|
INJ PARAVERT F JNT L/S 1 LEV
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
4850188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.65 |
| Max. Negotiated Rate |
$2,168.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| 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: 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 |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,247.06
|
| Rate for Payer: Multiplan Commercial |
$2,168.80
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$406.65
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$1,084.40
|
| Rate for Payer: WellCare Medicare |
$1,491.05
|
|
|
INJ RETACRIT ESRD ON DIALYSIS, PER 100 UNITS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
4401954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna of NY Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.79
|
| Rate for Payer: EmblemHealth Select Care |
$0.79
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
INJ RETACRIT ESRD ON DIALYSIS, PER 100 UNITS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
4401954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$0.79
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
INJ RETACRIT NON-ESRD USE, PER 1000 UNITS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
4401953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.88
|
| Rate for Payer: EmblemHealth Select Care |
$7.88
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
INJ RETACRIT NON-ESRD USE, PER 1000 UNITS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
4401953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$320.00
|
| Rate for Payer: EmblemHealth Medicaid |
$320.00
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$7.88
|
| Rate for Payer: Fidelis Medicare |
$160.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.00
|
| Rate for Payer: Humana Medicare |
$160.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$225.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$168.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$12.38
|
| Rate for Payer: United Healthcare Medicare |
$160.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
INJ(S) FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
4851985
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.65 |
| Max. Negotiated Rate |
$2,168.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| 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: 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 |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,247.06
|
| Rate for Payer: Multiplan Commercial |
$2,168.80
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$406.65
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$1,084.40
|
| Rate for Payer: WellCare Medicare |
$1,491.05
|
|
|
INJ(S) FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
4851985
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
INJ SGL TENDON SHTH OR LIGAMENT
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4856653
|
|
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 SGL TENDON SHTH OR LIGAMENT
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4856653
|
|
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 SULF HEXA LIPID MICROSPH, PER ML (LUMASON)
|
Facility
|
OP
|
$95.79
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
4471372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Aetna of NY Medicare |
$44.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.32
|
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: CDPHP Medicare |
$35.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$76.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$76.63
|
| Rate for Payer: EmblemHealth Medicaid |
$76.63
|
| Rate for Payer: EmblemHealth Medicare |
$32.57
|
| Rate for Payer: EmblemHealth Select Care |
$18.12
|
| Rate for Payer: Fidelis Medicare |
$38.32
|
| Rate for Payer: Galaxy Health Commercial |
$62.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.32
|
| Rate for Payer: Humana Medicare |
$38.32
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare |
$38.32
|
| Rate for Payer: WellCare Medicare |
$52.68
|
|
|
INJ SULF HEXA LIPID MICROSPH, PER ML (LUMASON)
|
Facility
|
IP
|
$95.79
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
4471372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$62.26 |
| Rate for Payer: Aetna of NY Commercial |
$52.68
|
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.12
|
| Rate for Payer: EmblemHealth Select Care |
$18.12
|
| Rate for Payer: Galaxy Health Commercial |
$62.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.68
|
| Rate for Payer: WellCare Medicare |
$52.68
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4609654
|
|
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 TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4609654
|
|
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 TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4601195
|
|
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 TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4601195
|
|
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
|
|
|
INNER CANNULA DISPOSABLE
|
Facility
|
IP
|
$27.81
|
|
| Hospital Charge Code |
4479110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
|
|
INNER CANNULA DISPOSABLE
|
Facility
|
OP
|
$27.81
|
|
| Hospital Charge Code |
4479110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of NY Commercial |
$19.47
|
| Rate for Payer: Aetna of NY Medicare |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: CDPHP Medicare |
$10.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.25
|
| Rate for Payer: EmblemHealth Medicaid |
$22.25
|
| Rate for Payer: EmblemHealth Medicare |
$9.46
|
| Rate for Payer: EmblemHealth Select Care |
$20.02
|
| Rate for Payer: Fidelis Medicare |
$11.12
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.12
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: WellCare Medicare |
$15.30
|
|
|
INSERT BLADDER CATHETER
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4852006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
INSERT BLADDER CATHETER
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4852006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
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 |
$1,900.00 |
| Max. Negotiated Rate |
$12,539.82 |
| 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 |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12,539.82
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
|
|
INSERTION OF PICC,W/O SUBCUTANEOUS PORT
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
4850252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,377.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,474.00
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,377.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,618.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,716.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,026.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
|
INSERTION OF PICC,W/O SUBCUTANEOUS PORT
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
4850252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
|
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 |
$1,900.00 |
| Max. Negotiated Rate |
$29,586.29 |
| 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 |
$2,763.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29,586.29
|
| Rate for Payer: United Healthcare Commercial |
$2,763.00
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4852013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,377.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,474.00
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,377.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,618.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,716.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,026.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4852013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
