|
INSERT BLADDER CATHETER
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4852006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$263.52
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INSERT BLADDER CATHETER
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4852006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT OPEN DECOMPRESSION OR FUSION, INCLUDING IMAGE GUIDANCE WHEN PERFORMED, LUMBAR; SINGLE LEVEL
|
Facility
|
OP
|
$12,539.82
|
|
|
Service Code
|
CPT 22869
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$12,539.82 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,421.00
|
| 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 |
$12,539.82
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
|
|
INSERTION OF PICC,W/O SUBCUTANEOUS PORT
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
4850252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$3,299.76
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
INSERTION OF PICC,W/O SUBCUTANEOUS PORT
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
4850252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$29,586.29
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$29,586.29 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,640.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29,586.29
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4852013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4852013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$3,299.76
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Facility
|
OP
|
$62,594.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
4002012
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$50,388.17 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$28,793.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23,159.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,640.00
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: CDPHP Commercial |
$50,388.17
|
| Rate for Payer: CDPHP Medicare |
$23,159.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$50,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$21,281.96
|
| Rate for Payer: EmblemHealth Select Care |
$45,067.68
|
| Rate for Payer: Fidelis Medicare |
$23,854.57
|
| Rate for Payer: Galaxy Health Commercial |
$40,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$23,159.78
|
| Rate for Payer: Humana Medicare |
$23,159.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28,793.24
|
| Rate for Payer: Multiplan Commercial |
$50,075.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46,945.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,240.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24,317.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20,842.84
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare |
$23,159.78
|
| Rate for Payer: WellCare Medicare |
$34,426.70
|
|
|
INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Facility
|
IP
|
$62,594.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
4002012
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$40,686.10 |
| Max. Negotiated Rate |
$40,686.10 |
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: Galaxy Health Commercial |
$40,686.10
|
|
|
INSERT NON-TUNNEL CV CATH <5 YRS
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
4602153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,928.65 |
| Max. Negotiated Rate |
$5,928.65 |
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
|
|
INSERT NON-TUNNEL CV CATH <5 YRS
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
4602153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,342.40 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,195.66
|
| 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 |
$3,374.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,560.50
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: CDPHP Commercial |
$7,342.40
|
| Rate for Payer: CDPHP Medicare |
$3,374.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,296.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,101.14
|
| 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 |
$3,476.01
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,374.77
|
| Rate for Payer: Humana Medicare |
$3,374.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,195.66
|
| 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 |
$3,543.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,037.01
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,374.77
|
| Rate for Payer: WellCare Medicare |
$5,016.55
|
|
|
IN SITU HYBRIDIZATION 1ST PROBE STAIN
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
4008365
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$213.32 |
| Rate for Payer: Aetna of NY Commercial |
$172.25
|
| Rate for Payer: Aetna of NY Medicare |
$121.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$132.50
|
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: CDPHP Commercial |
$213.32
|
| Rate for Payer: CDPHP Medicare |
$98.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.00
|
| Rate for Payer: EmblemHealth Medicaid |
$212.00
|
| Rate for Payer: EmblemHealth Medicare |
$90.10
|
| Rate for Payer: EmblemHealth Select Care |
$159.00
|
| Rate for Payer: Fidelis Medicare |
$100.99
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.05
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$102.95
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$198.75
|
| Rate for Payer: United Healthcare Commercial |
$198.75
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
| Rate for Payer: WellCare Medicare |
$145.75
|
|
|
IN SITU HYBRIDIZATION 1ST PROBE STAIN
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
4008365
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
|
|
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Hospital Charge Code |
4008364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$130.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: CDPHP Commercial |
$161.00
|
| Rate for Payer: CDPHP Medicare |
$74.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$120.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.00
|
| Rate for Payer: EmblemHealth Medicaid |
$160.00
|
| Rate for Payer: EmblemHealth Medicare |
$68.00
|
| Rate for Payer: EmblemHealth Select Care |
$120.00
|
| Rate for Payer: Fidelis Medicare |
$76.22
|
| Rate for Payer: Galaxy Health Commercial |
$130.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.00
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$130.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$150.00
|
| Rate for Payer: United Healthcare Medicare |
$74.00
|
| Rate for Payer: WellCare Medicare |
$110.00
|
|
|
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Hospital Charge Code |
4008364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Galaxy Health Commercial |
$130.00
|
|
|
INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
IP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 53445
|
| Hospital Charge Code |
4002070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$37,517.35 |
| Max. Negotiated Rate |
$37,517.35 |
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
|
|
INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 53445
|
| Hospital Charge Code |
4002070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: EmblemHealth Select Care |
$41,557.68
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Facility
|
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
4002067
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: EmblemHealth Select Care |
$41,557.68
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Facility
|
IP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
4002067
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$37,517.35 |
| Max. Negotiated Rate |
$37,517.35 |
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
|
|
INS NON-TUNNEL CV CATH 5 YRS/>
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
4609603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,342.40 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,195.66
|
| 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 |
$3,374.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,560.50
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: CDPHP Commercial |
$7,342.40
|
| Rate for Payer: CDPHP Medicare |
$3,374.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,296.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,101.14
|
| 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 |
$3,476.01
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,374.77
|
| Rate for Payer: Humana Medicare |
$3,374.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,195.66
|
| 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 |
$3,543.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,037.01
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,374.77
|
| Rate for Payer: WellCare Medicare |
$5,016.55
|
|
|
INS NON-TUNNEL CV CATH 5 YRS/>
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
4609603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,928.65 |
| Max. Negotiated Rate |
$5,928.65 |
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
|
|
INS TEMP BLADDER CATH (FOLEY CATH)
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4600050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
INS TEMP BLADDER CATH (FOLEY CATH)
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4600050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| 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 |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| 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 |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4851253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$263.52
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
