|
INJ PARAVERT F JNT L/S 1 LEV
|
Facility
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
4850188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,199.68
|
| 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 |
$964.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: CDPHP Commercial |
$2,099.44
|
| Rate for Payer: CDPHP Medicare |
$964.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,086.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicare |
$886.72
|
| Rate for Payer: Fidelis Medicare |
$993.91
|
| Rate for Payer: Galaxy Health Commercial |
$1,695.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$964.96
|
| Rate for Payer: Humana Medicare |
$964.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,199.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,956.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,468.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,013.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$868.45
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$964.96
|
| Rate for Payer: WellCare Medicare |
$1,434.40
|
|
|
INJ(S) FORAMEN EPIDURAL L/S
|
Facility
OP
|
$2,608.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
4851985
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,199.68
|
| 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 |
$964.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: CDPHP Commercial |
$2,099.44
|
| Rate for Payer: CDPHP Medicare |
$964.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,086.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,086.40
|
| Rate for Payer: EmblemHealth Medicare |
$886.72
|
| Rate for Payer: Fidelis Medicare |
$993.91
|
| Rate for Payer: Galaxy Health Commercial |
$1,695.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$964.96
|
| Rate for Payer: Humana Medicare |
$964.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,199.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,956.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,468.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,013.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$868.45
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$964.96
|
| Rate for Payer: WellCare Medicare |
$1,434.40
|
|
|
INJ SGL TENDON SHTH OR LIGAMENT
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4856653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
INJ SULF HEXA LIPID MICROSPH, PER ML (LUMASON)
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
4471372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna of NY Commercial |
$51.15
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.50
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Commercial |
$74.86
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: EmblemHealth Select Care |
$18.94
|
| Rate for Payer: Fidelis Medicare |
$35.44
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.41
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.94
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare |
$34.41
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4601195
|
|
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 |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| 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 |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| 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 |
$329.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
INNER CANNULA DISPOSABLE
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
4479110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
INSERT BLADDER CATHETER
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4852006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT OPEN DECOMPRESSION OR FUSION, INCLUDING IMAGE GUIDANCE WHEN PERFORMED, LUMBAR; SINGLE LEVEL
|
Facility
OP
|
$12,539.82
|
|
|
Service Code
|
CPT 22869
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$12,539.82 |
| 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 |
$1,421.00
|
| 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 |
$12,539.82
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
|
|
INSERTION OF PICC,W/O SUBCUTANEOUS PORT
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
4850252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
OP
|
$29,586.29
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$29,586.29 |
| 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 |
$29,586.29
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4852013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.93 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Facility
OP
|
$62,594.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
4002012
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$50,388.17 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$28,793.24
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$23,159.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,640.00
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: Cash Price |
$46,945.50
|
| Rate for Payer: CDPHP Commercial |
$50,388.17
|
| Rate for Payer: CDPHP Medicare |
$23,159.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$50,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$21,281.96
|
| Rate for Payer: Fidelis Medicare |
$23,854.57
|
| Rate for Payer: Galaxy Health Commercial |
$40,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$23,159.78
|
| Rate for Payer: Humana Medicare |
$23,159.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28,793.24
|
| Rate for Payer: Multiplan Commercial |
$50,075.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46,945.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,240.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24,317.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20,842.84
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare |
$23,159.78
|
| Rate for Payer: WellCare Medicare |
$34,426.70
|
|
|
INSERT NON-TUNNEL CV CATH <5 YRS
|
Facility
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
4602153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,342.40 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,195.66
|
| 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 |
$3,374.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,560.50
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: CDPHP Commercial |
$7,342.40
|
| Rate for Payer: CDPHP Medicare |
$3,374.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,296.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,101.14
|
| 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 |
$3,476.01
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,374.77
|
| Rate for Payer: Humana Medicare |
$3,374.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,195.66
|
| 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 |
$3,543.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,037.01
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,374.77
|
| Rate for Payer: WellCare Medicare |
$5,016.55
|
|
|
IN SITU HYBRIDIZATION 1ST PROBE STAIN
|
Facility
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
4008365
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$213.32 |
| Rate for Payer: Aetna of NY Commercial |
$172.25
|
| Rate for Payer: Aetna of NY Medicare |
$121.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$132.50
|
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: CDPHP Commercial |
$213.32
|
| Rate for Payer: CDPHP Medicare |
$98.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.00
|
| Rate for Payer: EmblemHealth Medicaid |
$212.00
|
| Rate for Payer: EmblemHealth Medicare |
$90.10
|
| Rate for Payer: Fidelis Medicare |
$100.99
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.05
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$102.95
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$198.75
|
| Rate for Payer: United Healthcare Commercial |
$198.75
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
| Rate for Payer: WellCare Medicare |
$145.75
|
|
|
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Hospital Charge Code |
4008364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$130.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: CDPHP Commercial |
$161.00
|
| Rate for Payer: CDPHP Medicare |
$74.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.00
|
| Rate for Payer: EmblemHealth Medicaid |
$160.00
|
| Rate for Payer: EmblemHealth Medicare |
$68.00
|
| Rate for Payer: Fidelis Medicare |
$76.22
|
| Rate for Payer: Galaxy Health Commercial |
$130.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.00
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$130.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$150.00
|
| Rate for Payer: United Healthcare Medicare |
$74.00
|
| Rate for Payer: WellCare Medicare |
$110.00
|
|
|
INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Facility
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 53445
|
| Hospital Charge Code |
4002070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Facility
OP
|
$57,719.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
4002067
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$46,463.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$26,550.74
|
| 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: Blue Cross Blue Shield of New York (Empire) Medicare |
$21,356.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,563.00
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: Cash Price |
$43,289.25
|
| Rate for Payer: CDPHP Commercial |
$46,463.80
|
| Rate for Payer: CDPHP Medicare |
$21,356.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46,175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$46,175.20
|
| Rate for Payer: EmblemHealth Medicare |
$19,624.46
|
| Rate for Payer: Fidelis Medicare |
$21,996.71
|
| Rate for Payer: Galaxy Health Commercial |
$37,517.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21,356.03
|
| Rate for Payer: Humana Medicare |
$21,356.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26,550.74
|
| Rate for Payer: Multiplan Commercial |
$46,175.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43,289.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32,495.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22,423.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19,219.50
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare Medicare |
$21,356.03
|
| Rate for Payer: WellCare Medicare |
$31,745.45
|
|
|
INS NON-TUNNEL CV CATH 5 YRS/>
|
Facility
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
4609603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,342.40 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,195.66
|
| 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 |
$3,374.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,560.50
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: Cash Price |
$6,840.75
|
| Rate for Payer: CDPHP Commercial |
$7,342.40
|
| Rate for Payer: CDPHP Medicare |
$3,374.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,296.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,296.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,101.14
|
| 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 |
$3,476.01
|
| Rate for Payer: Galaxy Health Commercial |
$5,928.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,374.77
|
| Rate for Payer: Humana Medicare |
$3,374.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,195.66
|
| 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 |
$3,543.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,037.01
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,374.77
|
| Rate for Payer: WellCare Medicare |
$5,016.55
|
|
|
INS TEMP BLADDER CATH (FOLEY CATH)
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4600050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| 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 |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4451253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INS TEMP BLADDER CATH SIMPLE
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4851253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INS TEMP BLADDER CATH (STRAIGHT CATH)
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
4609611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| 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 |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
INSULIN GLARGINE 100U/ML SYRN 5X3ML
|
Facility
OP
|
$276.56
|
|
| Hospital Charge Code |
4400415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$222.63 |
| Rate for Payer: Aetna of NY Commercial |
$193.59
|
| Rate for Payer: Aetna of NY Medicare |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$207.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$207.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$138.28
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: CDPHP Commercial |
$222.63
|
| Rate for Payer: CDPHP Medicare |
$102.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$221.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$221.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.25
|
| Rate for Payer: EmblemHealth Medicaid |
$221.25
|
| Rate for Payer: EmblemHealth Medicare |
$94.03
|
| Rate for Payer: EmblemHealth Select Care |
$199.12
|
| Rate for Payer: Fidelis Medicare |
$105.40
|
| Rate for Payer: Galaxy Health Commercial |
$179.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.33
|
| Rate for Payer: Humana Medicare |
$102.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$193.59
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$107.44
|
| Rate for Payer: United Healthcare Medicare |
$102.33
|
| Rate for Payer: WellCare Medicare |
$152.11
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| 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: 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
INSULIN INJ PER 5 UNITS
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4400353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| 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: 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
