60
|
| Rate for Payer: EmblemHealth Medicaid |
$161.60
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
IMMUNIZATION ADMIN 1 VACCINE
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
4604611
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
|
|
IMMUNOASSAY NONANTIBODY
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
4302004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$29.25
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$33.75
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
IMMUNOASSAY NONANTIBODY
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
4302004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
IMMUNOASSAY QUANT NOS NONAB
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
4301073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$120.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: CDPHP Commercial |
$193.20
|
| Rate for Payer: CDPHP Medicare |
$88.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$192.00
|
| Rate for Payer: EmblemHealth Medicaid |
$192.00
|
| Rate for Payer: EmblemHealth Medicare |
$81.60
|
| Rate for Payer: EmblemHealth Select Care |
$144.00
|
| Rate for Payer: Fidelis Medicare |
$91.46
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.80
|
| Rate for Payer: Humana Medicare |
$88.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$110.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$135.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$93.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$180.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicare |
$88.80
|
| Rate for Payer: WellCare Medicare |
$132.00
|
|
|
IMMUNOASSAY QUANT NOS NONAB
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
4301073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
|
|
IM OR SUBCUTANEOUS
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4450101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13.36
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Essential Plan |
$30.06
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.36
|
| Rate for Payer: EmblemHealth Medicaid |
$13.36
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.06
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$19.64
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,336.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$151.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.03
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
