|
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
|
|
|
IMPLANTABLE BIOPSY SITE MARKER
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4473021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$194.60 |
| Rate for Payer: Aetna of NY Commercial |
$194.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$125.10
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.00
|
| Rate for Payer: EmblemHealth Select Care |
$139.00
|
| Rate for Payer: Galaxy Health Commercial |
$180.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$125.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.70
|
| Rate for Payer: WellCare Medicare |
$152.90
|
|
|
IMPLANTABLE BIOPSY SITE MARKER
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4473021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Aetna of NY Commercial |
$194.60
|
| Rate for Payer: Aetna of NY Medicare |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$139.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: CDPHP Commercial |
$223.79
|
| Rate for Payer: CDPHP Medicare |
$102.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$222.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$222.40
|
| Rate for Payer: EmblemHealth Medicaid |
$222.40
|
| Rate for Payer: EmblemHealth Medicare |
$94.52
|
| Rate for Payer: EmblemHealth Select Care |
$139.00
|
| Rate for Payer: Fidelis Medicare |
$105.95
|
| Rate for Payer: Galaxy Health Commercial |
$180.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.86
|
| Rate for Payer: Humana Medicare |
$102.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$194.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.00
|
| Rate for Payer: United Healthcare Medicare |
$102.86
|
| Rate for Payer: WellCare Medicare |
$152.90
|
|
|
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING
|
Facility
|
OP
|
$16,992.38
|
|
|
Service Code
|
CPT 62362
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$16,992.38 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,640.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16,992.38
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
|
|
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY
|
Facility
|
OP
|
$6,346.97
|
|
|
Service Code
|
CPT 62350
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$6,346.97 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,346.97
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
INCAL BX SKN EA SEP/ADDL
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
4853030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
|
|
INCAL BX SKN EA SEP/ADDL
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
4853030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$87.50
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$62.50
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Commercial |
$100.62
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: EmblemHealth Select Care |
$90.00
|
| Rate for Payer: Fidelis Medicare |
$47.64
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.25
|
| Rate for Payer: Humana Medicare |
$46.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$87.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.29
|
| Rate for Payer: United Healthcare Medicare |
$46.25
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
4853029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,293.84
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
4853029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.05 |
| Max. Negotiated Rate |
$1,168.05 |
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
|
|
INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE
|
Facility
|
OP
|
$19,569.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
4002011
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$15,753.04 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$9,001.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7,240.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,491.00
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: CDPHP Commercial |
$15,753.04
|
| Rate for Payer: CDPHP Medicare |
$7,240.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15,655.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,655.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15,655.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15,655.20
|
| Rate for Payer: EmblemHealth Medicare |
$6,653.46
|
| Rate for Payer: EmblemHealth Select Care |
$14,089.68
|
| Rate for Payer: Fidelis Medicare |
$7,457.75
|
| Rate for Payer: Galaxy Health Commercial |
$12,719.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$7,240.53
|
| Rate for Payer: Humana Medicare |
$7,240.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9,001.74
|
| Rate for Payer: Multiplan Commercial |
$15,655.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14,676.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11,017.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7,602.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,516.28
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$7,240.53
|
| Rate for Payer: WellCare Medicare |
$10,762.95
|
|
|
INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE
|
Facility
|
IP
|
$19,569.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
4002011
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$12,719.85 |
| Max. Negotiated Rate |
$12,719.85 |
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: Galaxy Health Commercial |
$12,719.85
|
|
|
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
INCISION EXT THROMB HEMORRHOID
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
4600112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
INCISION EXT THROMB HEMORRHOID
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
4600112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| 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 |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| 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 |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
INC & REM FB SQ; COMPL
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
4856683
|
|
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
|
|
|
INC & REM FB SQ; COMPL
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
4856683
|
|
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
|
|
|
INC & REM FB SQ; SMPL
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4856682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
INC & REM FB SQ; SMPL
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4856682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
INC/REM FOR BODY SUBCUT SIMPLE
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4600111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
INC/REM FOR BODY SUBCUT SIMPLE
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4600111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
INDIGO CARMINE 0.8% AMPUL 5 mL, 5 mL
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$499.10 |
| Rate for Payer: Aetna of NY Commercial |
$341.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$310.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: CDPHP Commercial |
$499.10
|
| Rate for Payer: CDPHP Medicare |
$229.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.00
|
| Rate for Payer: EmblemHealth Medicaid |
$496.00
|
| Rate for Payer: EmblemHealth Medicare |
$210.80
|
| Rate for Payer: EmblemHealth Select Care |
$446.40
|
| Rate for Payer: Fidelis Medicare |
$236.28
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.40
|
| Rate for Payer: Humana Medicare |
$229.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$240.87
|
| Rate for Payer: United Healthcare Medicare |
$229.40
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
INDIGO CARMINE 0.8% AMPUL 5 mL, 5 mL
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna of NY Commercial |
$341.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$279.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.00
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
INDIUM IN-111 AUTO PLATELET PER DOSE
|
Facility
|
IP
|
$3,138.00
|
|
|
Service Code
|
HCPCS A9571
|
| Hospital Charge Code |
4210070
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,039.70 |
| Max. Negotiated Rate |
$2,039.70 |
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,039.70
|
|
|
INDIUM IN-111 AUTO PLATELET PER DOSE
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
HCPCS A9571
|
| Hospital Charge Code |
4210070
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,066.92 |
| Max. Negotiated Rate |
$6,554.23 |
| Rate for Payer: Aetna of NY Medicare |
$1,443.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,161.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,569.00
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: CDPHP Commercial |
$2,526.09
|
| Rate for Payer: CDPHP Medicare |
$1,161.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,510.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,510.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,510.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,510.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,066.92
|
| Rate for Payer: EmblemHealth Select Care |
$2,259.36
|
| Rate for Payer: Fidelis Medicare |
$1,195.89
|
| Rate for Payer: Galaxy Health Commercial |
$2,039.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,161.06
|
| Rate for Payer: Humana Medicare |
$1,161.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,443.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,353.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,766.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,219.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$1,161.06
|
| Rate for Payer: WellCare Medicare |
$1,725.90
|
|
|
INDIUM IN-111 AUTO WBC
|
Facility
|
OP
|
$11,309.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
4211250
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,845.06 |
| Max. Negotiated Rate |
$9,103.74 |
| Rate for Payer: Aetna of NY Medicare |
$5,202.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8,481.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8,481.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,184.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,654.50
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: CDPHP Commercial |
$9,103.74
|
| Rate for Payer: CDPHP Medicare |
$4,184.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicaid |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,845.06
|
| Rate for Payer: EmblemHealth Select Care |
$8,142.48
|
| Rate for Payer: Fidelis Medicare |
$4,309.86
|
| Rate for Payer: Galaxy Health Commercial |
$7,350.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,184.33
|
| Rate for Payer: Humana Medicare |
$4,184.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,202.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,481.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,366.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,393.55
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$4,184.33
|
| Rate for Payer: WellCare Medicare |
$6,219.95
|
|
