|
BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 19084 26
|
| Hospital Charge Code |
5201069
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$155.35 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Galaxy Health Commercial |
$155.35
|
|
|
BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 19084 26
|
| Hospital Charge Code |
5201069
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$191.20 |
| Rate for Payer: Aetna of NY Commercial |
$167.30
|
| Rate for Payer: Aetna of NY Medicare |
$109.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$95.60
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: CDPHP Medicare |
$88.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$191.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$191.20
|
| Rate for Payer: EmblemHealth Medicaid |
$191.20
|
| Rate for Payer: EmblemHealth Medicare |
$81.26
|
| Rate for Payer: Fidelis Medicare |
$95.60
|
| Rate for Payer: Galaxy Health Commercial |
$155.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$95.60
|
| Rate for Payer: Humana Medicare |
$95.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$167.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$109.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$100.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.85
|
| Rate for Payer: United Healthcare Medicare |
$95.60
|
| Rate for Payer: WellCare Medicare |
$131.45
|
|
|
BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4201069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$176.10 |
| Max. Negotiated Rate |
$939.20 |
| Rate for Payer: Aetna of NY Commercial |
$821.80
|
| Rate for Payer: Aetna of NY Medicare |
$540.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$469.60
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: CDPHP Medicare |
$434.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$821.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$939.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$939.20
|
| Rate for Payer: EmblemHealth Medicaid |
$939.20
|
| Rate for Payer: EmblemHealth Medicare |
$399.16
|
| Rate for Payer: EmblemHealth Select Care |
$763.10
|
| Rate for Payer: Fidelis Medicare |
$469.60
|
| Rate for Payer: Galaxy Health Commercial |
$763.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$469.60
|
| Rate for Payer: Humana Medicare |
$469.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$821.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$540.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$880.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$660.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$493.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$176.10
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$469.60
|
| Rate for Payer: WellCare Medicare |
$645.70
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
4201080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,543.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,290.30
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 38505 26
|
| Hospital Charge Code |
5201080
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 38505 26
|
| Hospital Charge Code |
5201080
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$213.60 |
| Rate for Payer: Aetna of NY Commercial |
$186.90
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$106.80
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: Fidelis Medicare |
$106.80
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$106.80
|
| Rate for Payer: Humana Medicare |
$106.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$186.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$112.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.05
|
| Rate for Payer: United Healthcare Medicare |
$106.80
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
4201080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
BX NAIL UNIT
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
4856703
|
|
Hospital Revenue Code
|
761
|
| 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: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,736.00
|
| 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 |
$1,562.40
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
BX NAIL UNIT
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
4856703
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
BX PROSTATE EA ADDL MRI-US FUSION/IN-BORE CT/MRI
|
Facility
|
OP
|
$10,956.00
|
|
|
Service Code
|
HCPCS 55714
|
| Hospital Charge Code |
4002082
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$8,764.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,039.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,382.40
|
| Rate for Payer: Cash Price |
$8,217.00
|
| Rate for Payer: Cash Price |
$8,217.00
|
| Rate for Payer: CDPHP Medicare |
$4,053.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,764.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,764.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,764.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8,764.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,725.04
|
| Rate for Payer: EmblemHealth Select Care |
$7,888.32
|
| Rate for Payer: Fidelis Medicare |
$4,382.40
|
| Rate for Payer: Galaxy Health Commercial |
$7,121.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,382.40
|
| Rate for Payer: Humana Medicare |
$4,382.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,039.76
|
| Rate for Payer: Multiplan Commercial |
$8,764.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,217.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,168.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,601.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,643.40
|
| Rate for Payer: United Healthcare Medicare |
$4,382.40
|
| Rate for Payer: WellCare Medicare |
$6,025.80
|
|
|
BX PROSTATE EA ADDL MRI-US FUSION/IN-BORE CT/MRI
|
Facility
|
IP
|
$10,956.00
|
|
|
Service Code
|
HCPCS 55714
|
| Hospital Charge Code |
4002082
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,121.40 |
| Max. Negotiated Rate |
$7,121.40 |
| Rate for Payer: Cash Price |
$8,217.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,121.40
|
|
|
BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 55706
|
| Hospital Charge Code |
4002066
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,620.60 |
| Max. Negotiated Rate |
$8,643.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,969.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,321.60
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: CDPHP Medicare |
$3,997.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,673.36
|
| Rate for Payer: EmblemHealth Select Care |
$7,778.88
|
| Rate for Payer: Fidelis Medicare |
$4,321.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,321.60
|
| Rate for Payer: Humana Medicare |
$4,321.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,969.84
|
| Rate for Payer: Multiplan Commercial |
$8,643.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,103.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,082.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,537.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,620.60
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$4,321.60
|
| Rate for Payer: WellCare Medicare |
$5,942.20
|
|
|
BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 55706
|
| Hospital Charge Code |
4002066
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,022.60 |
| Max. Negotiated Rate |
$7,022.60 |
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
|
|
BX PROSTATE TPRNL MRI-US GID TRGT LES 1ST
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55712
|
| Hospital Charge Code |
4002081
|
|
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
|
|
|
BX PROSTATE TPRNL MRI-US GID TRGT LES 1ST
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55712
|
| Hospital Charge Code |
4002081
|
|
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
|
|
|
BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55709
|
| Hospital Charge Code |
4002078
|
|
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
|
|
|
BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55709
|
| Hospital Charge Code |
4002078
|
|
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
|
|
|
BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55710
|
| Hospital Charge Code |
4002079
|
|
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
|
|
|
BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55710
|
| Hospital Charge Code |
4002079
|
|
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
|
|
|
BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55711
|
| Hospital Charge Code |
4002080
|
|
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
|
|
|
BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55711
|
| Hospital Charge Code |
4002080
|
|
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
|
|
|
BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55708
|
| Hospital Charge Code |
4002077
|
|
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
|
|
|
BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55708
|
| Hospital Charge Code |
4002077
|
|
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
|
|
|
CA 19-9
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
4301023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna of NY Commercial |
$40.30
|
| Rate for Payer: Aetna of NY Medicare |
$28.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.80
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: CDPHP Medicare |
$22.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$49.60
|
| Rate for Payer: EmblemHealth Medicaid |
$49.60
|
| Rate for Payer: EmblemHealth Medicare |
$21.08
|
| Rate for Payer: EmblemHealth Select Care |
$37.20
|
| Rate for Payer: Fidelis Medicare |
$24.80
|
| Rate for Payer: Galaxy Health Commercial |
$40.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.80
|
| Rate for Payer: Humana Medicare |
$24.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$46.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$46.50
|
| Rate for Payer: United Healthcare Medicare |
$24.80
|
| Rate for Payer: WellCare Medicare |
$34.10
|
|
|
CA 19-9
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
4301023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Galaxy Health Commercial |
$40.30
|
|
