|
INJECTION CEFTAZIDIME PER 500 MG
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4400145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Aetna of NY Medicare |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.72
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: CDPHP Medicare |
$7.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.45
|
| Rate for Payer: EmblemHealth Medicaid |
$15.45
|
| Rate for Payer: EmblemHealth Medicare |
$6.57
|
| Rate for Payer: EmblemHealth Select Care |
$1.41
|
| Rate for Payer: Fidelis Medicare |
$7.72
|
| Rate for Payer: Galaxy Health Commercial |
$12.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.72
|
| Rate for Payer: Humana Medicare |
$7.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.90
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$7.72
|
| Rate for Payer: WellCare Medicare |
$10.62
|
|
|
INJECTION CEFTAZIDIME PER 500 MG
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4400145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna of NY Commercial |
$10.62
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.41
|
| Rate for Payer: EmblemHealth Select Care |
$1.41
|
| Rate for Payer: Galaxy Health Commercial |
$12.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.62
|
| Rate for Payer: WellCare Medicare |
$10.62
|
|
|
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
|
Facility
|
IP
|
$29.10
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
4400844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna of NY Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.58
|
| Rate for Payer: EmblemHealth Select Care |
$8.58
|
| Rate for Payer: Galaxy Health Commercial |
$18.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.00
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
|
Facility
|
OP
|
$29.10
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
4400844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna of NY Medicare |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.64
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: CDPHP Medicare |
$10.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.28
|
| Rate for Payer: EmblemHealth Medicaid |
$23.28
|
| Rate for Payer: EmblemHealth Medicare |
$9.89
|
| Rate for Payer: EmblemHealth Select Care |
$8.58
|
| Rate for Payer: Fidelis Medicare |
$11.64
|
| Rate for Payer: Galaxy Health Commercial |
$18.91
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.64
|
| Rate for Payer: Humana Medicare |
$11.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$14.17
|
| Rate for Payer: United Healthcare Medicare |
$11.64
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
INJECTION, DURAMORPH, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10 MG
|
Facility
|
IP
|
$65.92
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
4401349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna of NY Commercial |
$36.26
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Select Care |
$12.15
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.26
|
| Rate for Payer: WellCare Medicare |
$36.26
|
|
|
INJECTION, DURAMORPH, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10 MG
|
Facility
|
OP
|
$65.92
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
4401349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of NY Medicare |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.37
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: CDPHP Medicare |
$24.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.74
|
| Rate for Payer: EmblemHealth Medicaid |
$52.74
|
| Rate for Payer: EmblemHealth Medicare |
$22.41
|
| Rate for Payer: EmblemHealth Select Care |
$12.15
|
| Rate for Payer: Fidelis Medicare |
$26.37
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.37
|
| Rate for Payer: Humana Medicare |
$26.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$25.91
|
| Rate for Payer: United Healthcare Medicare |
$26.37
|
| Rate for Payer: WellCare Medicare |
$36.26
|
|
|
INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 62273
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
INJECTION, GADOXETATE DISODIUM, 1 ML (EOVIST)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
4401952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna of NY Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.73
|
| Rate for Payer: EmblemHealth Select Care |
$14.73
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.60
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
INJECTION, GADOXETATE DISODIUM, 1 ML (EOVIST)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
4401952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$14.73
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
INJECTION, HYDROMORPHONE, UP TO 4 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4409126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INJECTION, HYDROMORPHONE, UP TO 4 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4409126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| 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
|
|
|
INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, (AVSOLA), 10 MG
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
4401966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of NY Medicare |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: CDPHP Medicare |
$66.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.00
|
| Rate for Payer: EmblemHealth Medicaid |
$144.00
|
| Rate for Payer: EmblemHealth Medicare |
$61.20
|
| Rate for Payer: EmblemHealth Select Care |
$28.04
|
| Rate for Payer: Fidelis Medicare |
$72.00
|
| Rate for Payer: Galaxy Health Commercial |
$117.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.00
|
| Rate for Payer: Humana Medicare |
$72.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$46.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$46.74
|
| Rate for Payer: United Healthcare Medicare |
$72.00
|
| Rate for Payer: WellCare Medicare |
$99.00
|
|
|
INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, (AVSOLA), 10 MG
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
4401966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of NY Commercial |
$99.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.04
|
| Rate for Payer: EmblemHealth Select Care |
$28.04
|
| Rate for Payer: Galaxy Health Commercial |
$117.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$99.00
|
| Rate for Payer: WellCare Medicare |
$99.00
|
|
|
INJECTION INTO SKIN LESIONS =<7
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
4853012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
INJECTION INTO SKIN LESIONS =<7
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
4853012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$430.50
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$430.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$346.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
INJECTION, METHYLPREDNISOLONE ACETATE,40 MG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4401946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
INJECTION, METHYLPREDNISOLONE ACETATE,40 MG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4401946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$16.80
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
INJECTION, METHYLPREDNISOLONE ACETATE,80 MG
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4401950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Aetna of NY Commercial |
$46.20
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$54.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.20
|
| Rate for Payer: WellCare Medicare |
$46.20
|
|
|
INJECTION, METHYLPREDNISOLONE ACETATE,80 MG
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4401950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna of NY Medicare |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$33.60
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: CDPHP Medicare |
$31.08
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$67.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$67.20
|
| Rate for Payer: EmblemHealth Medicaid |
$67.20
|
| Rate for Payer: EmblemHealth Medicare |
$28.56
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$33.60
|
| Rate for Payer: Galaxy Health Commercial |
$54.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$33.60
|
| Rate for Payer: Humana Medicare |
$33.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.60
|
| Rate for Payer: United Healthcare Medicare |
$33.60
|
| Rate for Payer: WellCare Medicare |
$46.20
|
|
|
INJECTION, OCRELIZUMAB, 1 MG
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
4400117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna of NY Commercial |
$126.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.60
|
| Rate for Payer: EmblemHealth Select Care |
$59.60
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.50
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
|
INJECTION, OCRELIZUMAB, 1 MG
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
4400117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna of NY Medicare |
$105.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: CDPHP Medicare |
$85.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.00
|
| Rate for Payer: EmblemHealth Medicaid |
$184.00
|
| Rate for Payer: EmblemHealth Medicare |
$78.20
|
| Rate for Payer: EmblemHealth Select Care |
$59.60
|
| Rate for Payer: Fidelis Medicare |
$92.00
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.00
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$129.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$101.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.50
|
| Rate for Payer: United Healthcare Commercial |
$101.34
|
| Rate for Payer: United Healthcare Medicare |
$92.00
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
|
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 27095
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$80.89
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT ANESTHESIA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 27093
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$66.91 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$66.91
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 64447
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 64454
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
