|
DIGITAL BREAST TOMOSYNTHESIS UNILATERAL (NON-MEDICARE)
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 77061 TC
|
| Hospital Charge Code |
4150405
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
|
|
DIGITAL BREAST TOMOSYNTHESIS UNILATERAL, RIGHT (NON-MEDICARE)
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 77061 RT,TC
|
| Hospital Charge Code |
4150413
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
|
|
DIGITAL BREAST TOMOSYNTHESIS UNILATERAL, RIGHT (NON-MEDICARE)
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 77061 RT,TC
|
| Hospital Charge Code |
4150413
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$132.30
|
| Rate for Payer: Aetna of NY Medicare |
$86.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$94.50
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: CDPHP Commercial |
$152.14
|
| Rate for Payer: CDPHP Medicare |
$69.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$132.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$151.20
|
| Rate for Payer: EmblemHealth Medicaid |
$151.20
|
| Rate for Payer: EmblemHealth Medicare |
$64.26
|
| Rate for Payer: EmblemHealth Select Care |
$122.85
|
| Rate for Payer: Fidelis Medicare |
$72.03
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.93
|
| Rate for Payer: Humana Medicare |
$69.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$132.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$106.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
| Rate for Payer: WellCare Medicare |
$103.95
|
|
|
DIGOXIN 0.125MG TABS 100 EA
|
Facility
|
IP
|
$26.78
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
4400414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Galaxy Health Commercial |
$17.41
|
| Rate for Payer: WellCare Medicare |
$14.73
|
|
|
DIGOXIN 0.125MG TABS 100 EA
|
Facility
|
OP
|
$26.78
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
4400414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$21.56 |
| Rate for Payer: Aetna of NY Commercial |
$18.75
|
| Rate for Payer: Aetna of NY Medicare |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.39
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: CDPHP Commercial |
$21.56
|
| Rate for Payer: CDPHP Medicare |
$9.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.42
|
| Rate for Payer: EmblemHealth Medicaid |
$21.42
|
| Rate for Payer: EmblemHealth Medicare |
$9.11
|
| Rate for Payer: EmblemHealth Select Care |
$19.28
|
| Rate for Payer: Fidelis Medicare |
$10.21
|
| Rate for Payer: Galaxy Health Commercial |
$17.41
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.91
|
| Rate for Payer: Humana Medicare |
$9.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.40
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WellCare Medicare |
$14.73
|
|
|
DIGOXIN IMMUNE FAB (OVINE) PER VIAL
|
Facility
|
OP
|
$10,849.51
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
4400229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,688.83 |
| Max. Negotiated Rate |
$8,733.86 |
| Rate for Payer: Aetna of NY Commercial |
$5,967.23
|
| Rate for Payer: Aetna of NY Medicare |
$4,990.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,777.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,777.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,014.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,424.76
|
| Rate for Payer: Cash Price |
$8,137.13
|
| Rate for Payer: Cash Price |
$8,137.13
|
| Rate for Payer: CDPHP Commercial |
$8,733.86
|
| Rate for Payer: CDPHP Medicare |
$4,014.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,777.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,679.61
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,679.61
|
| Rate for Payer: EmblemHealth Medicaid |
$8,679.61
|
| Rate for Payer: EmblemHealth Medicare |
$3,688.83
|
| Rate for Payer: EmblemHealth Select Care |
$4,777.44
|
| Rate for Payer: Fidelis Medicare |
$4,134.75
|
| Rate for Payer: Galaxy Health Commercial |
$7,052.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,014.32
|
| Rate for Payer: Humana Medicare |
$4,014.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,967.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,990.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,137.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,108.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,215.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7,579.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,777.44
|
| Rate for Payer: United Healthcare Commercial |
$7,579.39
|
| Rate for Payer: United Healthcare Medicare |
$4,014.32
|
| Rate for Payer: WellCare Medicare |
$5,967.23
|
|
|
DIGOXIN IMMUNE FAB (OVINE) PER VIAL
|
Facility
|
IP
|
$10,849.51
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
4400229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,777.44 |
| Max. Negotiated Rate |
$7,052.18 |
| Rate for Payer: Aetna of NY Commercial |
$5,967.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,777.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,777.44
|
| Rate for Payer: Cash Price |
$8,137.13
|
| Rate for Payer: Cash Price |
$8,137.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,777.44
|
| Rate for Payer: EmblemHealth Select Care |
$4,777.44
|
| Rate for Payer: Galaxy Health Commercial |
$7,052.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,967.23
|
| Rate for Payer: WellCare Medicare |
$5,967.23
|
|
|
DIGOXIN INJ, UP TO 0.5 MG
|
Facility
|
OP
|
$20.34
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
4408962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna of NY Commercial |
$11.19
|
| Rate for Payer: Aetna of NY Medicare |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.17
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: CDPHP Commercial |
$16.37
|
| Rate for Payer: CDPHP Medicare |
$7.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.27
|
| Rate for Payer: EmblemHealth Medicaid |
$16.27
|
| Rate for Payer: EmblemHealth Medicare |
$6.92
|
| Rate for Payer: EmblemHealth Select Care |
$9.06
|
| Rate for Payer: Fidelis Medicare |
$7.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.22
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.53
|
| Rate for Payer: Humana Medicare |
$7.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$17.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.06
|
| Rate for Payer: United Healthcare Commercial |
$17.84
|
| Rate for Payer: United Healthcare Medicare |
$7.53
|
| Rate for Payer: WellCare Medicare |
$11.19
|
|
|
DIGOXIN INJ, UP TO 0.5 MG
|
Facility
|
IP
|
$20.34
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
4408962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna of NY Commercial |
$11.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.06
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.06
|
| Rate for Payer: EmblemHealth Select Care |
$9.06
|
| Rate for Payer: Galaxy Health Commercial |
$13.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.19
|
| Rate for Payer: WellCare Medicare |
$11.19
|
|
|
DIGOXIN SERUM
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
4300271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
DIGOXIN SERUM
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
4300271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Commercial |
$57.96
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: EmblemHealth Select Care |
$43.20
|
| Rate for Payer: Fidelis Medicare |
$27.44
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.64
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.97
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
DILANTIN SERUM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
4300272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
DILANTIN SERUM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
4300272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$33.15
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$30.60
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 53665
|
| Hospital Charge Code |
4002038
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 53665
|
| Hospital Charge Code |
4002038
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| 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 |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 53660
|
| Hospital Charge Code |
4002037
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 53660
|
| Hospital Charge Code |
4002037
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| 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 |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$321.84
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.83
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
DILATION SYRINGE 60CC
|
Facility
|
IP
|
$126.00
|
|
| Hospital Charge Code |
4471843
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Galaxy Health Commercial |
$81.90
|
|
|
DILATION SYRINGE 60CC
|
Facility
|
OP
|
$126.00
|
|
| Hospital Charge Code |
4471843
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$101.43 |
| Rate for Payer: Aetna of NY Commercial |
$88.20
|
| Rate for Payer: Aetna of NY Medicare |
$57.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$63.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: CDPHP Commercial |
$101.43
|
| Rate for Payer: CDPHP Medicare |
$46.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$100.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.80
|
| Rate for Payer: EmblemHealth Medicaid |
$100.80
|
| Rate for Payer: EmblemHealth Medicare |
$42.84
|
| Rate for Payer: EmblemHealth Select Care |
$90.72
|
| Rate for Payer: Fidelis Medicare |
$48.02
|
| Rate for Payer: Galaxy Health Commercial |
$81.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.62
|
| Rate for Payer: Humana Medicare |
$46.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$88.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.95
|
| Rate for Payer: United Healthcare Medicare |
$46.62
|
| Rate for Payer: WellCare Medicare |
$69.30
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 53600
|
| Hospital Charge Code |
4002035
|
|
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
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 53600
|
| Hospital Charge Code |
4002035
|
|
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
|
|
|
DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 53605
|
| Hospital Charge Code |
4002036
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 53605
|
| Hospital Charge Code |
4002036
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
DILAT XST TRC NDURLGC PX
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 50436
|
| Hospital Charge Code |
4853033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
DILAT XST TRC NDURLGC PX
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 50436
|
| Hospital Charge Code |
4853033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,017.33 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$6,982.50
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,987.50
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,982.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
