|
IMMUNOASSAY NONANTIBODY
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
4302004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$29.25
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$33.75
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
IMMUNOASSAY QUANT NOS NONAB
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
4301073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$120.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: CDPHP Commercial |
$193.20
|
| Rate for Payer: CDPHP Medicare |
$88.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$192.00
|
| Rate for Payer: EmblemHealth Medicaid |
$192.00
|
| Rate for Payer: EmblemHealth Medicare |
$81.60
|
| Rate for Payer: Fidelis Medicare |
$91.46
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.80
|
| Rate for Payer: Humana Medicare |
$88.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$110.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$135.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$93.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$180.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicare |
$88.80
|
| Rate for Payer: WellCare Medicare |
$132.00
|
|
|
IM OR SUBCUTANEOUS
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4450101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$1,336.00 |
| 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 |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.36
|
| 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 |
$101.00
|
| 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 Child Health Plus/HARP/Select Plan |
$13.36
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Essential Plan |
$30.06
|
| 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 |
$16.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.36
|
| Rate for Payer: EmblemHealth Medicaid |
$13.36
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.06
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$13.09
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,336.00
|
| 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 Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.72
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$151.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.03
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
IMPLANTABLE BIOPSY SITE MARKER
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4473021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Aetna of NY Commercial |
$194.60
|
| Rate for Payer: Aetna of NY Medicare |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$139.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: CDPHP Commercial |
$223.79
|
| Rate for Payer: CDPHP Medicare |
$102.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$222.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$222.40
|
| Rate for Payer: EmblemHealth Medicaid |
$222.40
|
| Rate for Payer: EmblemHealth Medicare |
$94.52
|
| Rate for Payer: EmblemHealth Select Care |
$139.00
|
| Rate for Payer: Fidelis Medicare |
$105.95
|
| Rate for Payer: Galaxy Health Commercial |
$180.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.86
|
| Rate for Payer: Humana Medicare |
$102.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$194.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.00
|
| Rate for Payer: United Healthcare Medicare |
$102.86
|
| Rate for Payer: WellCare Medicare |
$152.90
|
|
|
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING
|
Facility
OP
|
$16,992.38
|
|
|
Service Code
|
CPT 62362
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$16,992.38 |
| 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 |
$3,739.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,673.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,640.00
|
| 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 |
$16,992.38
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
|
|
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY
|
Facility
OP
|
$6,346.97
|
|
|
Service Code
|
CPT 62350
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$6,346.97 |
| 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 |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| 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 |
$6,346.97
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
INCAL BX SKN EA SEP/ADDL
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
4853030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$87.50
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| 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 |
$46.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$62.50
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Commercial |
$100.62
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: Fidelis Medicare |
$47.64
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.25
|
| Rate for Payer: Humana Medicare |
$46.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$87.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.29
|
| Rate for Payer: United Healthcare Medicare |
$46.25
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
4853029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| Rate for Payer: Aetna of NY Commercial |
$1,257.90
|
| 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 |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,257.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,011.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE
|
Facility
OP
|
$19,569.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
4002011
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$15,753.04 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$9,001.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7,240.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,491.00
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: Cash Price |
$14,676.75
|
| Rate for Payer: CDPHP Commercial |
$15,753.04
|
| Rate for Payer: CDPHP Medicare |
$7,240.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,655.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15,655.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15,655.20
|
| Rate for Payer: EmblemHealth Medicare |
$6,653.46
|
| Rate for Payer: Fidelis Medicare |
$7,457.75
|
| Rate for Payer: Galaxy Health Commercial |
$12,719.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$7,240.53
|
| Rate for Payer: Humana Medicare |
$7,240.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9,001.74
|
| Rate for Payer: Multiplan Commercial |
$15,655.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14,676.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11,017.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7,602.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,516.28
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$7,240.53
|
| Rate for Payer: WellCare Medicare |
$10,762.95
|
|
|
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| 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 |
$1,266.00
|
| 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 |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
INCISION EXT THROMB HEMORRHOID
|
Facility
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
4600112
|
|
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
|
|
|
INC & REM FB SQ; COMPL
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
4856683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.75 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| 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 |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
INC & REM FB SQ; SMPL
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4856682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
INC/REM FOR BODY SUBCUT SIMPLE
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
4600111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| 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 |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
INCRUSE ELLIPTA 62.5 MCG INH 1 ea, 7 eaches
|
Facility
OP
|
$255.00
|
|
| Hospital Charge Code |
4401371
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$205.28 |
| Rate for Payer: Aetna of NY Commercial |
$178.50
|
| Rate for Payer: Aetna of NY Medicare |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$127.50
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: CDPHP Commercial |
$205.28
|
| Rate for Payer: CDPHP Medicare |
$94.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$204.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$204.00
|
| Rate for Payer: EmblemHealth Medicare |
$86.70
|
| Rate for Payer: EmblemHealth Select Care |
$183.60
|
| Rate for Payer: Fidelis Medicare |
$97.18
|
| Rate for Payer: Galaxy Health Commercial |
$165.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.35
|
| Rate for Payer: Humana Medicare |
$94.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$178.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$117.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$143.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.07
|
| Rate for Payer: United Healthcare Medicare |
$94.35
|
| Rate for Payer: WellCare Medicare |
$140.25
|
|
|
INDIGO CARMINE 0.8% AMPUL 5 mL, 5 mL
|
Facility
OP
|
$620.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$499.10 |
| Rate for Payer: Aetna of NY Commercial |
$341.00
|
| Rate for Payer: Aetna of NY Medicare |
$285.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$229.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$310.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: CDPHP Commercial |
$499.10
|
| Rate for Payer: CDPHP Medicare |
$229.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.00
|
| Rate for Payer: EmblemHealth Medicaid |
$496.00
|
| Rate for Payer: EmblemHealth Medicare |
$210.80
|
| Rate for Payer: EmblemHealth Select Care |
$446.40
|
| Rate for Payer: Fidelis Medicare |
$236.28
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$229.40
|
| Rate for Payer: Humana Medicare |
$229.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$240.87
|
| Rate for Payer: United Healthcare Medicare |
$229.40
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
INDIUM IN-111 AUTO PLATELET PER DOSE
|
Facility
OP
|
$3,138.00
|
|
|
Service Code
|
HCPCS A9571
|
| Hospital Charge Code |
4210070
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,066.92 |
| Max. Negotiated Rate |
$6,554.23 |
| Rate for Payer: Aetna of NY Medicare |
$1,443.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,161.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,569.00
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: CDPHP Commercial |
$2,526.09
|
| Rate for Payer: CDPHP Medicare |
$1,161.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,510.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,510.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,510.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,510.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,066.92
|
| Rate for Payer: EmblemHealth Select Care |
$2,259.36
|
| Rate for Payer: Fidelis Medicare |
$1,195.89
|
| Rate for Payer: Galaxy Health Commercial |
$2,039.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,161.06
|
| Rate for Payer: Humana Medicare |
$1,161.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,443.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,353.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,766.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,219.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$1,161.06
|
| Rate for Payer: WellCare Medicare |
$1,725.90
|
|
|
INDIUM IN-111 AUTO WBC
|
Facility
OP
|
$11,309.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
4211250
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,845.06 |
| Max. Negotiated Rate |
$9,103.74 |
| Rate for Payer: Aetna of NY Medicare |
$5,202.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8,481.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8,481.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,184.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,654.50
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: CDPHP Commercial |
$9,103.74
|
| Rate for Payer: CDPHP Medicare |
$4,184.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicaid |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,845.06
|
| Rate for Payer: EmblemHealth Select Care |
$8,142.48
|
| Rate for Payer: Fidelis Medicare |
$4,309.86
|
| Rate for Payer: Galaxy Health Commercial |
$7,350.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,184.33
|
| Rate for Payer: Humana Medicare |
$4,184.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,202.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,481.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,366.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,393.55
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$4,184.33
|
| Rate for Payer: WellCare Medicare |
$6,219.95
|
|
|
INDIUM IN-111 PENTETREOTIDE =< 6 MCI
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
4210078
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$10,595.67 |
| Rate for Payer: Aetna of NY Medicare |
$339.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$554.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$554.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$273.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$369.50
|
| Rate for Payer: Cash Price |
$554.25
|
| Rate for Payer: Cash Price |
$554.25
|
| Rate for Payer: CDPHP Commercial |
$594.90
|
| Rate for Payer: CDPHP Medicare |
$273.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$591.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$591.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$591.20
|
| Rate for Payer: EmblemHealth Medicaid |
$591.20
|
| Rate for Payer: EmblemHealth Medicare |
$251.26
|
| Rate for Payer: EmblemHealth Select Care |
$532.08
|
| Rate for Payer: Fidelis Medicare |
$281.63
|
| Rate for Payer: Galaxy Health Commercial |
$480.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$273.43
|
| Rate for Payer: Humana Medicare |
$273.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$339.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$416.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$287.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$10,595.67
|
| Rate for Payer: United Healthcare Commercial |
$10,595.67
|
| Rate for Payer: United Healthcare Medicare |
$273.43
|
| Rate for Payer: WellCare Medicare |
$406.45
|
|
|
INDOMETHACIN 25MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400387
|
|
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
|
|
|
INFINION 50 CM 16 CONTACT LEAD KIT
|
Facility
OP
|
$16,208.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.72 |
| Max. Negotiated Rate |
$13,047.44 |
| Rate for Payer: Aetna of NY Commercial |
$11,345.60
|
| Rate for Payer: Aetna of NY Medicare |
$7,455.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,293.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,293.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,996.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8,104.00
|
| Rate for Payer: Cash Price |
$12,156.00
|
| Rate for Payer: CDPHP Commercial |
$13,047.44
|
| Rate for Payer: CDPHP Medicare |
$5,996.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,966.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,966.40
|
| Rate for Payer: EmblemHealth Medicaid |
$12,966.40
|
| Rate for Payer: EmblemHealth Medicare |
$5,510.72
|
| Rate for Payer: EmblemHealth Select Care |
$8,104.00
|
| Rate for Payer: Fidelis Medicare |
$6,176.87
|
| Rate for Payer: Galaxy Health Commercial |
$10,535.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,996.96
|
| Rate for Payer: Humana Medicare |
$5,996.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,345.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,455.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,535.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,535.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,296.81
|
| Rate for Payer: United Healthcare Medicare |
$5,996.96
|
| Rate for Payer: WellCare Medicare |
$8,914.40
|
|
|
INFLECTRA 100 MG VIAL 100 mg, 1 each
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
4401942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of NY Commercial |
$187.55
|
| Rate for Payer: Aetna of NY Medicare |
$156.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$170.50
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: CDPHP Commercial |
$274.50
|
| Rate for Payer: CDPHP Medicare |
$126.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.80
|
| Rate for Payer: EmblemHealth Medicaid |
$272.80
|
| Rate for Payer: EmblemHealth Medicare |
$115.94
|
| Rate for Payer: EmblemHealth Select Care |
$11.09
|
| Rate for Payer: Fidelis Medicare |
$129.96
|
| Rate for Payer: Galaxy Health Commercial |
$221.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.17
|
| Rate for Payer: Humana Medicare |
$126.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$187.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$132.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.41
|
| Rate for Payer: United Healthcare Commercial |
$30.41
|
| Rate for Payer: United Healthcare Medicare |
$126.17
|
| Rate for Payer: WellCare Medicare |
$187.55
|
|
|
INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG
|
Facility
OP
|
$420.42
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
4400677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$7,766.00 |
| Rate for Payer: Aetna of NY Commercial |
$231.23
|
| Rate for Payer: Aetna of NY Medicare |
$193.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$174.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$155.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$210.21
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$77.66
|
| Rate for Payer: CDPHP Commercial |
$338.44
|
| Rate for Payer: CDPHP Essential Plan |
$174.74
|
| Rate for Payer: CDPHP Medicare |
$155.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.66
|
| Rate for Payer: EmblemHealth Medicaid |
$77.66
|
| Rate for Payer: EmblemHealth Medicare |
$142.94
|
| Rate for Payer: EmblemHealth Select Care |
$31.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$174.74
|
| Rate for Payer: Fidelis Medicare |
$160.22
|
| Rate for Payer: Galaxy Health Commercial |
$273.27
|
| Rate for Payer: Galaxy Health Workers Comp |
$76.11
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7,766.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$155.56
|
| Rate for Payer: Humana Medicare |
$155.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$231.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$193.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7,766.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$236.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$163.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$77.66
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
| Rate for Payer: United Healthcare Medicare |
$155.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$81.54
|
| Rate for Payer: WellCare Medicare |
$231.23
|
|
|
INFLUENZA A ANTIBODY
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
4300486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
INFLUENZA A/B AG EIA
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 87400
|
| Hospital Charge Code |
4301263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$95.80 |
| Rate for Payer: Aetna of NY Commercial |
$77.35
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$59.50
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$67.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$89.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Commercial |
$89.25
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
