|
PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONIC SALINE, ENZYME) OR MECHANICAL MEANS (EG, CATHETER) INCLUDING RADIOLOGIC LOCALIZATION (INCLUDES CONTRAST WHEN ADMINISTERED), MULTIPLE ADHESIOLYSIS SESSIONS; 1 DAY
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62264
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$868.45
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
PERFIX PLUG LARGE, 1.6"
|
Facility
|
OP
|
$1,427.00
|
|
| Hospital Charge Code |
4471028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.18 |
| Max. Negotiated Rate |
$1,148.74 |
| Rate for Payer: Aetna of NY Commercial |
$998.90
|
| Rate for Payer: Aetna of NY Medicare |
$656.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$527.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$713.50
|
| Rate for Payer: Cash Price |
$1,070.25
|
| Rate for Payer: CDPHP Commercial |
$1,148.74
|
| Rate for Payer: CDPHP Medicare |
$527.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$713.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,141.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,141.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,141.60
|
| Rate for Payer: EmblemHealth Medicare |
$485.18
|
| Rate for Payer: EmblemHealth Select Care |
$713.50
|
| Rate for Payer: Fidelis Medicare |
$543.83
|
| Rate for Payer: Galaxy Health Commercial |
$927.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$527.99
|
| Rate for Payer: Humana Medicare |
$527.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$998.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$656.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$927.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$927.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$554.39
|
| Rate for Payer: United Healthcare Medicare |
$527.99
|
| Rate for Payer: WellCare Medicare |
$784.85
|
|
|
PERFIX PLUG LARGE, 1.6"
|
Facility
|
IP
|
$1,427.00
|
|
| Hospital Charge Code |
4471028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.15 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna of NY Commercial |
$998.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$642.15
|
| Rate for Payer: Cash Price |
$1,070.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$713.50
|
| Rate for Payer: EmblemHealth Select Care |
$713.50
|
| Rate for Payer: Galaxy Health Commercial |
$927.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$642.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$927.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$927.55
|
| Rate for Payer: WellCare Medicare |
$784.85
|
|
|
PERFIX PLUG MEDIUM, 1.3" X 1.
|
Facility
|
IP
|
$1,851.00
|
|
| Hospital Charge Code |
4471027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.95 |
| Max. Negotiated Rate |
$1,295.70 |
| Rate for Payer: Aetna of NY Commercial |
$1,295.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$832.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$832.95
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$925.50
|
| Rate for Payer: EmblemHealth Select Care |
$925.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,203.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$832.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,203.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,203.15
|
| Rate for Payer: WellCare Medicare |
$1,018.05
|
|
|
PERFIX PLUG MEDIUM, 1.3" X 1.
|
Facility
|
OP
|
$1,851.00
|
|
| Hospital Charge Code |
4471027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.34 |
| Max. Negotiated Rate |
$1,490.06 |
| Rate for Payer: Aetna of NY Commercial |
$1,295.70
|
| Rate for Payer: Aetna of NY Medicare |
$851.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$832.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$832.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$684.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$925.50
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: CDPHP Commercial |
$1,490.06
|
| Rate for Payer: CDPHP Medicare |
$684.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$925.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,480.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,480.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,480.80
|
| Rate for Payer: EmblemHealth Medicare |
$629.34
|
| Rate for Payer: EmblemHealth Select Care |
$925.50
|
| Rate for Payer: Fidelis Medicare |
$705.42
|
| Rate for Payer: Galaxy Health Commercial |
$1,203.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$684.87
|
| Rate for Payer: Humana Medicare |
$684.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,295.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$851.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,203.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,203.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$719.11
|
| Rate for Payer: United Healthcare Medicare |
$684.87
|
| Rate for Payer: WellCare Medicare |
$1,018.05
|
|
|
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
4601206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
4601206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
PERMETHRIN CREAM
|
Facility
|
OP
|
$573.45
|
|
|
Service Code
|
NDC 00472024260
|
| Hospital Charge Code |
4408968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.97 |
| Max. Negotiated Rate |
$461.63 |
| Rate for Payer: Aetna of NY Commercial |
$401.42
|
| Rate for Payer: Aetna of NY Medicare |
$263.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$430.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$430.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.72
|
| Rate for Payer: Cash Price |
$430.09
|
| Rate for Payer: CDPHP Commercial |
$461.63
|
| Rate for Payer: CDPHP Medicare |
$212.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.76
|
| Rate for Payer: EmblemHealth Medicaid |
$458.76
|
| Rate for Payer: EmblemHealth Medicare |
$194.97
|
| Rate for Payer: EmblemHealth Select Care |
$412.88
|
| Rate for Payer: Fidelis Medicare |
$218.54
|
| Rate for Payer: Galaxy Health Commercial |
$372.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.18
|
| Rate for Payer: Humana Medicare |
$212.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$430.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.79
|
| Rate for Payer: United Healthcare Medicare |
$212.18
|
| Rate for Payer: WellCare Medicare |
$315.40
|
|
|
PERMETHRIN CREAM
|
Facility
|
IP
|
$573.45
|
|
|
Service Code
|
NDC 00472024260
|
| Hospital Charge Code |
4408968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$315.40 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Cash Price |
$430.09
|
| Rate for Payer: Galaxy Health Commercial |
$372.74
|
| Rate for Payer: WellCare Medicare |
$315.40
|
|
|
PERPHENAZINE 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904660061
|
| Hospital Charge Code |
4401466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of NY Commercial |
$2.80
|
| Rate for Payer: Aetna of NY Medicare |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: CDPHP Commercial |
$3.22
|
| Rate for Payer: CDPHP Medicare |
$1.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3.20
|
| Rate for Payer: EmblemHealth Medicare |
$1.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.88
|
| Rate for Payer: Fidelis Medicare |
$1.52
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.55
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
PERPHENAZINE 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904660061
|
| Hospital Charge Code |
4401466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4201070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4201070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,409.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,308.45
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, LEFT SIDE
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 LT
|
| Hospital Charge Code |
4201077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, LEFT SIDE
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 LT
|
| Hospital Charge Code |
4201077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,409.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,308.45
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, RIGHT SIDE
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 RT
|
| Hospital Charge Code |
4201078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, RIGHT SIDE
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 RT
|
| Hospital Charge Code |
4201078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,409.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,308.45
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
4201083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
4201083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$108.50
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$100.75
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$108.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.28
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
4201081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
4201081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,208.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$2,978.95
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
PERSONAL THERAPY MANAGER
|
Facility
|
IP
|
$2,762.00
|
|
| Hospital Charge Code |
4471656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.90 |
| Max. Negotiated Rate |
$1,933.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,933.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,242.90
|
| Rate for Payer: Cash Price |
$2,071.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,381.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,381.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,795.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,933.40
|
| Rate for Payer: Multiplan Commercial |
$1,242.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,795.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,795.30
|
| Rate for Payer: WellCare Medicare |
$1,519.10
|
|
|
PERSONAL THERAPY MANAGER
|
Facility
|
OP
|
$2,762.00
|
|
| Hospital Charge Code |
4471656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.08 |
| Max. Negotiated Rate |
$2,223.41 |
| Rate for Payer: Aetna of NY Commercial |
$1,933.40
|
| Rate for Payer: Aetna of NY Medicare |
$1,270.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,021.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,381.00
|
| Rate for Payer: Cash Price |
$2,071.50
|
| Rate for Payer: CDPHP Commercial |
$2,223.41
|
| Rate for Payer: CDPHP Medicare |
$1,021.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,381.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,209.60
|
| Rate for Payer: EmblemHealth Medicare |
$939.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,381.00
|
| Rate for Payer: Fidelis Medicare |
$1,052.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,795.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,021.94
|
| Rate for Payer: Humana Medicare |
$1,021.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,933.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,270.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,795.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,795.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,073.04
|
| Rate for Payer: United Healthcare Medicare |
$1,021.94
|
| Rate for Payer: WellCare Medicare |
$1,519.10
|
|
|
PFIZER COVID VACCINE 10 MCG/0.2 ML 5 Y - 11Y
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
4403002
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$87.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$87.78
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 10 MCG/0.2 ML 5 Y - 11Y
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
4403002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.78
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$87.78
|
| Rate for Payer: EmblemHealth Select Care |
$87.78
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
