|
IODINE I-123 IOBENGUANE =< 15 MCI
|
Facility
|
IP
|
$6,953.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
4210080
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,519.45 |
| Max. Negotiated Rate |
$4,519.45 |
| Rate for Payer: Cash Price |
$5,214.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,519.45
|
|
|
IODINE I-123 SOD IODIDE 100-999 UCI
|
Facility
|
IP
|
$392.43
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
4210058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$255.08 |
| Max. Negotiated Rate |
$255.08 |
| Rate for Payer: Cash Price |
$294.32
|
| Rate for Payer: Galaxy Health Commercial |
$255.08
|
|
|
IODINE I-123 SOD IODIDE 100-999 UCI
|
Facility
|
OP
|
$392.43
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
4210058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$313.94 |
| Rate for Payer: Aetna of NY Medicare |
$180.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$156.97
|
| Rate for Payer: Cash Price |
$294.32
|
| Rate for Payer: Cash Price |
$294.32
|
| Rate for Payer: CDPHP Medicare |
$145.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$313.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$313.94
|
| Rate for Payer: EmblemHealth Medicaid |
$313.94
|
| Rate for Payer: EmblemHealth Medicare |
$133.43
|
| Rate for Payer: EmblemHealth Select Care |
$282.55
|
| Rate for Payer: Fidelis Medicare |
$156.97
|
| Rate for Payer: Galaxy Health Commercial |
$255.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$156.97
|
| Rate for Payer: Humana Medicare |
$156.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$180.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$220.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$164.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$192.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.86
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
| Rate for Payer: United Healthcare Medicare |
$156.97
|
| Rate for Payer: WellCare Medicare |
$215.84
|
|
|
IODINE I-123 SOD IODIDE MIL PER 1 MCI
|
Facility
|
IP
|
$36.05
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
4210081
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
|
|
IODINE I-123 SOD IODIDE MIL PER 1 MCI
|
Facility
|
OP
|
$36.05
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
4210081
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$309.77 |
| Rate for Payer: Aetna of NY Medicare |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.42
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: CDPHP Medicare |
$13.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.84
|
| Rate for Payer: EmblemHealth Medicaid |
$28.84
|
| Rate for Payer: EmblemHealth Medicare |
$12.26
|
| Rate for Payer: EmblemHealth Select Care |
$25.96
|
| Rate for Payer: Fidelis Medicare |
$14.42
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.42
|
| Rate for Payer: Humana Medicare |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$309.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.41
|
| Rate for Payer: United Healthcare Commercial |
$309.77
|
| Rate for Payer: United Healthcare Medicare |
$14.42
|
| Rate for Payer: WellCare Medicare |
$19.83
|
|
|
IODINE I-125 SERUM ALBUMIN DX PER 5 UCI
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
HCPCS A9532
|
| Hospital Charge Code |
4210076
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$1,125.60 |
| Rate for Payer: Aetna of NY Medicare |
$647.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$562.80
|
| Rate for Payer: Cash Price |
$1,055.25
|
| Rate for Payer: Cash Price |
$1,055.25
|
| Rate for Payer: CDPHP Medicare |
$520.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$478.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,013.04
|
| Rate for Payer: Fidelis Medicare |
$562.80
|
| Rate for Payer: Galaxy Health Commercial |
$914.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$562.80
|
| Rate for Payer: Humana Medicare |
$562.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$647.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,055.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$792.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$590.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$354.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$354.49
|
| Rate for Payer: United Healthcare Medicare |
$562.80
|
| Rate for Payer: WellCare Medicare |
$773.85
|
|
|
IODINE I-125 SERUM ALBUMIN DX PER 5 UCI
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
HCPCS A9532
|
| Hospital Charge Code |
4210076
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$914.55 |
| Rate for Payer: Cash Price |
$1,055.25
|
| Rate for Payer: Galaxy Health Commercial |
$914.55
|
|
|
IODOSORB GEL 40 g, 40 g
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
NDC 40565012249
|
| Hospital Charge Code |
4401556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$205.60 |
| Rate for Payer: Aetna of NY Commercial |
$179.90
|
| Rate for Payer: Aetna of NY Medicare |
$118.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.80
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: CDPHP Medicare |
$95.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$205.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$205.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$205.60
|
| Rate for Payer: EmblemHealth Medicaid |
$205.60
|
| Rate for Payer: EmblemHealth Medicare |
$87.38
|
| Rate for Payer: EmblemHealth Select Care |
$185.04
|
| Rate for Payer: Fidelis Medicare |
$102.80
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.80
|
| Rate for Payer: Humana Medicare |
$102.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$179.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$118.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$144.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$107.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.55
|
| Rate for Payer: United Healthcare Medicare |
$102.80
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
IODOSORB GEL 40 g, 40 g
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
NDC 40565012249
|
| Hospital Charge Code |
4401556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.35 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
IONIZED CALCIUM
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4300495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
IONIZED CALCIUM
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4300495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$16.40
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.40
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.15
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
IPG GENERATOR SC-1110-02
|
Facility
|
IP
|
$77,963.79
|
|
| Hospital Charge Code |
4479090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,083.71 |
| Max. Negotiated Rate |
$54,574.65 |
| Rate for Payer: Aetna of NY Commercial |
$54,574.65
|
| Rate for Payer: Cash Price |
$58,472.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38,981.89
|
| Rate for Payer: EmblemHealth Select Care |
$38,981.89
|
| Rate for Payer: Galaxy Health Commercial |
$50,676.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54,574.65
|
| Rate for Payer: Multiplan Commercial |
$35,083.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50,676.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50,676.46
|
| Rate for Payer: WellCare Medicare |
$42,880.08
|
|
|
IPG GENERATOR SC-1110-02
|
Facility
|
OP
|
$77,963.79
|
|
| Hospital Charge Code |
4479090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,694.57 |
| Max. Negotiated Rate |
$62,371.03 |
| Rate for Payer: Aetna of NY Commercial |
$54,574.65
|
| Rate for Payer: Aetna of NY Medicare |
$35,863.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31,185.52
|
| Rate for Payer: Cash Price |
$58,472.84
|
| Rate for Payer: CDPHP Medicare |
$28,846.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38,981.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$62,371.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$62,371.03
|
| Rate for Payer: EmblemHealth Medicaid |
$62,371.03
|
| Rate for Payer: EmblemHealth Medicare |
$26,507.69
|
| Rate for Payer: EmblemHealth Select Care |
$38,981.89
|
| Rate for Payer: Fidelis Medicare |
$31,185.52
|
| Rate for Payer: Galaxy Health Commercial |
$50,676.46
|
| Rate for Payer: Hamaspik Choice Medicare |
$31,185.52
|
| Rate for Payer: Humana Medicare |
$31,185.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54,574.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$35,863.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50,676.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50,676.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32,744.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11,694.57
|
| Rate for Payer: United Healthcare Medicare |
$31,185.52
|
| Rate for Payer: WellCare Medicare |
$42,880.08
|
|
|
IPRATROPIUM BROMIDE 0.2MG/ML AMIH 60X2.5
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 487980160
|
| Hospital Charge Code |
4400393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
IPRATROPIUM BROMIDE 0.2MG/ML AMIH 60X2.5
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 487980160
|
| Hospital Charge Code |
4400393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| 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: 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 Aetna Signature Administrators |
$4.33
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
IRON
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
4300496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
IRON
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
4300496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$11.40
|
| Rate for Payer: Fidelis Medicare |
$7.60
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.60
|
| Rate for Payer: Humana Medicare |
$7.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.85
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.60
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
4602235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| 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 |
$321.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
4602235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
IRRIGATION/ TUR SET "Y" TYPE
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4478211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
IRRIGATION/ TUR SET "Y" TYPE
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4478211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
|
IRRIG IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
4450116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
IRRIG IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
4450116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$135.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Commercial |
$135.75
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
4401287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
4401287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of NY Commercial |
$63.00
|
| Rate for Payer: Aetna of NY Medicare |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: CDPHP Medicare |
$33.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.00
|
| Rate for Payer: EmblemHealth Medicaid |
$72.00
|
| Rate for Payer: EmblemHealth Medicare |
$30.60
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.00
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.50
|
| Rate for Payer: United Healthcare Medicare |
$36.00
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
