|
PERFIX PLUG MEDIUM, 1.3" X 1.
|
Facility
|
OP
|
$1,906.53
|
|
| Hospital Charge Code |
4471027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$1,525.22 |
| Rate for Payer: Aetna of NY Commercial |
$1,334.57
|
| Rate for Payer: Aetna of NY Medicare |
$877.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$762.61
|
| Rate for Payer: Cash Price |
$1,429.90
|
| Rate for Payer: CDPHP Medicare |
$705.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$953.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,525.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,525.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,525.22
|
| Rate for Payer: EmblemHealth Medicare |
$648.22
|
| Rate for Payer: EmblemHealth Select Care |
$953.26
|
| Rate for Payer: Fidelis Medicare |
$762.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,239.24
|
| Rate for Payer: Hamaspik Choice Medicare |
$762.61
|
| Rate for Payer: Humana Medicare |
$762.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,334.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$877.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,239.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,239.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$800.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$285.98
|
| Rate for Payer: United Healthcare Medicare |
$762.61
|
| Rate for Payer: WellCare Medicare |
$1,048.59
|
|
|
PERFIX PLUG MEDIUM, 1.3" X 1.
|
Facility
|
IP
|
$1,906.53
|
|
| Hospital Charge Code |
4471027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.94 |
| Max. Negotiated Rate |
$1,334.57 |
| Rate for Payer: Aetna of NY Commercial |
$1,334.57
|
| Rate for Payer: Cash Price |
$1,429.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$953.26
|
| Rate for Payer: EmblemHealth Select Care |
$953.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,239.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,334.57
|
| Rate for Payer: Multiplan Commercial |
$857.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,239.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,239.24
|
| Rate for Payer: WellCare Medicare |
$1,048.59
|
|
|
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
4601206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| 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 |
$2,026.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
|
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
4601206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
|
PERMETHRIN CREAM
|
Facility
|
OP
|
$573.45
|
|
|
Service Code
|
NDC 472024260
|
| Hospital Charge Code |
4408968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.02 |
| Max. Negotiated Rate |
$458.76 |
| 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) Medicare |
$229.38
|
| Rate for Payer: Cash Price |
$430.09
|
| 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 |
$229.38
|
| Rate for Payer: Galaxy Health Commercial |
$372.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.38
|
| Rate for Payer: Humana Medicare |
$229.38
|
| 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 |
$240.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$86.02
|
| Rate for Payer: United Healthcare Medicare |
$229.38
|
| Rate for Payer: WellCare Medicare |
$315.40
|
|
|
PERMETHRIN CREAM
|
Facility
|
IP
|
$573.45
|
|
|
Service Code
|
NDC 472024260
|
| 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
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 904660061
|
| Hospital Charge Code |
4401466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PERPHENAZINE 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 904660061
|
| Hospital Charge Code |
4401466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESION US IMAG
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26
|
| Hospital Charge Code |
5201070
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$207.20 |
| Rate for Payer: Aetna of NY Commercial |
$181.30
|
| Rate for Payer: Aetna of NY Medicare |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$103.60
|
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: CDPHP Medicare |
$95.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$207.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$207.20
|
| Rate for Payer: EmblemHealth Medicaid |
$207.20
|
| Rate for Payer: EmblemHealth Medicare |
$88.06
|
| Rate for Payer: Fidelis Medicare |
$103.60
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$103.60
|
| Rate for Payer: Humana Medicare |
$103.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$181.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$145.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.85
|
| Rate for Payer: United Healthcare Medicare |
$103.60
|
| Rate for Payer: WellCare Medicare |
$142.45
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESION US IMAG
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26
|
| Hospital Charge Code |
5201070
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESION US IMAGE, RIGHT
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26,LT
|
| Hospital Charge Code |
5201078
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$207.20 |
| Rate for Payer: Aetna of NY Commercial |
$181.30
|
| Rate for Payer: Aetna of NY Medicare |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$103.60
|
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: CDPHP Medicare |
$95.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$207.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$207.20
|
| Rate for Payer: EmblemHealth Medicaid |
$207.20
|
| Rate for Payer: EmblemHealth Medicare |
$88.06
|
| Rate for Payer: Fidelis Medicare |
$103.60
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$103.60
|
| Rate for Payer: Humana Medicare |
$103.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$181.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$145.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.85
|
| Rate for Payer: United Healthcare Medicare |
$103.60
|
| Rate for Payer: WellCare Medicare |
$142.45
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESION US IMAGE, RIGHT
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26,LT
|
| Hospital Charge Code |
5201078
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4201070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,519.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,410.50
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4201070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, LEFT SIDE
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285 LT
|
| Hospital Charge Code |
4201077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,519.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,410.50
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, LEFT SIDE
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285 LT
|
| Hospital Charge Code |
4201077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, RIGHT SIDE
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285 RT
|
| Hospital Charge Code |
4201078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,519.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,410.50
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, RIGHT SIDE
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19285 RT
|
| Hospital Charge Code |
4201078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 19286 26
|
| Hospital Charge Code |
5201083
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of NY Commercial |
$91.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: Fidelis Medicare |
$52.00
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.00
|
| Rate for Payer: Humana Medicare |
$52.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$91.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$73.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$54.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$52.00
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
4201083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$754.40 |
| Rate for Payer: Aetna of NY Commercial |
$660.10
|
| Rate for Payer: Aetna of NY Medicare |
$433.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$377.20
|
| Rate for Payer: Cash Price |
$707.25
|
| Rate for Payer: Cash Price |
$707.25
|
| Rate for Payer: CDPHP Medicare |
$348.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$660.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$754.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$754.40
|
| Rate for Payer: EmblemHealth Medicaid |
$754.40
|
| Rate for Payer: EmblemHealth Medicare |
$320.62
|
| Rate for Payer: EmblemHealth Select Care |
$612.95
|
| Rate for Payer: Fidelis Medicare |
$377.20
|
| Rate for Payer: Galaxy Health Commercial |
$612.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$377.20
|
| Rate for Payer: Humana Medicare |
$377.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$660.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$433.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$707.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$530.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$396.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.45
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$377.20
|
| Rate for Payer: WellCare Medicare |
$518.65
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 19286 26
|
| Hospital Charge Code |
5201083
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
4201083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$612.95 |
| Max. Negotiated Rate |
$612.95 |
| Rate for Payer: Cash Price |
$707.25
|
| Rate for Payer: Galaxy Health Commercial |
$612.95
|
|
|
PERQ BREAST LOC DEVICE PLACMT 1ST LESION US IMAGE, LEFT
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26,LT
|
| Hospital Charge Code |
5201077
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
|
|
PERQ BREAST LOC DEVICE PLACMT 1ST LESION US IMAGE, LEFT
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 19285 26,LT
|
| Hospital Charge Code |
5201077
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$207.20 |
| Rate for Payer: Aetna of NY Commercial |
$181.30
|
| Rate for Payer: Aetna of NY Medicare |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$103.60
|
| Rate for Payer: Cash Price |
$194.25
|
| Rate for Payer: CDPHP Medicare |
$95.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$207.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$207.20
|
| Rate for Payer: EmblemHealth Medicaid |
$207.20
|
| Rate for Payer: EmblemHealth Medicare |
$88.06
|
| Rate for Payer: Fidelis Medicare |
$103.60
|
| Rate for Payer: Galaxy Health Commercial |
$168.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$103.60
|
| Rate for Payer: Humana Medicare |
$103.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$181.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$145.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.85
|
| Rate for Payer: United Healthcare Medicare |
$103.60
|
| Rate for Payer: WellCare Medicare |
$142.45
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
4201081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,377.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,377.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,136.25
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,377.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,618.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,716.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,026.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
