|
INJ INTERLAM LMBR/SAC W/ IMG
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
4853003
|
|
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/O IMG
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
4853002
|
|
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 LMBR/SAC W/O IMG
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
4853002
|
|
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 INTLAM W/ CATH C/T W/ IMG
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
4853005
|
|
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 INTLAM W/ CATH C/T W/ IMG
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
4853005
|
|
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 INTLAM W/ CATH C/T W/O IMG
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62324
|
| Hospital Charge Code |
4853004
|
|
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 INTLAM W/ CATH C/T W/O IMG
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62324
|
| Hospital Charge Code |
4853004
|
|
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 INTLAM W/ CATH L/S W/ IMG
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
4853007
|
|
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 INTLAM W/ CATH L/S W/ IMG
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
4853007
|
|
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 INTLAM W/ CATH L/S W/O IMG
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
4853006
|
|
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 INTLAM W/ CATH L/S W/O IMG
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
4853006
|
|
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 MAGNESIUM SULFATE/500 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4450011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| 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: 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 |
$0.64
|
| 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 |
$0.64
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INJ MAGNESIUM SULFATE/500 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4450011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.64
|
| Rate for Payer: EmblemHealth Select Care |
$0.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INJ PARAVERT F JNT L/S 1 LEV
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
4850188
|
|
Hospital Revenue Code
|
361
|
| 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 PARAVERT F JNT L/S 1 LEV
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
4850188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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 |
$636.00
|
| 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 |
$1,857.00
|
| 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: 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
|
| Rate for Payer: United Healthcare Medicare |
$964.96
|
| Rate for Payer: WellCare Medicare |
$1,434.40
|
|
|
INJ(S) FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
4851985
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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 |
$636.00
|
| 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 |
$1,857.00
|
| 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: 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
|
| Rate for Payer: United Healthcare Medicare |
$964.96
|
| Rate for Payer: WellCare Medicare |
$1,434.40
|
|
|
INJ(S) FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
4851985
|
|
Hospital Revenue Code
|
361
|
| 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 SGL TENDON SHTH OR LIGAMENT
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4856653
|
|
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 SGL TENDON SHTH OR LIGAMENT
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4856653
|
|
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 SULF HEXA LIPID MICROSPH, PER ML (LUMASON)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
4471372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna of NY Commercial |
$51.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.94
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.94
|
| Rate for Payer: EmblemHealth Select Care |
$18.94
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.15
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
INJ SULF HEXA LIPID MICROSPH, PER ML (LUMASON)
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
4471372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna of NY Commercial |
$51.15
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.50
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Commercial |
$74.86
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: EmblemHealth Select Care |
$18.94
|
| Rate for Payer: Fidelis Medicare |
$35.44
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.41
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.94
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare |
$34.41
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4601195
|
|
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 TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4601195
|
|
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
|
|
|
INNER CANNULA DISPOSABLE
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4479110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
INNER CANNULA DISPOSABLE
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4479110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
