|
GASTRIC EMPTYING STUDY
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78264
|
| Hospital Charge Code |
4210013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GASTRIC EMPTYING STUDY
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78264
|
| Hospital Charge Code |
4210013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
GASTROESOPHAGEAL REFLUX STUDY
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78262
|
| Hospital Charge Code |
4210014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
GASTROESOPHAGEAL REFLUX STUDY
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78262
|
| Hospital Charge Code |
4210014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GASTROGRAFFIN 120ML
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4471048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna of NY Commercial |
$51.10
|
| Rate for Payer: Aetna of NY Medicare |
$33.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.50
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: CDPHP Commercial |
$58.76
|
| Rate for Payer: CDPHP Medicare |
$27.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.40
|
| Rate for Payer: EmblemHealth Medicaid |
$58.40
|
| Rate for Payer: EmblemHealth Medicare |
$24.82
|
| Rate for Payer: EmblemHealth Select Care |
$36.50
|
| Rate for Payer: Fidelis Medicare |
$27.82
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.01
|
| Rate for Payer: Humana Medicare |
$27.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.36
|
| Rate for Payer: United Healthcare Medicare |
$27.01
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
GASTROGRAFFIN 120ML
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4471048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$51.10 |
| Rate for Payer: Aetna of NY Commercial |
$51.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.85
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.50
|
| Rate for Payer: EmblemHealth Select Care |
$36.50
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.10
|
| Rate for Payer: Multiplan Commercial |
$32.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.45
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
GB SCAN W DRUG
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
4211247
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
GB SCAN W DRUG
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
4211247
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$143.43 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$143.43
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
GB SCAN W/O DRUG
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
4210016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
GB SCAN W/O DRUG
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
4210016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$104.78
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GELSYN-3 16.8 MG/2 ML SYRINGE 16.8 mg, 2 mL
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
4401552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.49
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.49
|
| Rate for Payer: EmblemHealth Select Care |
$0.49
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
GELSYN-3 16.8 MG/2 ML SYRINGE 16.8 mg, 2 mL
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
4401552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$0.49
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
GEMFIBROZIL 600MG TABS 25 EA
|
Facility
|
IP
|
$13.65
|
|
|
Service Code
|
NDC 50268035015
|
| Hospital Charge Code |
4400318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Galaxy Health Commercial |
$8.87
|
| Rate for Payer: WellCare Medicare |
$7.51
|
|
|
GEMFIBROZIL 600MG TABS 25 EA
|
Facility
|
OP
|
$13.65
|
|
|
Service Code
|
NDC 50268035015
|
| Hospital Charge Code |
4400318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Aetna of NY Commercial |
$9.56
|
| Rate for Payer: Aetna of NY Medicare |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.82
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: CDPHP Commercial |
$10.99
|
| Rate for Payer: CDPHP Medicare |
$5.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
| Rate for Payer: EmblemHealth Medicaid |
$10.92
|
| Rate for Payer: EmblemHealth Medicare |
$4.64
|
| Rate for Payer: EmblemHealth Select Care |
$9.83
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.05
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.30
|
| Rate for Payer: United Healthcare Medicare |
$5.05
|
| Rate for Payer: WellCare Medicare |
$7.51
|
|
|
GEN COOLED PROBE NO TIP CRI-17-100
|
Facility
|
OP
|
$407.00
|
|
| Hospital Charge Code |
4479259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$327.64 |
| Rate for Payer: Aetna of NY Commercial |
$284.90
|
| Rate for Payer: Aetna of NY Medicare |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.50
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: CDPHP Commercial |
$327.64
|
| Rate for Payer: CDPHP Medicare |
$150.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$325.60
|
| Rate for Payer: EmblemHealth Medicaid |
$325.60
|
| Rate for Payer: EmblemHealth Medicare |
$138.38
|
| Rate for Payer: EmblemHealth Select Care |
$293.04
|
| Rate for Payer: Fidelis Medicare |
$155.11
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.59
|
| Rate for Payer: Humana Medicare |
$150.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$158.12
|
| Rate for Payer: United Healthcare Medicare |
$150.59
|
| Rate for Payer: WellCare Medicare |
$223.85
|
|
|
GEN COOLED PROBE NO TIP CRI-17-100
|
Facility
|
IP
|
$407.00
|
|
| Hospital Charge Code |
4479259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.55 |
| Max. Negotiated Rate |
$264.55 |
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
|
|
GEN COOLED RF GUAGE CRP-17-75-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479261
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
GEN COOLED RF GUAGE CRP-17-75-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479261
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
GEN COOLED RF KIT 75MM CRK-17-75-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479260
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
GEN COOLED RF KIT 75MM CRK-17-75-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479260
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
GEN COOLED RF KIT CRK-17-100-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479257
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
GEN COOLED RF KIT CRK-17-100-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479257
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
GEN COOLED RF PROBE CRI 17-75
|
Facility
|
OP
|
$407.00
|
|
| Hospital Charge Code |
4479262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$327.64 |
| Rate for Payer: Aetna of NY Commercial |
$284.90
|
| Rate for Payer: Aetna of NY Medicare |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.50
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: CDPHP Commercial |
$327.64
|
| Rate for Payer: CDPHP Medicare |
$150.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$325.60
|
| Rate for Payer: EmblemHealth Medicaid |
$325.60
|
| Rate for Payer: EmblemHealth Medicare |
$138.38
|
| Rate for Payer: EmblemHealth Select Care |
$293.04
|
| Rate for Payer: Fidelis Medicare |
$155.11
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.59
|
| Rate for Payer: Humana Medicare |
$150.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$158.12
|
| Rate for Payer: United Healthcare Medicare |
$150.59
|
| Rate for Payer: WellCare Medicare |
$223.85
|
|
|
GEN COOLED RF PROBE CRI 17-75
|
Facility
|
IP
|
$407.00
|
|
| Hospital Charge Code |
4479262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.55 |
| Max. Negotiated Rate |
$264.55 |
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
|
|
GEN COOLED RF PROBE TIP CRP 17-100-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479258
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
