|
CYSTOURETHROSCOPY
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
4002013
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$320.55 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$983.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$854.80
|
| Rate for Payer: Cash Price |
$1,602.75
|
| Rate for Payer: Cash Price |
$1,602.75
|
| Rate for Payer: CDPHP Medicare |
$790.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,709.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,709.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,709.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,709.60
|
| Rate for Payer: EmblemHealth Medicare |
$726.58
|
| Rate for Payer: EmblemHealth Select Care |
$1,538.64
|
| Rate for Payer: Fidelis Medicare |
$854.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,389.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$854.80
|
| Rate for Payer: Humana Medicare |
$854.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$983.02
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,602.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,203.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$897.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$320.55
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$854.80
|
| Rate for Payer: WellCare Medicare |
$1,175.35
|
|
|
CYSTOURETHROSCOPY
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
4002013
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,389.05 |
| Max. Negotiated Rate |
$1,389.05 |
| Rate for Payer: Cash Price |
$1,602.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,389.05
|
|
|
CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
4002018
|
|
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
|
|
|
CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
4002018
|
|
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
|
|
|
CYSTOURETHROSCOPY WITH BIOPSY
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
4002016
|
|
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
|
|
|
CYSTOURETHROSCOPY WITH BIOPSY
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
4002016
|
|
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
|
|
|
CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
4002023
|
|
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
|
|
|
CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
4002023
|
|
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 W/DESTRUCTION OF LESIONS
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
4002017
|
|
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 W/DESTRUCTION OF LESIONS
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
4002017
|
|
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 W/INSERT URETERAL STENT
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
4002025
|
|
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 W/INSERT URETERAL STENT
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
4002025
|
|
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 W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
4002014
|
|
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 W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
4002014
|
|
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
|
|
|
CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
4002020
|
|
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
|
|
|
CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
4002020
|
|
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 W/URETEROSCOPY W/LITHOTRIPSY
|
Facility
|
OP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
4002028
|
|
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 W/URETEROSCOPY W/LITHOTRIPSY
|
Facility
|
IP
|
$16,434.00
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
4002028
|
|
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 W/URETEROSCOPY W/RMVL/MANJ STONES
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
4002027
|
|
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 W/URETEROSCOPY W/RMVL/MANJ STONES
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
4002027
|
|
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 W/URTROSCOPY&/PYELOSCOPY DX
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
4002026
|
|
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 W/URTROSCOPY&/PYELOSCOPY DX
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
4002026
|
|
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
|
|
|
CYTOLOGY EFFUSIONS
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300256
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
|
|
CYTOLOGY EFFUSIONS
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300256
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$94.40 |
| Rate for Payer: Aetna of NY Commercial |
$76.70
|
| Rate for Payer: Aetna of NY Medicare |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: CDPHP Medicare |
$43.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.40
|
| Rate for Payer: EmblemHealth Medicaid |
$94.40
|
| Rate for Payer: EmblemHealth Medicare |
$40.12
|
| Rate for Payer: EmblemHealth Select Care |
$70.80
|
| Rate for Payer: Fidelis Medicare |
$47.20
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.20
|
| Rate for Payer: Humana Medicare |
$47.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$88.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
| Rate for Payer: WellCare Medicare |
$64.90
|
|
|
CYTOLOGY RESPIRATORY
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300258
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$94.40 |
| Rate for Payer: Aetna of NY Commercial |
$76.70
|
| Rate for Payer: Aetna of NY Medicare |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: CDPHP Medicare |
$43.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.40
|
| Rate for Payer: EmblemHealth Medicaid |
$94.40
|
| Rate for Payer: EmblemHealth Medicare |
$40.12
|
| Rate for Payer: EmblemHealth Select Care |
$70.80
|
| Rate for Payer: Fidelis Medicare |
$47.20
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.20
|
| Rate for Payer: Humana Medicare |
$47.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$88.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
| Rate for Payer: WellCare Medicare |
$64.90
|
|
