|
INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Facility
|
OP
|
$9,212.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4601204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,415.66 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,237.52
|
| 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 |
$3,408.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,606.00
|
| Rate for Payer: Cash Price |
$6,909.00
|
| Rate for Payer: Cash Price |
$6,909.00
|
| Rate for Payer: Cash Price |
$6,909.00
|
| Rate for Payer: Cash Price |
$6,909.00
|
| Rate for Payer: CDPHP Commercial |
$7,415.66
|
| Rate for Payer: CDPHP Medicare |
$3,408.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,369.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,369.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,369.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,132.08
|
| 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 |
$3,510.69
|
| Rate for Payer: Galaxy Health Commercial |
$5,987.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,408.44
|
| Rate for Payer: Humana Medicare |
$3,408.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,237.52
|
| 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 |
$3,578.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,067.62
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,408.44
|
| Rate for Payer: WellCare Medicare |
$5,066.60
|
|
|
INTUBATION ET EMERGENT
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4601988
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$232.73 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Aetna of NY Commercial |
$489.30
|
| Rate for Payer: Aetna of NY Medicare |
$321.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$524.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$524.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$258.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$349.50
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: CDPHP Commercial |
$562.70
|
| Rate for Payer: CDPHP Medicare |
$258.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$559.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$559.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$559.20
|
| Rate for Payer: EmblemHealth Medicaid |
$559.20
|
| Rate for Payer: EmblemHealth Medicare |
$237.66
|
| Rate for Payer: EmblemHealth Select Care |
$503.28
|
| Rate for Payer: Fidelis Medicare |
$266.39
|
| Rate for Payer: Galaxy Health Commercial |
$454.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$258.63
|
| Rate for Payer: Humana Medicare |
$258.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$489.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$321.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$393.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$271.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$232.73
|
| Rate for Payer: United Healthcare Medicare |
$258.63
|
| Rate for Payer: WellCare Medicare |
$384.45
|
|
|
INTUBATION ET EMERGENT
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4601988
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$454.35 |
| Max. Negotiated Rate |
$454.35 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Galaxy Health Commercial |
$454.35
|
|
|
INTUBATION MED SURG
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4530047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$454.35 |
| Max. Negotiated Rate |
$454.35 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Galaxy Health Commercial |
$454.35
|
|
|
INTUBATION MED SURG
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4530047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$232.73 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Aetna of NY Commercial |
$489.30
|
| Rate for Payer: Aetna of NY Medicare |
$321.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$524.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$524.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$258.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$349.50
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: CDPHP Commercial |
$562.70
|
| Rate for Payer: CDPHP Medicare |
$258.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$559.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$559.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$559.20
|
| Rate for Payer: EmblemHealth Medicaid |
$559.20
|
| Rate for Payer: EmblemHealth Medicare |
$237.66
|
| Rate for Payer: EmblemHealth Select Care |
$503.28
|
| Rate for Payer: Fidelis Medicare |
$266.39
|
| Rate for Payer: Galaxy Health Commercial |
$454.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$258.63
|
| Rate for Payer: Humana Medicare |
$258.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$489.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$321.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$393.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$271.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$232.73
|
| Rate for Payer: United Healthcare Medicare |
$258.63
|
| Rate for Payer: WellCare Medicare |
$384.45
|
|
|
IODINE I-123 IOBENGUANE =< 15 MCI
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
4210080
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$3,745.67 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3,745.67
|
| Rate for Payer: United Healthcare Commercial |
$3,745.67
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
IODINE I-123 IOBENGUANE =< 15 MCI
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
4210080
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
IODINE I-123 SOD IODIDE 100-999 UCI
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
4210058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$247.65 |
| Max. Negotiated Rate |
$247.65 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Galaxy Health Commercial |
$247.65
|
|
|
IODINE I-123 SOD IODIDE 100-999 UCI
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
4210058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$306.70 |
| Rate for Payer: Aetna of NY Medicare |
$175.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$285.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$285.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$140.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$190.50
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: CDPHP Commercial |
$306.70
|
| Rate for Payer: CDPHP Medicare |
$140.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$304.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$304.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$304.80
|
| Rate for Payer: EmblemHealth Medicaid |
$304.80
|
| Rate for Payer: EmblemHealth Medicare |
$129.54
|
| Rate for Payer: EmblemHealth Select Care |
$274.32
|
| Rate for Payer: Fidelis Medicare |
$145.20
|
| Rate for Payer: Galaxy Health Commercial |
$247.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$140.97
|
| Rate for Payer: Humana Medicare |
$140.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$175.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$285.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$214.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$148.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$192.90
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
| Rate for Payer: United Healthcare Medicare |
$140.97
|
| Rate for Payer: WellCare Medicare |
$209.55
|
|
|
IODINE I-123 SOD IODIDE MIL PER 1 MCI
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
4210081
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
IODINE I-123 SOD IODIDE MIL PER 1 MCI
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
4210081
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$309.77 |
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.50
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Commercial |
$28.18
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$13.34
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.95
|
| Rate for Payer: Humana Medicare |
$12.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$309.77
|
| Rate for Payer: United Healthcare Commercial |
$309.77
|
| Rate for Payer: United Healthcare Medicare |
$12.95
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
|
IODINE I-125 SERUM ALBUMIN DX PER 5 UCI
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS A9532
|
| Hospital Charge Code |
4210076
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
IODINE I-125 SERUM ALBUMIN DX PER 5 UCI
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS A9532
|
| Hospital Charge Code |
4210076
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$354.49 |
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$354.49
|
| Rate for Payer: United Healthcare Commercial |
$354.49
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
IODOSORB GEL 40 g, 40 g
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
NDC 40565012249
|
| Hospital Charge Code |
4401556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$206.88 |
| Rate for Payer: Aetna of NY Commercial |
$179.90
|
| Rate for Payer: Aetna of NY Medicare |
$118.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$192.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$192.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$95.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$128.50
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: CDPHP Commercial |
$206.88
|
| Rate for Payer: CDPHP Medicare |
$95.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$205.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$205.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$205.60
|
| Rate for Payer: EmblemHealth Medicaid |
$205.60
|
| Rate for Payer: EmblemHealth Medicare |
$87.38
|
| Rate for Payer: EmblemHealth Select Care |
$185.04
|
| Rate for Payer: Fidelis Medicare |
$97.94
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$95.09
|
| Rate for Payer: Humana Medicare |
$95.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$179.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$118.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$144.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.84
|
| Rate for Payer: United Healthcare Medicare |
$95.09
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
IODOSORB GEL 40 g, 40 g
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
NDC 40565012249
|
| Hospital Charge Code |
4401556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.35 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
IONIZED CALCIUM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4300495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$79.70 |
| Rate for Payer: Aetna of NY Commercial |
$64.35
|
| Rate for Payer: Aetna of NY Medicare |
$45.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.50
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: CDPHP Commercial |
$79.70
|
| Rate for Payer: CDPHP Medicare |
$36.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$79.20
|
| Rate for Payer: EmblemHealth Medicaid |
$79.20
|
| Rate for Payer: EmblemHealth Medicare |
$33.66
|
| Rate for Payer: EmblemHealth Select Care |
$59.40
|
| Rate for Payer: Fidelis Medicare |
$37.73
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.63
|
| Rate for Payer: Humana Medicare |
$36.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$74.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$74.25
|
| Rate for Payer: United Healthcare Medicare |
$36.63
|
| Rate for Payer: WellCare Medicare |
$54.45
|
|
|
IONIZED CALCIUM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4300495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
|
|
IPG GENERATOR SC-1110-02
|
Facility
|
IP
|
$75,693.00
|
|
| Hospital Charge Code |
4479090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34,061.85 |
| Max. Negotiated Rate |
$52,985.10 |
| Rate for Payer: Aetna of NY Commercial |
$52,985.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34,061.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34,061.85
|
| Rate for Payer: Cash Price |
$56,769.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37,846.50
|
| Rate for Payer: EmblemHealth Select Care |
$37,846.50
|
| Rate for Payer: Galaxy Health Commercial |
$49,200.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52,985.10
|
| Rate for Payer: Multiplan Commercial |
$34,061.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49,200.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49,200.45
|
| Rate for Payer: WellCare Medicare |
$41,631.15
|
|
|
IPG GENERATOR SC-1110-02
|
Facility
|
OP
|
$75,693.00
|
|
| Hospital Charge Code |
4479090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,735.62 |
| Max. Negotiated Rate |
$60,932.86 |
| Rate for Payer: Aetna of NY Commercial |
$52,985.10
|
| Rate for Payer: Aetna of NY Medicare |
$34,818.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34,061.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34,061.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28,006.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37,846.50
|
| Rate for Payer: Cash Price |
$56,769.75
|
| Rate for Payer: CDPHP Commercial |
$60,932.86
|
| Rate for Payer: CDPHP Medicare |
$28,006.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37,846.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60,554.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60,554.40
|
| Rate for Payer: EmblemHealth Medicaid |
$60,554.40
|
| Rate for Payer: EmblemHealth Medicare |
$25,735.62
|
| Rate for Payer: EmblemHealth Select Care |
$37,846.50
|
| Rate for Payer: Fidelis Medicare |
$28,846.60
|
| Rate for Payer: Galaxy Health Commercial |
$49,200.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$28,006.41
|
| Rate for Payer: Humana Medicare |
$28,006.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52,985.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$34,818.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49,200.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49,200.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29,406.73
|
| Rate for Payer: United Healthcare Medicare |
$28,006.41
|
| Rate for Payer: WellCare Medicare |
$41,631.15
|
|
|
IPRATROPIUM BROMIDE 0.2MG/ML AMIH 60X2.5
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00487980160
|
| Hospital Charge Code |
4400393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
IPRATROPIUM BROMIDE 0.2MG/ML AMIH 60X2.5
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00487980160
|
| Hospital Charge Code |
4400393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
IRON
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
4300496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$22.20
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
IRON
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
4300496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
4602235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| 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 |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| 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 |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
4602235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
