|
CYCLOPENTOLATE 1 % OS
|
Facility
|
IP
|
$57.17
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
4409051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$37.16 |
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: Galaxy Health Commercial |
$37.16
|
| Rate for Payer: WellCare Medicare |
$31.44
|
|
|
CYCLOSPORIN WHOLE BLOOD
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
4300252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CYCLOSPORIN WHOLE BLOOD
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
4300252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
CYGNUS MATRIX, PER SQUARE CENTIMETER
|
Facility
|
IP
|
$1,254.54
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
4473041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$815.45 |
| Rate for Payer: Aetna of NY Commercial |
$690.00
|
| Rate for Payer: Cash Price |
$940.90
|
| Rate for Payer: Galaxy Health Commercial |
$815.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$690.00
|
| Rate for Payer: WellCare Medicare |
$690.00
|
|
|
CYGNUS MATRIX, PER SQUARE CENTIMETER
|
Facility
|
OP
|
$1,254.54
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
4473041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.18 |
| Max. Negotiated Rate |
$1,003.63 |
| Rate for Payer: Aetna of NY Commercial |
$690.00
|
| Rate for Payer: Aetna of NY Medicare |
$577.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$501.82
|
| Rate for Payer: Cash Price |
$940.90
|
| Rate for Payer: Cash Price |
$940.90
|
| Rate for Payer: CDPHP Medicare |
$464.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,003.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,003.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,003.63
|
| Rate for Payer: EmblemHealth Medicaid |
$1,003.63
|
| Rate for Payer: EmblemHealth Medicare |
$426.54
|
| Rate for Payer: EmblemHealth Select Care |
$903.27
|
| Rate for Payer: Fidelis Medicare |
$501.82
|
| Rate for Payer: Galaxy Health Commercial |
$815.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$501.82
|
| Rate for Payer: Humana Medicare |
$501.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$690.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$577.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$940.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$706.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$526.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$469.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$188.18
|
| Rate for Payer: United Healthcare Commercial |
$469.67
|
| Rate for Payer: United Healthcare Medicare |
$501.82
|
| Rate for Payer: WellCare Medicare |
$690.00
|
|
|
CYMBALTA 20 MG
|
Facility
|
IP
|
$23.95
|
|
|
Service Code
|
NDC 904645204
|
| Hospital Charge Code |
4401251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$15.57 |
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Galaxy Health Commercial |
$15.57
|
| Rate for Payer: WellCare Medicare |
$13.17
|
|
|
CYMBALTA 20 MG
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 904645204
|
| Hospital Charge Code |
4401251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna of NY Commercial |
$16.77
|
| Rate for Payer: Aetna of NY Medicare |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.58
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: CDPHP Medicare |
$8.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.16
|
| Rate for Payer: EmblemHealth Medicaid |
$19.16
|
| Rate for Payer: EmblemHealth Medicare |
$8.14
|
| Rate for Payer: EmblemHealth Select Care |
$17.24
|
| Rate for Payer: Fidelis Medicare |
$9.58
|
| Rate for Payer: Galaxy Health Commercial |
$15.57
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.58
|
| Rate for Payer: Humana Medicare |
$9.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.96
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.59
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
| Rate for Payer: WellCare Medicare |
$13.17
|
|
|
CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
4002015
|
|
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
|
|
|
CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
4002015
|
|
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
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
4002019
|
|
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
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
4002019
|
|
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 |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
4002006
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
4002006
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,682.10 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
|
|
CYSTO MANJ W/O RMVL URETERAL STONE
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52330
|
| Hospital Charge Code |
4002024
|
|
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
|
|
|
CYSTO MANJ W/O RMVL URETERAL STONE
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52330
|
| Hospital Charge Code |
4002024
|
|
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 |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,620.60
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,321.60
|
| Rate for Payer: WellCare Medicare |
$5,942.20
|
|
|
CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
4002029
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
4002029
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,682.10 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
|
|
CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
4002030
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
4002030
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,682.10 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
|
|
CYSTOSCOPY PROSTATIC IMP 1-3
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
4002073
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,682.10 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
|
|
CYSTOSCOPY PROSTATIC IMP 1-3
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
4002073
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,147.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,559.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,573.60
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: Cash Price |
$12,325.50
|
| Rate for Payer: CDPHP Medicare |
$6,080.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13,147.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,587.56
|
| Rate for Payer: EmblemHealth Select Care |
$11,832.48
|
| Rate for Payer: Fidelis Medicare |
$6,573.60
|
| Rate for Payer: Galaxy Health Commercial |
$10,682.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,573.60
|
| Rate for Payer: Humana Medicare |
$6,573.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,559.64
|
| Rate for Payer: Multiplan Commercial |
$13,147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12,325.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,252.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,902.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,465.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$6,573.60
|
| Rate for Payer: WellCare Medicare |
$9,038.70
|
|
|
CYSTOSCOPY PROSTATIC IMP 4 OR MORE
|
Facility
|
OP
|
$29,015.00
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
4002074
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$23,212.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$13,346.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11,606.00
|
| Rate for Payer: Cash Price |
$21,761.25
|
| Rate for Payer: Cash Price |
$21,761.25
|
| Rate for Payer: CDPHP Medicare |
$10,735.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23,212.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23,212.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23,212.00
|
| Rate for Payer: EmblemHealth Medicaid |
$23,212.00
|
| Rate for Payer: EmblemHealth Medicare |
$9,865.10
|
| Rate for Payer: EmblemHealth Select Care |
$20,890.80
|
| Rate for Payer: Fidelis Medicare |
$11,606.00
|
| Rate for Payer: Galaxy Health Commercial |
$18,859.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$11,606.00
|
| Rate for Payer: Humana Medicare |
$11,606.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13,346.90
|
| Rate for Payer: Multiplan Commercial |
$23,212.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21,761.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16,335.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12,186.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,352.25
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$11,606.00
|
| Rate for Payer: WellCare Medicare |
$15,958.25
|
|
|
CYSTOSCOPY PROSTATIC IMP 4 OR MORE
|
Facility
|
IP
|
$29,015.00
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
4002074
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$18,859.75 |
| Max. Negotiated Rate |
$18,859.75 |
| Rate for Payer: Cash Price |
$21,761.25
|
| Rate for Payer: Galaxy Health Commercial |
$18,859.75
|
|
|
CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
4002004
|
|
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
|
|
|
CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
4002004
|
|
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
|
|
