|
INJ CLONIDINE HCL 1 MG
|
Facility
|
IP
|
$162.23
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
4400175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of NY Commercial |
$89.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.02
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.02
|
| Rate for Payer: EmblemHealth Select Care |
$17.02
|
| Rate for Payer: Galaxy Health Commercial |
$105.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.23
|
| Rate for Payer: WellCare Medicare |
$89.23
|
|
|
INJ CLONIDINE HCL 1 MG
|
Facility
|
OP
|
$162.23
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
4400175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$130.60 |
| Rate for Payer: Aetna of NY Commercial |
$89.23
|
| Rate for Payer: Aetna of NY Medicare |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$60.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$81.12
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: CDPHP Commercial |
$130.60
|
| Rate for Payer: CDPHP Medicare |
$60.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.78
|
| Rate for Payer: EmblemHealth Medicaid |
$129.78
|
| Rate for Payer: EmblemHealth Medicare |
$55.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.02
|
| Rate for Payer: Fidelis Medicare |
$61.83
|
| Rate for Payer: Galaxy Health Commercial |
$105.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$60.03
|
| Rate for Payer: Humana Medicare |
$60.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$63.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$34.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.02
|
| Rate for Payer: United Healthcare Commercial |
$34.72
|
| Rate for Payer: United Healthcare Medicare |
$60.03
|
| Rate for Payer: WellCare Medicare |
$89.23
|
|
|
INJ DESMOPRESSIN ACETATE PER 1 MCG
|
Facility
|
IP
|
$211.75
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
4400214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna of NY Commercial |
$116.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.27
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.27
|
| Rate for Payer: EmblemHealth Select Care |
$6.27
|
| Rate for Payer: Galaxy Health Commercial |
$137.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.46
|
| Rate for Payer: WellCare Medicare |
$116.46
|
|
|
INJ DESMOPRESSIN ACETATE PER 1 MCG
|
Facility
|
OP
|
$211.75
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
4400214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$170.46 |
| Rate for Payer: Aetna of NY Commercial |
$116.46
|
| Rate for Payer: Aetna of NY Medicare |
$97.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$78.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$105.88
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: CDPHP Commercial |
$170.46
|
| Rate for Payer: CDPHP Medicare |
$78.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$169.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$169.40
|
| Rate for Payer: EmblemHealth Medicaid |
$169.40
|
| Rate for Payer: EmblemHealth Medicare |
$72.00
|
| Rate for Payer: EmblemHealth Select Care |
$6.27
|
| Rate for Payer: Fidelis Medicare |
$80.70
|
| Rate for Payer: Galaxy Health Commercial |
$137.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$78.35
|
| Rate for Payer: Humana Medicare |
$78.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$119.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$82.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$78.35
|
| Rate for Payer: WellCare Medicare |
$116.46
|
|
|
INJECTAFER 750 MG/15 ML VIAL 1 mg, 15 mL
|
Facility
|
OP
|
$7.36
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
4401329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna of NY Commercial |
$4.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.68
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: CDPHP Commercial |
$5.92
|
| Rate for Payer: CDPHP Medicare |
$2.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.89
|
| Rate for Payer: EmblemHealth Medicaid |
$5.89
|
| Rate for Payer: EmblemHealth Medicare |
$2.50
|
| Rate for Payer: EmblemHealth Select Care |
$1.09
|
| Rate for Payer: Fidelis Medicare |
$2.80
|
| Rate for Payer: Galaxy Health Commercial |
$4.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.72
|
| Rate for Payer: Humana Medicare |
$2.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Medicare |
$2.72
|
| Rate for Payer: WellCare Medicare |
$4.05
|
|
|
INJECTAFER 750 MG/15 ML VIAL 1 mg, 15 mL
|
Facility
|
IP
|
$7.36
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
4401329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna of NY Commercial |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.09
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.09
|
| Rate for Payer: EmblemHealth Select Care |
$1.09
|
| Rate for Payer: Galaxy Health Commercial |
$4.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.05
|
| Rate for Payer: WellCare Medicare |
$4.05
|
|
|
INJECTION AA&/STRD FEMORAL NERVE
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
4852016
|
|
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
|
|
|
INJECTION AA&/STRD FEMORAL NERVE
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
4852016
|
|
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
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
4853038
|
|
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
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
4853038
|
|
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
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
4853041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$868.45 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,825.60
|
| Rate for Payer: Aetna of NY Medicare |
$1,199.68
|
| 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 |
$964.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,304.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: CDPHP Commercial |
$2,099.44
|
| Rate for Payer: CDPHP Medicare |
$964.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,086.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,086.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicare |
$886.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,877.76
|
| Rate for Payer: Fidelis Medicare |
$993.91
|
| Rate for Payer: Galaxy Health Commercial |
$1,695.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$964.96
|
| Rate for Payer: Humana Medicare |
$964.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,825.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,199.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,956.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,468.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,013.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$868.45
|
| Rate for Payer: United Healthcare Medicare |
$964.96
|
| Rate for Payer: WellCare Medicare |
$1,434.40
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
4853041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.20 |
| Max. Negotiated Rate |
$1,695.20 |
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,695.20
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
4853040
|
|
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
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
4853040
|
|
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
|
|
|
INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4852012
|
|
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
|
|
|
INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4852012
|
|
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
|
|
|
INJECTION, BUPIVACAINE LIPOSOME, 1 MG
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4401899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
INJECTION, BUPIVACAINE LIPOSOME, 1 MG
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4401899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
INJECTION CEFTAZIDIME PER 500 MG
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4400145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Aetna of NY Commercial |
$10.62
|
| Rate for Payer: Aetna of NY Medicare |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.66
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: CDPHP Commercial |
$15.54
|
| Rate for Payer: CDPHP Medicare |
$7.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.45
|
| Rate for Payer: EmblemHealth Medicaid |
$15.45
|
| Rate for Payer: EmblemHealth Medicare |
$6.57
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| Rate for Payer: Fidelis Medicare |
$7.36
|
| Rate for Payer: Galaxy Health Commercial |
$12.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.14
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$7.14
|
| Rate for Payer: WellCare Medicare |
$10.62
|
|
|
INJECTION CEFTAZIDIME PER 500 MG
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4400145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna of NY Commercial |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.66
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| Rate for Payer: Galaxy Health Commercial |
$12.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.62
|
| Rate for Payer: WellCare Medicare |
$10.62
|
|
|
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
|
Facility
|
IP
|
$29.10
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
4400844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna of NY Commercial |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.02
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.02
|
| Rate for Payer: EmblemHealth Select Care |
$9.02
|
| Rate for Payer: Galaxy Health Commercial |
$18.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.00
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
|
Facility
|
OP
|
$29.10
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
4400844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna of NY Commercial |
$16.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.55
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: CDPHP Commercial |
$23.43
|
| Rate for Payer: CDPHP Medicare |
$10.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.28
|
| Rate for Payer: EmblemHealth Medicaid |
$23.28
|
| Rate for Payer: EmblemHealth Medicare |
$9.89
|
| Rate for Payer: EmblemHealth Select Care |
$9.02
|
| Rate for Payer: Fidelis Medicare |
$11.09
|
| Rate for Payer: Galaxy Health Commercial |
$18.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.77
|
| Rate for Payer: Humana Medicare |
$10.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$14.17
|
| Rate for Payer: United Healthcare Medicare |
$10.77
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
INJECTION, DURAMORPH, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10 MG
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
4401349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna of NY Commercial |
$35.20
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$14.43
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.43
|
| Rate for Payer: United Healthcare Commercial |
$25.91
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
INJECTION, DURAMORPH, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10 MG
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
4401349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Commercial |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.43
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.43
|
| Rate for Payer: EmblemHealth Select Care |
$14.43
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.20
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62273
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$636.00 |
| 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 |
$636.00
|
| 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 |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
