|
NEBULIZER TREATMENT 4
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$536.80 |
| Rate for Payer: Aetna of NY Commercial |
$469.70
|
| Rate for Payer: Aetna of NY Medicare |
$308.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$268.40
|
| Rate for Payer: Cash Price |
$503.25
|
| Rate for Payer: CDPHP Medicare |
$248.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$536.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$536.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$536.80
|
| Rate for Payer: EmblemHealth Medicaid |
$536.80
|
| Rate for Payer: EmblemHealth Medicare |
$228.14
|
| Rate for Payer: EmblemHealth Select Care |
$483.12
|
| Rate for Payer: Fidelis Medicare |
$268.40
|
| Rate for Payer: Galaxy Health Commercial |
$436.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$268.40
|
| Rate for Payer: Humana Medicare |
$268.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$469.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$308.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$503.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$377.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$281.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.65
|
| Rate for Payer: United Healthcare Medicare |
$268.40
|
| Rate for Payer: WellCare Medicare |
$369.05
|
|
|
NEEDLE EPIDURAL 18GX6IN DETAC
|
Facility
|
OP
|
$14.42
|
|
| Hospital Charge Code |
4472115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.77
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.77
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$5.77
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
NEEDLE EPIDURAL 18GX6IN DETAC
|
Facility
|
IP
|
$14.42
|
|
| Hospital Charge Code |
4472115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
|
|
NEEDLE SPINAL 20GX6 YELLOW
|
Facility
|
IP
|
$20.60
|
|
| Hospital Charge Code |
4471403
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
|
|
NEEDLE SPINAL 20GX6 YELLOW
|
Facility
|
OP
|
$20.60
|
|
| Hospital Charge Code |
4471403
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of NY Commercial |
$14.42
|
| Rate for Payer: Aetna of NY Medicare |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.24
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Medicare |
$7.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.48
|
| Rate for Payer: EmblemHealth Medicaid |
$16.48
|
| Rate for Payer: EmblemHealth Medicare |
$7.00
|
| Rate for Payer: EmblemHealth Select Care |
$14.83
|
| Rate for Payer: Fidelis Medicare |
$8.24
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.24
|
| Rate for Payer: Humana Medicare |
$8.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
NEISSERIA AMPLIF NA PROBE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
4300895
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna of NY Commercial |
$73.45
|
| Rate for Payer: Aetna of NY Medicare |
$51.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.20
|
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: CDPHP Medicare |
$41.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$67.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$90.40
|
| Rate for Payer: EmblemHealth Medicaid |
$90.40
|
| Rate for Payer: EmblemHealth Medicare |
$38.42
|
| Rate for Payer: EmblemHealth Select Care |
$67.80
|
| Rate for Payer: Fidelis Medicare |
$45.20
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.20
|
| Rate for Payer: Humana Medicare |
$45.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$51.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$63.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$84.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.95
|
| Rate for Payer: United Healthcare Commercial |
$84.75
|
| Rate for Payer: United Healthcare Medicare |
$45.20
|
| Rate for Payer: WellCare Medicare |
$62.15
|
|
|
NEISSERIA AMPLIF NA PROBE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
4300895
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
|
|
NEOMYCIN/POLYMYXIN/DEXAMETH 0.001 DROP 5
|
Facility
|
OP
|
$135.96
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
4400549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$108.77 |
| Rate for Payer: Aetna of NY Commercial |
$95.17
|
| Rate for Payer: Aetna of NY Medicare |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.38
|
| Rate for Payer: Cash Price |
$101.97
|
| Rate for Payer: CDPHP Medicare |
$50.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.77
|
| Rate for Payer: EmblemHealth Medicaid |
$108.77
|
| Rate for Payer: EmblemHealth Medicare |
$46.23
|
| Rate for Payer: EmblemHealth Select Care |
$97.89
|
| Rate for Payer: Fidelis Medicare |
$54.38
|
| Rate for Payer: Galaxy Health Commercial |
$88.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.38
|
| Rate for Payer: Humana Medicare |
$54.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.39
|
| Rate for Payer: United Healthcare Medicare |
$54.38
|
| Rate for Payer: WellCare Medicare |
$74.78
|
|
|
NEOMYCIN/POLYMYXIN/DEXAMETH 0.001 DROP 5
|
Facility
|
IP
|
$135.96
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
4400549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$88.37 |
| Rate for Payer: Cash Price |
$101.97
|
| Rate for Payer: Galaxy Health Commercial |
$88.37
|
| Rate for Payer: WellCare Medicare |
$74.78
|
|
|
NEOMYCIN/POLYMYXIN/GRAMIC DROP 10 ML
|
Facility
|
OP
|
$191.32
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
4400550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Aetna of NY Commercial |
$133.92
|
| Rate for Payer: Aetna of NY Medicare |
$88.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$76.53
|
| Rate for Payer: Cash Price |
$143.49
|
| Rate for Payer: CDPHP Medicare |
$70.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$153.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$153.06
|
| Rate for Payer: EmblemHealth Medicaid |
$153.06
|
| Rate for Payer: EmblemHealth Medicare |
$65.05
|
| Rate for Payer: EmblemHealth Select Care |
$137.75
|
| Rate for Payer: Fidelis Medicare |
$76.53
|
| Rate for Payer: Galaxy Health Commercial |
$124.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.53
|
| Rate for Payer: Humana Medicare |
$76.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$133.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.49
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$107.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.70
|
| Rate for Payer: United Healthcare Medicare |
$76.53
|
| Rate for Payer: WellCare Medicare |
$105.23
|
|
|
NEOMYCIN/POLYMYXIN/GRAMIC DROP 10 ML
|
Facility
|
IP
|
$191.32
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
4400550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Cash Price |
$143.49
|
| Rate for Payer: Galaxy Health Commercial |
$124.36
|
| Rate for Payer: WellCare Medicare |
$105.23
|
|
|
NEOMYCIN/POLYMYXIN/HC 0.01 DROP 10 ML
|
Facility
|
OP
|
$311.06
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
4400551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$248.85 |
| Rate for Payer: Aetna of NY Commercial |
$217.74
|
| Rate for Payer: Aetna of NY Medicare |
$143.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$124.42
|
| Rate for Payer: Cash Price |
$233.30
|
| Rate for Payer: CDPHP Medicare |
$115.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$248.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$248.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$248.85
|
| Rate for Payer: EmblemHealth Medicaid |
$248.85
|
| Rate for Payer: EmblemHealth Medicare |
$105.76
|
| Rate for Payer: EmblemHealth Select Care |
$223.96
|
| Rate for Payer: Fidelis Medicare |
$124.42
|
| Rate for Payer: Galaxy Health Commercial |
$202.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$124.42
|
| Rate for Payer: Humana Medicare |
$124.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$217.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$175.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$130.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.66
|
| Rate for Payer: United Healthcare Medicare |
$124.42
|
| Rate for Payer: WellCare Medicare |
$171.08
|
|
|
NEOMYCIN/POLYMYXIN/HC 0.01 DROP 10 ML
|
Facility
|
IP
|
$311.06
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
4400551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Cash Price |
$233.30
|
| Rate for Payer: Galaxy Health Commercial |
$202.19
|
| Rate for Payer: WellCare Medicare |
$171.08
|
|
|
NEO-POLYCIN EYE OINTMENT 3.5 g, 3.5 g
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 574425035
|
| Hospital Charge Code |
4401367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
NEO-POLYCIN EYE OINTMENT 3.5 g, 3.5 g
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
NDC 574425035
|
| Hospital Charge Code |
4401367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$115.20
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
NERVE BLOCK ILIOING/ILIOHYPOGASTRIC
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
4850253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
NERVE BLOCK ILIOING/ILIOHYPOGASTRIC
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
4850253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,514.80
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,558.08
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,514.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,623.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,218.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$908.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
NERVER BLOCK TRAY W/O DRUGS-SUPPLY ONLY
|
Facility
|
OP
|
$69.01
|
|
| Hospital Charge Code |
4471696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna of NY Commercial |
$48.31
|
| Rate for Payer: Aetna of NY Medicare |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.60
|
| Rate for Payer: Cash Price |
$51.76
|
| Rate for Payer: CDPHP Medicare |
$25.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.21
|
| Rate for Payer: EmblemHealth Medicaid |
$55.21
|
| Rate for Payer: EmblemHealth Medicare |
$23.46
|
| Rate for Payer: EmblemHealth Select Care |
$49.69
|
| Rate for Payer: Fidelis Medicare |
$27.60
|
| Rate for Payer: Galaxy Health Commercial |
$44.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.60
|
| Rate for Payer: Humana Medicare |
$27.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.35
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
| Rate for Payer: WellCare Medicare |
$37.96
|
|
|
NERVER BLOCK TRAY W/O DRUGS-SUPPLY ONLY
|
Facility
|
IP
|
$69.01
|
|
| Hospital Charge Code |
4471696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$44.86 |
| Rate for Payer: Cash Price |
$51.76
|
| Rate for Payer: Galaxy Health Commercial |
$44.86
|
|
|
NEUROMUSC REEDUCATION 15 MIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4650025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.80
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$54.80
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.80
|
| Rate for Payer: Humana Medicare |
$54.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4650025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59
|
| Hospital Charge Code |
4650371
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.80
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$54.80
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.80
|
| Rate for Payer: Humana Medicare |
$54.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59
|
| Hospital Charge Code |
4650371
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59,KX
|
| Hospital Charge Code |
4650423
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59,KX
|
| Hospital Charge Code |
4650423
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.80
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$54.80
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.80
|
| Rate for Payer: Humana Medicare |
$54.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
