|
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
|
|
|
INDIUM IN-111 PENTETREOTIDE =< 6 MCI
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
4210078
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$10,595.67 |
| Rate for Payer: Aetna of NY Medicare |
$339.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$554.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$554.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$273.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$369.50
|
| Rate for Payer: Cash Price |
$554.25
|
| Rate for Payer: Cash Price |
$554.25
|
| Rate for Payer: CDPHP Commercial |
$594.90
|
| Rate for Payer: CDPHP Medicare |
$273.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$591.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$591.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$591.20
|
| Rate for Payer: EmblemHealth Medicaid |
$591.20
|
| Rate for Payer: EmblemHealth Medicare |
$251.26
|
| Rate for Payer: EmblemHealth Select Care |
$532.08
|
| Rate for Payer: Fidelis Medicare |
$281.63
|
| Rate for Payer: Galaxy Health Commercial |
$480.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$273.43
|
| Rate for Payer: Humana Medicare |
$273.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$339.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$416.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$287.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$10,595.67
|
| Rate for Payer: United Healthcare Commercial |
$10,595.67
|
| Rate for Payer: United Healthcare Medicare |
$273.43
|
| Rate for Payer: WellCare Medicare |
$406.45
|
|
|
INDIUM IN-111 PENTETREOTIDE =< 6 MCI
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
4210078
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$480.35 |
| Max. Negotiated Rate |
$480.35 |
| Rate for Payer: Cash Price |
$554.25
|
| Rate for Payer: Galaxy Health Commercial |
$480.35
|
|
|
INDOMETHACIN 25MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
4400387
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INDOMETHACIN 25MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
4400387
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INFINION 50 CM 16 CONTACT LEAD KIT
|
Facility
|
IP
|
$16,208.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,293.60 |
| Max. Negotiated Rate |
$11,345.60 |
| Rate for Payer: Aetna of NY Commercial |
$11,345.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,293.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,293.60
|
| Rate for Payer: Cash Price |
$12,156.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,104.00
|
| Rate for Payer: EmblemHealth Select Care |
$8,104.00
|
| Rate for Payer: Galaxy Health Commercial |
$10,535.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,345.60
|
| Rate for Payer: Multiplan Commercial |
$7,293.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,535.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,535.20
|
| Rate for Payer: WellCare Medicare |
$8,914.40
|
|
|
INFINION 50 CM 16 CONTACT LEAD KIT
|
Facility
|
OP
|
$16,208.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.72 |
| Max. Negotiated Rate |
$13,047.44 |
| Rate for Payer: Aetna of NY Commercial |
$11,345.60
|
| Rate for Payer: Aetna of NY Medicare |
$7,455.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,293.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,293.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,996.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8,104.00
|
| Rate for Payer: Cash Price |
$12,156.00
|
| Rate for Payer: CDPHP Commercial |
$13,047.44
|
| Rate for Payer: CDPHP Medicare |
$5,996.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,966.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,966.40
|
| Rate for Payer: EmblemHealth Medicaid |
$12,966.40
|
| Rate for Payer: EmblemHealth Medicare |
$5,510.72
|
| Rate for Payer: EmblemHealth Select Care |
$8,104.00
|
| Rate for Payer: Fidelis Medicare |
$6,176.87
|
| Rate for Payer: Galaxy Health Commercial |
$10,535.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,996.96
|
| Rate for Payer: Humana Medicare |
$5,996.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,345.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,455.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,535.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,535.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,296.81
|
| Rate for Payer: United Healthcare Medicare |
$5,996.96
|
| Rate for Payer: WellCare Medicare |
$8,914.40
|
|
|
INFLECTRA 100 MG VIAL 100 mg, 1 each
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
4401942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna of NY Commercial |
$187.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.09
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.09
|
| Rate for Payer: EmblemHealth Select Care |
$11.09
|
| Rate for Payer: Galaxy Health Commercial |
$221.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$187.55
|
| Rate for Payer: WellCare Medicare |
$187.55
|
|
|
INFLECTRA 100 MG VIAL 100 mg, 1 each
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
4401942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of NY Commercial |
$187.55
|
| Rate for Payer: Aetna of NY Medicare |
$156.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$170.50
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: CDPHP Commercial |
$274.50
|
| Rate for Payer: CDPHP Medicare |
$126.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.80
|
| Rate for Payer: EmblemHealth Medicaid |
$272.80
|
| Rate for Payer: EmblemHealth Medicare |
$115.94
|
| Rate for Payer: EmblemHealth Select Care |
$11.09
|
| Rate for Payer: Fidelis Medicare |
$129.96
|
| Rate for Payer: Galaxy Health Commercial |
$221.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.17
|
| Rate for Payer: Humana Medicare |
$126.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$187.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.41
|
| Rate for Payer: United Healthcare Commercial |
$30.41
|
| Rate for Payer: United Healthcare Medicare |
$126.17
|
| Rate for Payer: WellCare Medicare |
$187.55
|
|
|
INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG
|
Facility
|
IP
|
$420.42
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
4400677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$273.27 |
| Rate for Payer: Aetna of NY Commercial |
$231.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.67
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.67
|
| Rate for Payer: EmblemHealth Select Care |
$31.67
|
| Rate for Payer: Galaxy Health Commercial |
$273.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$231.23
|
| Rate for Payer: WellCare Medicare |
$231.23
|
|
|
INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG
|
Facility
|
OP
|
$420.42
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
4400677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$7,766.00 |
| Rate for Payer: Aetna of NY Commercial |
$231.23
|
| Rate for Payer: Aetna of NY Medicare |
$193.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$174.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$155.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$210.21
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$77.66
|
| Rate for Payer: CDPHP Commercial |
$338.44
|
| Rate for Payer: CDPHP Essential Plan |
$174.74
|
| Rate for Payer: CDPHP Medicare |
$155.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.66
|
| Rate for Payer: EmblemHealth Medicaid |
$77.66
|
| Rate for Payer: EmblemHealth Medicare |
$142.94
|
| Rate for Payer: EmblemHealth Select Care |
$31.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$174.74
|
| Rate for Payer: Fidelis Medicare |
$160.22
|
| Rate for Payer: Galaxy Health Commercial |
$273.27
|
| Rate for Payer: Galaxy Health Workers Comp |
$114.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7,766.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$155.56
|
| Rate for Payer: Humana Medicare |
$155.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$231.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$193.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7,766.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$236.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$163.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$77.66
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
| Rate for Payer: United Healthcare Medicare |
$155.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$81.54
|
| Rate for Payer: WellCare Medicare |
$231.23
|
|
|
INFLUENZA A ANTIBODY
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
4300486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
INFLUENZA A ANTIBODY
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
4300486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
INFLUENZA A/B AG EIA
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 87400
|
| Hospital Charge Code |
4301263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$95.80 |
| Rate for Payer: Aetna of NY Commercial |
$77.35
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$59.50
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$71.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$71.40
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$67.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$89.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Commercial |
$89.25
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
INFLUENZA A/B AG EIA
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 87400
|
| Hospital Charge Code |
4301263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
INJ ANESTH AGENT PERIPH NERVE
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4600114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,593.10 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$910.34
|
| 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 |
$732.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$989.50
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: CDPHP Commercial |
$1,593.10
|
| Rate for Payer: CDPHP Medicare |
$732.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,583.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicare |
$672.86
|
| 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 |
$754.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$732.23
|
| Rate for Payer: Humana Medicare |
$732.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$910.34
|
| 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 |
$768.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$732.23
|
| Rate for Payer: WellCare Medicare |
$1,088.45
|
|
|
INJ ANESTH AGENT PERIPH NERVE
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4600114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,286.35 |
| Max. Negotiated Rate |
$1,286.35 |
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4852009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: EmblemHealth Select Care |
$609.84
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4852009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4602220
|
|
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 |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| 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 |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| 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 |
$329.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4602220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
INJ ANESTH; OTHR PERIPHERAL NRV/BRANCH
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4852010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,385.30
|
| Rate for Payer: Aetna of NY Medicare |
$910.34
|
| 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 |
$732.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$989.50
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: CDPHP Commercial |
$1,593.10
|
| Rate for Payer: CDPHP Medicare |
$732.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,583.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,583.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicare |
$672.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,424.88
|
| Rate for Payer: Fidelis Medicare |
$754.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$732.23
|
| Rate for Payer: Humana Medicare |
$732.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,385.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$910.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,484.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,114.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$768.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Medicare |
$732.23
|
| Rate for Payer: WellCare Medicare |
$1,088.45
|
|
|
INJ ANESTH; OTHR PERIPHERAL NRV/BRANCH
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4852010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,286.35 |
| Max. Negotiated Rate |
$1,286.35 |
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
|
|
INJ ANESTH ; TRIGEMINAL NERVE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4609658
|
|
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 |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| 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 |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| 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 |
$329.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
INJ ANESTH ; TRIGEMINAL NERVE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4609658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
