|
INSULIN INJ PER 5 UNITS
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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 |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400354
|
|
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
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
|
IP
|
$299.22
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.57 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of NY Commercial |
$164.57
|
| Rate for Payer: Cash Price |
$224.42
|
| Rate for Payer: Galaxy Health Commercial |
$194.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$164.57
|
| Rate for Payer: WellCare Medicare |
$164.57
|
|
|
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
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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 |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INSULIN SYRINGE LO-DOSE
|
Facility
|
IP
|
$22.66
|
|
| Hospital Charge Code |
4472015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
|
|
INSULIN SYRINGE LO-DOSE
|
Facility
|
OP
|
$22.66
|
|
| Hospital Charge Code |
4472015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.06
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$9.06
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.06
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$9.06
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
INTERMEDIATE 12.6 TO 20 CM
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
4609620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| 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 |
$523.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
INTERMEDIATE 12.6 TO 20 CM
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
4609620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 64727
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$177.09 |
| 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 |
$177.09
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
INTRA-ARTERIAL
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
4450102
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$423.80 |
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Galaxy Health Commercial |
$423.80
|
|
|
INTRA-ARTERIAL
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
4450102
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$521.60 |
| Rate for Payer: Aetna of NY Commercial |
$456.40
|
| Rate for Payer: Aetna of NY Medicare |
$299.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: CDPHP Medicare |
$241.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$521.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$521.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$521.60
|
| Rate for Payer: EmblemHealth Medicaid |
$521.60
|
| Rate for Payer: EmblemHealth Medicare |
$221.68
|
| Rate for Payer: EmblemHealth Select Care |
$469.44
|
| Rate for Payer: Fidelis Medicare |
$260.80
|
| Rate for Payer: Galaxy Health Commercial |
$423.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.80
|
| Rate for Payer: Humana Medicare |
$260.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$456.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$299.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$367.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$97.80
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$260.80
|
| Rate for Payer: WellCare Medicare |
$358.60
|
|
|
INTRA-ARTERIAL PHARM RX PARTICULATE
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 79445
|
| Hospital Charge Code |
4210079
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$500.50
|
| Rate for Payer: Aetna of NY Medicare |
$328.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$286.00
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: CDPHP Medicare |
$264.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$500.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$572.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$572.00
|
| Rate for Payer: EmblemHealth Medicaid |
$572.00
|
| Rate for Payer: EmblemHealth Medicare |
$243.10
|
| Rate for Payer: EmblemHealth Select Care |
$464.75
|
| Rate for Payer: Fidelis Medicare |
$286.00
|
| Rate for Payer: Galaxy Health Commercial |
$464.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$286.00
|
| Rate for Payer: Humana Medicare |
$286.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$500.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$328.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$536.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$402.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$300.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$286.00
|
| Rate for Payer: WellCare Medicare |
$393.25
|
|
|
INTRA-ARTERIAL PHARM RX PARTICULATE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 79445 26
|
| Hospital Charge Code |
5210079
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.85 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: Aetna of NY Commercial |
$237.30
|
| Rate for Payer: Aetna of NY Medicare |
$155.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.60
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: CDPHP Medicare |
$125.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$271.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$271.20
|
| Rate for Payer: EmblemHealth Medicaid |
$271.20
|
| Rate for Payer: EmblemHealth Medicare |
$115.26
|
| Rate for Payer: Fidelis Medicare |
$135.60
|
| Rate for Payer: Galaxy Health Commercial |
$220.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.60
|
| Rate for Payer: Humana Medicare |
$135.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$190.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.85
|
| Rate for Payer: United Healthcare Medicare |
$135.60
|
| Rate for Payer: WellCare Medicare |
$186.45
|
|
|
INTRA-ARTERIAL PHARM RX PARTICULATE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 79445 26
|
| Hospital Charge Code |
5210079
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$220.35 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Galaxy Health Commercial |
$220.35
|
|
|
INTRA-ARTERIAL PHARM RX PARTICULATE
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 79445
|
| Hospital Charge Code |
4210079
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$464.75 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Galaxy Health Commercial |
$464.75
|
|
|
INTRALIPID 20% IV FAT EMUL 250 mL, 250 mL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
NDC 338051909
|
| Hospital Charge Code |
4401922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.75 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Galaxy Health Commercial |
$94.25
|
| Rate for Payer: WellCare Medicare |
$79.75
|
|
|
INTRALIPID 20% IV FAT EMUL 250 mL, 250 mL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
NDC 338051909
|
| Hospital Charge Code |
4401922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of NY Commercial |
$101.50
|
| Rate for Payer: Aetna of NY Medicare |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.00
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: CDPHP Medicare |
$53.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$116.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.00
|
| Rate for Payer: EmblemHealth Medicaid |
$116.00
|
| Rate for Payer: EmblemHealth Medicare |
$49.30
|
| Rate for Payer: EmblemHealth Select Care |
$104.40
|
| Rate for Payer: Fidelis Medicare |
$58.00
|
| Rate for Payer: Galaxy Health Commercial |
$94.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.00
|
| Rate for Payer: Humana Medicare |
$58.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$101.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$81.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WellCare Medicare |
$79.75
|
|
|
INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Facility
|
IP
|
$10,162.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4601204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,605.30 |
| Max. Negotiated Rate |
$6,605.30 |
| Rate for Payer: Cash Price |
$7,621.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,605.30
|
|
|
INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Facility
|
OP
|
$10,162.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4601204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$8,129.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,674.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,064.80
|
| Rate for Payer: Cash Price |
$7,621.50
|
| Rate for Payer: Cash Price |
$7,621.50
|
| Rate for Payer: Cash Price |
$7,621.50
|
| Rate for Payer: CDPHP Medicare |
$3,759.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,129.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,129.60
|
| Rate for Payer: EmblemHealth Medicaid |
$8,129.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,455.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$4,064.80
|
| Rate for Payer: Galaxy Health Commercial |
$6,605.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,064.80
|
| Rate for Payer: Humana Medicare |
$4,064.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,674.52
|
| 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 |
$4,268.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,524.30
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$4,064.80
|
| Rate for Payer: WellCare Medicare |
$5,589.10
|
|
|
INTUBATION ET EMERGENT
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4601988
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna of NY Commercial |
$508.20
|
| Rate for Payer: Aetna of NY Medicare |
$333.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: CDPHP Medicare |
$268.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$580.80
|
| Rate for Payer: EmblemHealth Medicare |
$246.84
|
| Rate for Payer: EmblemHealth Select Care |
$522.72
|
| Rate for Payer: Fidelis Medicare |
$290.40
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.40
|
| Rate for Payer: Humana Medicare |
$290.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$508.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.90
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WellCare Medicare |
$399.30
|
|
|
INTUBATION ET EMERGENT
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4601988
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
|
|
INTUBATION MED SURG
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4530047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
|
|
INTUBATION MED SURG
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4530047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna of NY Commercial |
$508.20
|
| Rate for Payer: Aetna of NY Medicare |
$333.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: CDPHP Medicare |
$268.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$580.80
|
| Rate for Payer: EmblemHealth Medicare |
$246.84
|
| Rate for Payer: EmblemHealth Select Care |
$522.72
|
| Rate for Payer: Fidelis Medicare |
$290.40
|
| Rate for Payer: Galaxy Health Commercial |
$471.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.40
|
| Rate for Payer: Humana Medicare |
$290.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$508.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.90
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WellCare Medicare |
$399.30
|
|
|
IODINE I-123 IOBENGUANE =< 15 MCI
|
Facility
|
OP
|
$6,953.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
4210080
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,042.95 |
| Max. Negotiated Rate |
$5,562.40 |
| Rate for Payer: Aetna of NY Commercial |
$4,867.10
|
| Rate for Payer: Aetna of NY Medicare |
$3,198.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,781.20
|
| Rate for Payer: Cash Price |
$5,214.75
|
| Rate for Payer: Cash Price |
$5,214.75
|
| Rate for Payer: CDPHP Medicare |
$2,572.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,562.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,562.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,562.40
|
| Rate for Payer: EmblemHealth Medicaid |
$5,562.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,364.02
|
| Rate for Payer: EmblemHealth Select Care |
$5,006.16
|
| Rate for Payer: Fidelis Medicare |
$2,781.20
|
| Rate for Payer: Galaxy Health Commercial |
$4,519.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,781.20
|
| Rate for Payer: Humana Medicare |
$2,781.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,867.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,198.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,214.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,914.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,920.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3,745.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,042.95
|
| Rate for Payer: United Healthcare Commercial |
$3,745.67
|
| Rate for Payer: United Healthcare Medicare |
$2,781.20
|
| Rate for Payer: WellCare Medicare |
$3,824.15
|
|
