|
CERVICOLL KIT CEK-17-75-2
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4002003
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,270.75 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Cash Price |
$1,466.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,270.75
|
|
|
CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4002003
|
|
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: Aetna of NY Medicare |
$899.30
|
| 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 |
$723.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$1,466.25
|
| Rate for Payer: Cash Price |
$1,466.25
|
| Rate for Payer: Cash Price |
$1,466.25
|
| Rate for Payer: CDPHP Commercial |
$1,573.78
|
| Rate for Payer: CDPHP Medicare |
$723.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,564.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,564.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,564.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,564.00
|
| Rate for Payer: EmblemHealth Medicare |
$664.70
|
| Rate for Payer: EmblemHealth Select Care |
$1,407.60
|
| Rate for Payer: Fidelis Medicare |
$745.05
|
| Rate for Payer: Galaxy Health Commercial |
$1,270.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$723.35
|
| Rate for Payer: Humana Medicare |
$723.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$899.30
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,466.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,100.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$759.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$650.86
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$723.35
|
| Rate for Payer: WellCare Medicare |
$1,075.25
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
4002002
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
4002002
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$509.04
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
4602000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| 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 |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| 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 |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
4602000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
CHARCOAL/SORBITOL SOLUTION 50GM LIQD 240
|
Facility
|
IP
|
$73.13
|
|
|
Service Code
|
NDC 00574012008
|
| Hospital Charge Code |
4400014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
| Rate for Payer: WellCare Medicare |
$40.22
|
|
|
CHARCOAL/SORBITOL SOLUTION 50GM LIQD 240
|
Facility
|
OP
|
$73.13
|
|
|
Service Code
|
NDC 00574012008
|
| Hospital Charge Code |
4400014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Aetna of NY Commercial |
$51.19
|
| Rate for Payer: Aetna of NY Medicare |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.56
|
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: CDPHP Commercial |
$58.87
|
| Rate for Payer: CDPHP Medicare |
$27.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.50
|
| Rate for Payer: EmblemHealth Medicaid |
$58.50
|
| Rate for Payer: EmblemHealth Medicare |
$24.86
|
| Rate for Payer: EmblemHealth Select Care |
$52.65
|
| Rate for Payer: Fidelis Medicare |
$27.87
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.06
|
| Rate for Payer: Humana Medicare |
$27.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.41
|
| Rate for Payer: United Healthcare Medicare |
$27.06
|
| Rate for Payer: WellCare Medicare |
$40.22
|
|
|
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE)
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 64615
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$282.20 |
| 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 |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
CHEMODENERVATION OF TRUNK MUSCLE(S); 6 OR MORE MUSCLES
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 64647
|
|
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
|
|
|
CHEMO IV INFUSION 1 HR
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
4451254
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$780.04 |
| Rate for Payer: Aetna of NY Commercial |
$678.30
|
| Rate for Payer: Aetna of NY Medicare |
$445.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$609.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$761.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$358.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$231.00
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: CDPHP Commercial |
$780.04
|
| Rate for Payer: CDPHP Medicare |
$358.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$775.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$775.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$775.20
|
| Rate for Payer: EmblemHealth Medicaid |
$775.20
|
| Rate for Payer: EmblemHealth Medicare |
$329.46
|
| Rate for Payer: EmblemHealth Select Care |
$697.68
|
| Rate for Payer: Fidelis Medicare |
$369.29
|
| Rate for Payer: Galaxy Health Commercial |
$629.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$358.53
|
| Rate for Payer: Humana Medicare |
$358.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$678.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$445.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$726.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$545.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$376.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Medicare |
$358.53
|
| Rate for Payer: WellCare Medicare |
$532.95
|
|
|
CHEMO IV INFUSION 1 HR
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
4451254
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Galaxy Health Commercial |
$629.85
|
|
|
CHEMO IV INFUSION ADDL HR
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
4451255
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
|
|
CHEMO IV INFUSION ADDL HR
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
4451255
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$761.57 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$609.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$761.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$231.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$161.60
|
| Rate for Payer: EmblemHealth Medicaid |
$161.60
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
CHEST PHYSICAL THERAPY-INITIAL
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
4530009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
CHEST PHYSICAL THERAPY-INITIAL
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
4530009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$263.52
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
CHEST TUBE INSERTION
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4600054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,978.95 |
| Max. Negotiated Rate |
$2,978.95 |
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
|
|
CHEST TUBE INSERTION
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4600054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
CHILDREN'S APAP SUSPENSION 160 MG/ 5 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
4409174
|
|
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
|
|
|
CHILDREN'S APAP SUSPENSION 160 MG/ 5 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
4409174
|
|
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
|
|
|
CHLAMYDIA T AMPLIF NA PROBE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
4304867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
CHLAMYDIA T AMPLIF NA PROBE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
4304867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$89.05
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$82.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$82.20
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$102.75
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
CHLAMYDIA T DIR NA PROBE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 87490
|
| Hospital Charge Code |
4301440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$81.30 |
| Rate for Payer: Aetna of NY Commercial |
$65.65
|
| Rate for Payer: Aetna of NY Medicare |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50.50
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: CDPHP Commercial |
$81.30
|
| Rate for Payer: CDPHP Medicare |
$37.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.80
|
| Rate for Payer: EmblemHealth Medicaid |
$80.80
|
| Rate for Payer: EmblemHealth Medicare |
$34.34
|
| Rate for Payer: EmblemHealth Select Care |
$60.60
|
| Rate for Payer: Fidelis Medicare |
$38.49
|
| Rate for Payer: Galaxy Health Commercial |
$65.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.37
|
| Rate for Payer: Humana Medicare |
$37.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$75.75
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
| Rate for Payer: WellCare Medicare |
$55.55
|
|
|
CHLAMYDIA T DIR NA PROBE
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 87490
|
| Hospital Charge Code |
4301440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Galaxy Health Commercial |
$65.65
|
|
