|
BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55707
|
| Hospital Charge Code |
4002076
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,080.45 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,313.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,881.20
|
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: CDPHP Medicare |
$2,665.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,762.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,762.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,762.40
|
| Rate for Payer: EmblemHealth Medicaid |
$5,762.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,449.02
|
| Rate for Payer: EmblemHealth Select Care |
$5,186.16
|
| Rate for Payer: Fidelis Medicare |
$2,881.20
|
| Rate for Payer: Galaxy Health Commercial |
$4,681.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,881.20
|
| Rate for Payer: Humana Medicare |
$2,881.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,313.38
|
| Rate for Payer: Multiplan Commercial |
$5,762.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,402.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,055.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,025.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,080.45
|
| Rate for Payer: United Healthcare Medicare |
$2,881.20
|
| Rate for Payer: WellCare Medicare |
$3,961.65
|
|
|
BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55707
|
| Hospital Charge Code |
4002076
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,681.95 |
| Max. Negotiated Rate |
$4,681.95 |
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,681.95
|
|
|
BIOPSY URETHRA
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 53200
|
| Hospital Charge Code |
4002033
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
|
BIOPSY URETHRA
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 53200
|
| Hospital Charge Code |
4002033
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
BIOSYN 5-0
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4479303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
BIOSYN 5-0
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4479303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
BIOSYN 6-0
|
Facility
|
IP
|
$15.45
|
|
| Hospital Charge Code |
4479305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.04
|
|
|
BIOSYN 6-0
|
Facility
|
OP
|
$15.45
|
|
| Hospital Charge Code |
4479305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$12.36 |
| Rate for Payer: Aetna of NY Commercial |
$10.81
|
| Rate for Payer: Aetna of NY Medicare |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.18
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: CDPHP Medicare |
$5.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.36
|
| Rate for Payer: EmblemHealth Medicaid |
$12.36
|
| Rate for Payer: EmblemHealth Medicare |
$5.25
|
| Rate for Payer: EmblemHealth Select Care |
$11.12
|
| Rate for Payer: Fidelis Medicare |
$6.18
|
| Rate for Payer: Galaxy Health Commercial |
$10.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.18
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$6.18
|
| Rate for Payer: WellCare Medicare |
$8.50
|
|
|
BIPOLAR PROBE 10FR.
|
Facility
|
IP
|
$538.69
|
|
| Hospital Charge Code |
4471734
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.15 |
| Max. Negotiated Rate |
$350.15 |
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Galaxy Health Commercial |
$350.15
|
|
|
BIPOLAR PROBE 10FR.
|
Facility
|
OP
|
$538.69
|
|
| Hospital Charge Code |
4471734
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Aetna of NY Commercial |
$377.08
|
| Rate for Payer: Aetna of NY Medicare |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$215.48
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: CDPHP Medicare |
$199.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$430.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$430.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$430.95
|
| Rate for Payer: EmblemHealth Medicaid |
$430.95
|
| Rate for Payer: EmblemHealth Medicare |
$183.15
|
| Rate for Payer: EmblemHealth Select Care |
$387.86
|
| Rate for Payer: Fidelis Medicare |
$215.48
|
| Rate for Payer: Galaxy Health Commercial |
$350.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$215.48
|
| Rate for Payer: Humana Medicare |
$215.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$377.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$247.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$303.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$226.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$80.80
|
| Rate for Payer: United Healthcare Medicare |
$215.48
|
| Rate for Payer: WellCare Medicare |
$296.28
|
|
|
BIPOLAR PROBE 7FR.
|
Facility
|
OP
|
$595.34
|
|
| Hospital Charge Code |
4471735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$476.27 |
| Rate for Payer: Aetna of NY Commercial |
$416.74
|
| Rate for Payer: Aetna of NY Medicare |
$273.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$238.14
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: CDPHP Medicare |
$220.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$476.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$476.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$476.27
|
| Rate for Payer: EmblemHealth Medicaid |
$476.27
|
| Rate for Payer: EmblemHealth Medicare |
$202.42
|
| Rate for Payer: EmblemHealth Select Care |
$428.64
|
| Rate for Payer: Fidelis Medicare |
$238.14
|
| Rate for Payer: Galaxy Health Commercial |
$386.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$238.14
|
| Rate for Payer: Humana Medicare |
$238.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$416.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$273.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$446.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$335.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$250.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$89.30
|
| Rate for Payer: United Healthcare Medicare |
$238.14
|
| Rate for Payer: WellCare Medicare |
$327.44
|
|
|
BIPOLAR PROBE 7FR.
|
Facility
|
IP
|
$595.34
|
|
| Hospital Charge Code |
4471735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$386.97 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Galaxy Health Commercial |
$386.97
|
|
|
BISACODYL 10MG SUPP 12 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 574705050
|
| Hospital Charge Code |
4400105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BISACODYL 10MG SUPP 12 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 574705050
|
| Hospital Charge Code |
4400105
|
|
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
|
|
|
BISACODYL 5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904640761
|
| Hospital Charge Code |
4400106
|
|
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
|
|
|
BISACODYL 5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904640761
|
| Hospital Charge Code |
4400106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BITE BLOCKS
|
Facility
|
IP
|
$50.47
|
|
| Hospital Charge Code |
4479157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
|
|
BITE BLOCKS
|
Facility
|
OP
|
$50.47
|
|
| Hospital Charge Code |
4479157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$40.38 |
| Rate for Payer: Aetna of NY Commercial |
$35.33
|
| Rate for Payer: Aetna of NY Medicare |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.19
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: CDPHP Medicare |
$18.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.38
|
| Rate for Payer: EmblemHealth Medicaid |
$40.38
|
| Rate for Payer: EmblemHealth Medicare |
$17.16
|
| Rate for Payer: EmblemHealth Select Care |
$36.34
|
| Rate for Payer: Fidelis Medicare |
$20.19
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.19
|
| Rate for Payer: Humana Medicare |
$20.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.57
|
| Rate for Payer: United Healthcare Medicare |
$20.19
|
| Rate for Payer: WellCare Medicare |
$27.76
|
|
|
BLADE SURGICAL SZ 10
|
Facility
|
OP
|
$35.02
|
|
| Hospital Charge Code |
4471117
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Aetna of NY Commercial |
$24.51
|
| Rate for Payer: Aetna of NY Medicare |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.01
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: CDPHP Medicare |
$12.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.02
|
| Rate for Payer: EmblemHealth Medicaid |
$28.02
|
| Rate for Payer: EmblemHealth Medicare |
$11.91
|
| Rate for Payer: EmblemHealth Select Care |
$25.21
|
| Rate for Payer: Fidelis Medicare |
$14.01
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.01
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.01
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
BLADE SURGICAL SZ 10
|
Facility
|
IP
|
$35.02
|
|
| Hospital Charge Code |
4471117
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
|
|
BLANKET
|
Facility
|
OP
|
$28.84
|
|
| Hospital Charge Code |
4478239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna of NY Commercial |
$20.19
|
| Rate for Payer: Aetna of NY Medicare |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.54
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: CDPHP Medicare |
$10.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.07
|
| Rate for Payer: EmblemHealth Medicaid |
$23.07
|
| Rate for Payer: EmblemHealth Medicare |
$9.81
|
| Rate for Payer: EmblemHealth Select Care |
$20.76
|
| Rate for Payer: Fidelis Medicare |
$11.54
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
BLANKET
|
Facility
|
IP
|
$28.84
|
|
| Hospital Charge Code |
4478239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4002005
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4002005
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$551.52
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
IP
|
$973.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
4602225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$632.45 |
| Max. Negotiated Rate |
$632.45 |
| Rate for Payer: Cash Price |
$729.75
|
| Rate for Payer: Galaxy Health Commercial |
$632.45
|
|
