|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4852009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4852009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4602220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
INJ ANESTH; OTHR PERIPHERAL NRV/BRANCH
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4852010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
INJ ANESTH; OTHR PERIPHERAL NRV/BRANCH
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4852010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
INJ ANESTH ; TRIGEMINAL NERVE
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4609658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
INJ ANESTH ; TRIGEMINAL NERVE
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4609658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
INJ CLONIDINE HCL 1 MG
|
Facility
|
OP
|
$162.23
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
4400175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Aetna of NY Medicare |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.89
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: CDPHP Medicare |
$60.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.78
|
| Rate for Payer: EmblemHealth Medicaid |
$129.78
|
| Rate for Payer: EmblemHealth Medicare |
$55.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.92
|
| Rate for Payer: Fidelis Medicare |
$64.89
|
| Rate for Payer: Galaxy Health Commercial |
$105.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.89
|
| Rate for Payer: Humana Medicare |
$64.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$68.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$34.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.33
|
| Rate for Payer: United Healthcare Commercial |
$34.72
|
| Rate for Payer: United Healthcare Medicare |
$64.89
|
| Rate for Payer: WellCare Medicare |
$89.23
|
|
|
INJ CLONIDINE HCL 1 MG
|
Facility
|
IP
|
$162.23
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
4400175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of NY Commercial |
$89.23
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: Cash Price |
$121.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.92
|
| Rate for Payer: EmblemHealth Select Care |
$17.92
|
| Rate for Payer: Galaxy Health Commercial |
$105.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.23
|
| Rate for Payer: WellCare Medicare |
$89.23
|
|
|
INJ DESMOPRESSIN ACETATE PER 1 MCG
|
Facility
|
IP
|
$211.75
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
4400214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna of NY Commercial |
$116.46
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$3.41
|
| Rate for Payer: Galaxy Health Commercial |
$137.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.46
|
| Rate for Payer: WellCare Medicare |
$116.46
|
|
|
INJ DESMOPRESSIN ACETATE PER 1 MCG
|
Facility
|
OP
|
$211.75
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
4400214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Aetna of NY Medicare |
$97.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.70
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: Cash Price |
$158.81
|
| Rate for Payer: CDPHP Medicare |
$78.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$169.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$169.40
|
| Rate for Payer: EmblemHealth Medicaid |
$169.40
|
| Rate for Payer: EmblemHealth Medicare |
$72.00
|
| Rate for Payer: EmblemHealth Select Care |
$3.41
|
| Rate for Payer: Fidelis Medicare |
$84.70
|
| Rate for Payer: Galaxy Health Commercial |
$137.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.70
|
| Rate for Payer: Humana Medicare |
$84.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$119.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.76
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$84.70
|
| Rate for Payer: WellCare Medicare |
$116.46
|
|
|
INJECTAFER 750 MG/15 ML VIAL 1 mg, 15 mL
|
Facility
|
IP
|
$7.36
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
4401329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna of NY Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.10
|
| Rate for Payer: EmblemHealth Select Care |
$1.10
|
| Rate for Payer: Galaxy Health Commercial |
$4.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.05
|
| Rate for Payer: WellCare Medicare |
$4.05
|
|
|
INJECTAFER 750 MG/15 ML VIAL 1 mg, 15 mL
|
Facility
|
OP
|
$7.36
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
4401329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Aetna of NY Medicare |
$3.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: CDPHP Medicare |
$2.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.89
|
| Rate for Payer: EmblemHealth Medicaid |
$5.89
|
| Rate for Payer: EmblemHealth Medicare |
$2.50
|
| Rate for Payer: EmblemHealth Select Care |
$1.10
|
| Rate for Payer: Fidelis Medicare |
$2.94
|
| Rate for Payer: Galaxy Health Commercial |
$4.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.94
|
| Rate for Payer: Humana Medicare |
$2.94
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Medicare |
$2.94
|
| Rate for Payer: WellCare Medicare |
$4.05
|
|
|
INJECTION AA&/STRD FEMORAL NERVE
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
4852016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
INJECTION AA&/STRD FEMORAL NERVE
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
4852016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
4853038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
4853038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
4853041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,762.15 |
| Max. Negotiated Rate |
$1,762.15 |
| Rate for Payer: Cash Price |
$2,033.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,762.15
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
4853041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.65 |
| Max. Negotiated Rate |
$2,168.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,897.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,247.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,084.40
|
| Rate for Payer: Cash Price |
$2,033.25
|
| Rate for Payer: CDPHP Medicare |
$1,003.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,168.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,168.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,168.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,168.80
|
| Rate for Payer: EmblemHealth Medicare |
$921.74
|
| Rate for Payer: EmblemHealth Select Care |
$1,951.92
|
| Rate for Payer: Fidelis Medicare |
$1,084.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,762.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,084.40
|
| Rate for Payer: Humana Medicare |
$1,084.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,897.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,247.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,033.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,526.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,138.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$406.65
|
| Rate for Payer: United Healthcare Medicare |
$1,084.40
|
| Rate for Payer: WellCare Medicare |
$1,491.05
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
4853040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
4853040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4852012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
4852012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.15 |
| Max. Negotiated Rate |
$752.80 |
| Rate for Payer: Aetna of NY Commercial |
$658.70
|
| Rate for Payer: Aetna of NY Medicare |
$432.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$376.40
|
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: CDPHP Medicare |
$348.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$752.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$752.80
|
| Rate for Payer: EmblemHealth Medicaid |
$752.80
|
| Rate for Payer: EmblemHealth Medicare |
$319.94
|
| Rate for Payer: EmblemHealth Select Care |
$677.52
|
| Rate for Payer: Fidelis Medicare |
$376.40
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$376.40
|
| Rate for Payer: Humana Medicare |
$376.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$658.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$432.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$529.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$395.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.15
|
| Rate for Payer: United Healthcare Medicare |
$376.40
|
| Rate for Payer: WellCare Medicare |
$517.55
|
|
|
INJECTION, BUPIVACAINE LIPOSOME, 1 MG
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4401899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.80
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.80
|
| Rate for Payer: Humana Medicare |
$4.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
INJECTION, BUPIVACAINE LIPOSOME, 1 MG
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4401899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
