|
PULSE OX MULTIPLE RESPIRATORY
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4530043
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
PULSE OX SINGLE RESPIRATORY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4530042
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
|
|
PULSE OX SINGLE RESPIRATORY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4530042
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Commercial |
$46.90
|
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$43.55
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.66
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
PUMP 8637-20 BATTERY PACEMAKER
|
Facility
|
IP
|
$40,516.00
|
|
| Hospital Charge Code |
4479122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,232.20 |
| Max. Negotiated Rate |
$28,361.20 |
| Rate for Payer: Aetna of NY Commercial |
$28,361.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18,232.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18,232.20
|
| Rate for Payer: Cash Price |
$30,387.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20,258.00
|
| Rate for Payer: EmblemHealth Select Care |
$20,258.00
|
| Rate for Payer: Galaxy Health Commercial |
$26,335.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28,361.20
|
| Rate for Payer: Multiplan Commercial |
$18,232.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26,335.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26,335.40
|
| Rate for Payer: WellCare Medicare |
$22,283.80
|
|
|
PUMP 8637-20 BATTERY PACEMAKER
|
Facility
|
OP
|
$40,516.00
|
|
| Hospital Charge Code |
4479122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,775.44 |
| Max. Negotiated Rate |
$32,615.38 |
| Rate for Payer: Aetna of NY Commercial |
$28,361.20
|
| Rate for Payer: Aetna of NY Medicare |
$18,637.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18,232.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18,232.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14,990.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20,258.00
|
| Rate for Payer: Cash Price |
$30,387.00
|
| Rate for Payer: CDPHP Commercial |
$32,615.38
|
| Rate for Payer: CDPHP Medicare |
$14,990.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20,258.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32,412.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32,412.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32,412.80
|
| Rate for Payer: EmblemHealth Medicare |
$13,775.44
|
| Rate for Payer: EmblemHealth Select Care |
$20,258.00
|
| Rate for Payer: Fidelis Medicare |
$15,440.65
|
| Rate for Payer: Galaxy Health Commercial |
$26,335.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14,990.92
|
| Rate for Payer: Humana Medicare |
$14,990.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28,361.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$18,637.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26,335.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26,335.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15,740.47
|
| Rate for Payer: United Healthcare Medicare |
$14,990.92
|
| Rate for Payer: WellCare Medicare |
$22,283.80
|
|
|
PUMP RENTAL FEE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
1050104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
PUMP RENTAL FEE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
1050104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
4853028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.30
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
4853028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
4853027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
4853027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
PUNCT ASP - ABSC HEMAT CYST
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
4856673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
PUNCT ASP - ABSC HEMAT CYST
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
4856673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
PUNCTURE ASP ABCESS HEMA CYST
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
4600138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
PUNCTURE ASP ABCESS HEMA CYST
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
4600138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| 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 |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
4201076
|
|
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
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
4201076
|
|
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
|
|
|
PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 61070
|
|
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 |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00115351101
|
| Hospital Charge Code |
4409130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00115351101
|
| Hospital Charge Code |
4409130
|
|
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
|
|
|
PYRIDOXINE HCL 100 MG INJ
|
Facility
|
OP
|
$56.39
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
4400671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna of NY Commercial |
$31.01
|
| Rate for Payer: Aetna of NY Medicare |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.20
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: CDPHP Commercial |
$45.39
|
| Rate for Payer: CDPHP Medicare |
$20.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.11
|
| Rate for Payer: EmblemHealth Medicaid |
$45.11
|
| Rate for Payer: EmblemHealth Medicare |
$19.17
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Fidelis Medicare |
$21.49
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.86
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$26.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$26.24
|
| Rate for Payer: United Healthcare Medicare |
$20.86
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
|
PYRIDOXINE HCL 100 MG INJ
|
Facility
|
IP
|
$56.39
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
4400671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna of NY Commercial |
$31.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.01
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
|
PYROPHOSPHATE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4211244
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$258.70 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Galaxy Health Commercial |
$258.70
|
|
|
PYROPHOSPHATE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4211244
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$135.32 |
| Max. Negotiated Rate |
$320.39 |
| Rate for Payer: Aetna of NY Medicare |
$183.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$147.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$199.00
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: CDPHP Commercial |
$320.39
|
| Rate for Payer: CDPHP Medicare |
$147.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$318.40
|
| Rate for Payer: EmblemHealth Medicaid |
$318.40
|
| Rate for Payer: EmblemHealth Medicare |
$135.32
|
| Rate for Payer: EmblemHealth Select Care |
$286.56
|
| Rate for Payer: Fidelis Medicare |
$151.68
|
| Rate for Payer: Galaxy Health Commercial |
$258.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$147.26
|
| Rate for Payer: Humana Medicare |
$147.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$183.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$224.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$154.62
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$172.21
|
| Rate for Payer: United Healthcare Commercial |
$172.21
|
| Rate for Payer: United Healthcare Medicare |
$147.26
|
| Rate for Payer: WellCare Medicare |
$218.90
|
|
|
QUANT BORDITELLA PERTUSSIS IGA IGM IGG
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
4301177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$216.54 |
| Rate for Payer: Aetna of NY Commercial |
$174.85
|
| Rate for Payer: Aetna of NY Medicare |
$123.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$201.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$201.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$99.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$134.50
|
| Rate for Payer: Cash Price |
$201.75
|
| Rate for Payer: Cash Price |
$201.75
|
| Rate for Payer: CDPHP Commercial |
$216.54
|
| Rate for Payer: CDPHP Medicare |
$99.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$215.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$215.20
|
| Rate for Payer: EmblemHealth Medicaid |
$215.20
|
| Rate for Payer: EmblemHealth Medicare |
$91.46
|
| Rate for Payer: EmblemHealth Select Care |
$161.40
|
| Rate for Payer: Fidelis Medicare |
$102.52
|
| Rate for Payer: Galaxy Health Commercial |
$174.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.53
|
| Rate for Payer: Humana Medicare |
$99.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$174.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$123.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$151.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$104.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$201.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$201.75
|
| Rate for Payer: United Healthcare Medicare |
$99.53
|
| Rate for Payer: WellCare Medicare |
$147.95
|
|
