|
INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Facility
|
IP
|
$64,333.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
4002012
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$41,816.45 |
| Max. Negotiated Rate |
$41,816.45 |
| Rate for Payer: Cash Price |
$48,249.75
|
| Rate for Payer: Galaxy Health Commercial |
$41,816.45
|
|
|
INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Facility
|
OP
|
$64,333.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
4002012
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$51,466.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$29,593.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,733.20
|
| Rate for Payer: Cash Price |
$48,249.75
|
| Rate for Payer: Cash Price |
$48,249.75
|
| Rate for Payer: CDPHP Medicare |
$23,803.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51,466.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51,466.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51,466.40
|
| Rate for Payer: EmblemHealth Medicaid |
$51,466.40
|
| Rate for Payer: EmblemHealth Medicare |
$21,873.22
|
| Rate for Payer: EmblemHealth Select Care |
$46,319.76
|
| Rate for Payer: Fidelis Medicare |
$25,733.20
|
| Rate for Payer: Galaxy Health Commercial |
$41,816.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,733.20
|
| Rate for Payer: Humana Medicare |
$25,733.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,593.18
|
| Rate for Payer: Multiplan Commercial |
$51,466.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48,249.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36,219.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27,019.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,763.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,649.95
|
| Rate for Payer: United Healthcare Commercial |
$2,763.00
|
| Rate for Payer: United Healthcare Medicare |
$25,733.20
|
| Rate for Payer: WellCare Medicare |
$35,383.15
|
|
|
INSERT NON-TUNNEL CV CATH <5 YRS
|
Facility
|
OP
|
$9,678.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
4602153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$7,742.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,451.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,871.20
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: CDPHP Medicare |
$3,580.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,742.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,742.40
|
| Rate for Payer: EmblemHealth Medicaid |
$7,742.40
|
| Rate for Payer: EmblemHealth Medicare |
$3,290.52
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$3,871.20
|
| Rate for Payer: Galaxy Health Commercial |
$6,290.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,871.20
|
| Rate for Payer: Humana Medicare |
$3,871.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,451.88
|
| 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 |
$4,064.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,451.70
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$3,871.20
|
| Rate for Payer: WellCare Medicare |
$5,322.90
|
|
|
INSERT NON-TUNNEL CV CATH <5 YRS
|
Facility
|
IP
|
$9,678.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
4602153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,290.70 |
| Max. Negotiated Rate |
$6,290.70 |
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,290.70
|
|
|
IN SITU HYBRIDIZATION 1ST PROBE STAIN
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
4008365
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
|
|
IN SITU HYBRIDIZATION 1ST PROBE STAIN
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
4008365
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of NY Commercial |
$339.30
|
| Rate for Payer: Aetna of NY Medicare |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: CDPHP Medicare |
$193.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$417.60
|
| Rate for Payer: EmblemHealth Medicare |
$177.48
|
| Rate for Payer: EmblemHealth Select Care |
$313.20
|
| Rate for Payer: Fidelis Medicare |
$208.80
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$208.80
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$339.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$240.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$391.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$293.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$391.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WellCare Medicare |
$287.10
|
|
|
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Hospital Charge Code |
4008364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Cash Price |
$311.25
|
| Rate for Payer: Galaxy Health Commercial |
$269.75
|
|
|
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Hospital Charge Code |
4008364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna of NY Commercial |
$269.75
|
| Rate for Payer: Aetna of NY Medicare |
$190.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.00
|
| Rate for Payer: Cash Price |
$311.25
|
| Rate for Payer: CDPHP Medicare |
$153.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$249.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$332.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$332.00
|
| Rate for Payer: EmblemHealth Medicaid |
$332.00
|
| Rate for Payer: EmblemHealth Medicare |
$141.10
|
| Rate for Payer: EmblemHealth Select Care |
$249.00
|
| Rate for Payer: Fidelis Medicare |
$166.00
|
| Rate for Payer: Galaxy Health Commercial |
$269.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.00
|
| Rate for Payer: Humana Medicare |
$166.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$269.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$190.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$233.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$174.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$311.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$62.25
|
| Rate for Payer: United Healthcare Commercial |
$311.25
|
| Rate for Payer: United Healthcare Medicare |
$166.00
|
| Rate for Payer: WellCare Medicare |
$228.25
|
|
|
INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
IP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 53445
|
| Hospital Charge Code |
4002070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$41,291.25 |
| Max. Negotiated Rate |
$41,291.25 |
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
|
|
INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
|
OP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 53445
|
| Hospital Charge Code |
4002070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$50,820.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$29,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,410.00
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: CDPHP Medicare |
$23,504.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicaid |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicare |
$21,598.50
|
| Rate for Payer: EmblemHealth Select Care |
$45,738.00
|
| Rate for Payer: Fidelis Medicare |
$25,410.00
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,410.00
|
| Rate for Payer: Humana Medicare |
$25,410.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,221.50
|
| Rate for Payer: Multiplan Commercial |
$50,820.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47,643.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,764.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26,680.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,528.75
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$25,410.00
|
| Rate for Payer: WellCare Medicare |
$34,938.75
|
|
|
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Facility
|
IP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
4002067
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$41,291.25 |
| Max. Negotiated Rate |
$41,291.25 |
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
|
|
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Facility
|
OP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
4002067
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$50,820.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$29,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,410.00
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: CDPHP Medicare |
$23,504.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicaid |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicare |
$21,598.50
|
| Rate for Payer: EmblemHealth Select Care |
$45,738.00
|
| Rate for Payer: Fidelis Medicare |
$25,410.00
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,410.00
|
| Rate for Payer: Humana Medicare |
$25,410.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,221.50
|
| Rate for Payer: Multiplan Commercial |
$50,820.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47,643.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,764.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26,680.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,528.75
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$25,410.00
|
| Rate for Payer: WellCare Medicare |
$34,938.75
|
|
|
INS NON-TUNNEL CV CATH 5 YRS/>
|
Facility
|
IP
|
$9,678.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
4609603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,290.70 |
| Max. Negotiated Rate |
$6,290.70 |
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,290.70
|
|
|
INS NON-TUNNEL CV CATH 5 YRS/>
|
Facility
|
OP
|
$9,678.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
4609603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$7,742.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,451.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,871.20
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: Cash Price |
$7,258.50
|
| Rate for Payer: CDPHP Medicare |
$3,580.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,742.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,742.40
|
| Rate for Payer: EmblemHealth Medicaid |
$7,742.40
|
| Rate for Payer: EmblemHealth Medicare |
$3,290.52
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$3,871.20
|
| Rate for Payer: Galaxy Health Commercial |
$6,290.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,871.20
|
| Rate for Payer: Humana Medicare |
$3,871.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,451.88
|
| 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 |
$4,064.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,451.70
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$3,871.20
|
| Rate for Payer: WellCare Medicare |
$5,322.90
|
|
|
INS TEMP BLADDER CATH (FOLEY CATH)
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4600050
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
INS TEMP BLADDER CATH (FOLEY CATH)
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4600050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| 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: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| 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 |
$1,085.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| 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 |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4451253
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4851253
|
|
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
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4851253
|
|
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
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4451253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| 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: 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 |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
INS TEMP BLADDER CATH (STRAIGHT CATH)
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4609611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| 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: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| 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 |
$1,085.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| 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 |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
INS TEMP BLADDER CATH (STRAIGHT CATH)
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4609611
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
INSULIN GLARGINE 100U/ML SYRN 5X3ML
|
Facility
|
IP
|
$276.56
|
|
|
Service Code
|
NDC 88221905
|
| Hospital Charge Code |
4400415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.11 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Galaxy Health Commercial |
$179.76
|
| Rate for Payer: WellCare Medicare |
$152.11
|
|
|
INSULIN GLARGINE 100U/ML SYRN 5X3ML
|
Facility
|
OP
|
$276.56
|
|
|
Service Code
|
NDC 88221905
|
| Hospital Charge Code |
4400415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Aetna of NY Commercial |
$193.59
|
| Rate for Payer: Aetna of NY Medicare |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.62
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: CDPHP Medicare |
$102.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$221.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$221.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.25
|
| Rate for Payer: EmblemHealth Medicaid |
$221.25
|
| Rate for Payer: EmblemHealth Medicare |
$94.03
|
| Rate for Payer: EmblemHealth Select Care |
$199.12
|
| Rate for Payer: Fidelis Medicare |
$110.62
|
| Rate for Payer: Galaxy Health Commercial |
$179.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.62
|
| Rate for Payer: Humana Medicare |
$110.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$193.59
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$116.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.48
|
| Rate for Payer: United Healthcare Medicare |
$110.62
|
| Rate for Payer: WellCare Medicare |
$152.11
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
|
OP
|
$299.22
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$239.38 |
| Rate for Payer: Aetna of NY Medicare |
$137.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$119.69
|
| Rate for Payer: Cash Price |
$224.42
|
| Rate for Payer: Cash Price |
$224.42
|
| Rate for Payer: CDPHP Medicare |
$110.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$239.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$239.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$239.38
|
| Rate for Payer: EmblemHealth Medicaid |
$239.38
|
| Rate for Payer: EmblemHealth Medicare |
$101.73
|
| Rate for Payer: EmblemHealth Select Care |
$215.44
|
| Rate for Payer: Fidelis Medicare |
$119.69
|
| Rate for Payer: Galaxy Health Commercial |
$194.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$119.69
|
| Rate for Payer: Humana Medicare |
$119.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$168.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$125.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.88
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$119.69
|
| Rate for Payer: WellCare Medicare |
$164.57
|
|
