|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 64493
|
|
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 |
$868.45
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 64495
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$51.26 |
| 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 |
$51.26
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62321
|
|
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
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62323
|
|
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
|
|
|
INJECTION, SOLU-MedroL 125 mg
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of NY Commercial |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Galaxy Health Commercial |
$0.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.83
|
| Rate for Payer: WellCare Medicare |
$0.83
|
|
|
INJECTION, SOLU-MedroL 125 mg
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of NY Commercial |
$0.83
|
| Rate for Payer: Aetna of NY Medicare |
$0.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.75
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: CDPHP Commercial |
$1.21
|
| Rate for Payer: CDPHP Medicare |
$0.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1.20
|
| Rate for Payer: EmblemHealth Medicare |
$0.51
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$0.57
|
| Rate for Payer: Galaxy Health Commercial |
$0.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.56
|
| Rate for Payer: Humana Medicare |
$0.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WellCare Medicare |
$0.83
|
|
|
INJECTION, SOLU-MedroL 1 gm
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of NY Commercial |
$0.33
|
| Rate for Payer: Aetna of NY Medicare |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.30
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: CDPHP Commercial |
$0.48
|
| Rate for Payer: CDPHP Medicare |
$0.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.48
|
| Rate for Payer: EmblemHealth Medicaid |
$0.48
|
| Rate for Payer: EmblemHealth Medicare |
$0.20
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$0.23
|
| Rate for Payer: Galaxy Health Commercial |
$0.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.22
|
| Rate for Payer: Humana Medicare |
$0.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WellCare Medicare |
$0.33
|
|
|
INJECTION, SOLU-MedroL 1 gm
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of NY Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Galaxy Health Commercial |
$0.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.33
|
| Rate for Payer: WellCare Medicare |
$0.33
|
|
|
INJECTION, SOLU-MedroL 5 mg
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401949
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
INJECTION, SOLU-MedroL 5 mg
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4401949
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG
|
Facility
|
IP
|
$255.45
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$166.04 |
| Rate for Payer: Aetna of NY Commercial |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$191.59
|
| Rate for Payer: Cash Price |
$191.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Galaxy Health Commercial |
$166.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$140.50
|
| Rate for Payer: WellCare Medicare |
$140.50
|
|
|
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG
|
Facility
|
OP
|
$255.45
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Aetna of NY Commercial |
$140.50
|
| Rate for Payer: Aetna of NY Medicare |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$127.72
|
| Rate for Payer: Cash Price |
$191.59
|
| Rate for Payer: Cash Price |
$191.59
|
| Rate for Payer: CDPHP Commercial |
$205.64
|
| Rate for Payer: CDPHP Medicare |
$94.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$204.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$204.36
|
| Rate for Payer: EmblemHealth Medicaid |
$204.36
|
| Rate for Payer: EmblemHealth Medicare |
$86.85
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$97.35
|
| Rate for Payer: Galaxy Health Commercial |
$166.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.52
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$140.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$117.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$143.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$94.52
|
| Rate for Payer: WellCare Medicare |
$140.50
|
|
|
INJECT TRIGGER POINTS =/> 3
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4856669
|
|
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
|
|
|
INJECT TRIGGER POINTS =/> 3
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4850173
|
|
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
|
|
|
INJECT TRIGGER POINTS =/> 3
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4856669
|
|
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
|
|
|
INJECT TRIGGER POINTS =/> 3
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4850173
|
|
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
|
|
|
INJECT TRIGGER POINTS 3/>
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4601196
|
|
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
|
|
|
INJECT TRIGGER POINTS 3/>
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
4601196
|
|
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 FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64479
|
| Hospital Charge Code |
4850198
|
|
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
|
|
|
INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64479
|
| Hospital Charge Code |
4850198
|
|
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
|
|
|
INJ INTERLAM CRV/THRC W/ IMG
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
4853001
|
|
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 INTERLAM CRV/THRC W/ IMG
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
4853001
|
|
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 INTERLAM CRV/THRC W/O IMG
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
4853000
|
|
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 INTERLAM CRV/THRC W/O IMG
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
4853000
|
|
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 INTERLAM LMBR/SAC W/ IMG
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
4853003
|
|
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
|
|
