|
HEP B SURF ANTIBODY
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
4300422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
HEP B SURF ANTIBODY
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
4300422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
HEP C RNA (PCR)
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
4300434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna of NY Commercial |
$161.20
|
| Rate for Payer: Aetna of NY Medicare |
$114.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$124.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: CDPHP Commercial |
$199.64
|
| Rate for Payer: CDPHP Medicare |
$91.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$148.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$198.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$198.40
|
| Rate for Payer: EmblemHealth Medicaid |
$198.40
|
| Rate for Payer: EmblemHealth Medicare |
$84.32
|
| Rate for Payer: EmblemHealth Select Care |
$148.80
|
| Rate for Payer: Fidelis Medicare |
$94.51
|
| Rate for Payer: Galaxy Health Commercial |
$161.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.76
|
| Rate for Payer: Humana Medicare |
$91.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$114.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$186.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$186.00
|
| Rate for Payer: United Healthcare Medicare |
$91.76
|
| Rate for Payer: WellCare Medicare |
$136.40
|
|
|
HEP C RNA (PCR)
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
4300434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Galaxy Health Commercial |
$161.20
|
|
|
HEP C VIRUS AB
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
4300424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$33.60
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
HEP C VIRUS AB
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
4300424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
HERCULES 3 STAGE #431928
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
4479314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$277.72 |
| Rate for Payer: Aetna of NY Commercial |
$241.50
|
| Rate for Payer: Aetna of NY Medicare |
$158.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.50
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: CDPHP Commercial |
$277.72
|
| Rate for Payer: CDPHP Medicare |
$127.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$276.00
|
| Rate for Payer: EmblemHealth Medicare |
$117.30
|
| Rate for Payer: EmblemHealth Select Care |
$248.40
|
| Rate for Payer: Fidelis Medicare |
$131.48
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.65
|
| Rate for Payer: Humana Medicare |
$127.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$241.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.03
|
| Rate for Payer: United Healthcare Medicare |
$127.65
|
| Rate for Payer: WellCare Medicare |
$189.75
|
|
|
HERCULES 3 STAGE #431928
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
4479314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
|
|
HERCULES 3 STAGE BALLOON 18-19-20
|
Facility
|
IP
|
$629.00
|
|
| Hospital Charge Code |
4473038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Cash Price |
$471.75
|
| Rate for Payer: Galaxy Health Commercial |
$408.85
|
|
|
HERCULES 3 STAGE BALLOON 18-19-20
|
Facility
|
OP
|
$629.00
|
|
| Hospital Charge Code |
4473038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: Aetna of NY Commercial |
$440.30
|
| Rate for Payer: Aetna of NY Medicare |
$289.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$232.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$314.50
|
| Rate for Payer: Cash Price |
$471.75
|
| Rate for Payer: CDPHP Commercial |
$506.34
|
| Rate for Payer: CDPHP Medicare |
$232.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$503.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$503.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$503.20
|
| Rate for Payer: EmblemHealth Medicaid |
$503.20
|
| Rate for Payer: EmblemHealth Medicare |
$213.86
|
| Rate for Payer: EmblemHealth Select Care |
$452.88
|
| Rate for Payer: Fidelis Medicare |
$239.71
|
| Rate for Payer: Galaxy Health Commercial |
$408.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$232.73
|
| Rate for Payer: Humana Medicare |
$232.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$440.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$289.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$354.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$244.37
|
| Rate for Payer: United Healthcare Medicare |
$232.73
|
| Rate for Payer: WellCare Medicare |
$345.95
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
4471894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
4471890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
4471890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
4471891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
4471892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
4471894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
4471892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
4471891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
|
|
HETEROPHILE ABS QUAL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
4300440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
HETEROPHILE ABS QUAL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
4300440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.78
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
HFO W/JOINT(S) CF
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
4690265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$717.26 |
| Rate for Payer: Aetna of NY Commercial |
$623.70
|
| Rate for Payer: Aetna of NY Medicare |
$409.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$329.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$445.50
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: CDPHP Commercial |
$717.26
|
| Rate for Payer: CDPHP Medicare |
$329.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$445.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$712.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$712.80
|
| Rate for Payer: EmblemHealth Medicaid |
$712.80
|
| Rate for Payer: EmblemHealth Medicare |
$302.94
|
| Rate for Payer: EmblemHealth Select Care |
$445.50
|
| Rate for Payer: Fidelis Medicare |
$339.56
|
| Rate for Payer: Galaxy Health Commercial |
$579.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$329.67
|
| Rate for Payer: Humana Medicare |
$329.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$623.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$409.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$668.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$501.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$346.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$312.33
|
| Rate for Payer: United Healthcare Medicare |
$329.67
|
| Rate for Payer: WellCare Medicare |
$490.05
|
|
|
HFO W/JOINT(S) CF
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
4690265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$400.95 |
| Max. Negotiated Rate |
$579.15 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.95
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$445.50
|
| Rate for Payer: EmblemHealth Select Care |
$445.50
|
| Rate for Payer: Galaxy Health Commercial |
$579.15
|
| Rate for Payer: Multiplan Commercial |
$400.95
|
| Rate for Payer: WellCare Medicare |
$490.05
|
|
|
HFO W/O JOINTS CF
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
4690165
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.75 |
| Max. Negotiated Rate |
$490.75 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$339.75
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$377.50
|
| Rate for Payer: EmblemHealth Select Care |
$377.50
|
| Rate for Payer: Galaxy Health Commercial |
$490.75
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: WellCare Medicare |
$415.25
|
|
|
HFO W/O JOINTS CF
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
4690165
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.70 |
| Max. Negotiated Rate |
$607.78 |
| Rate for Payer: Aetna of NY Commercial |
$528.50
|
| Rate for Payer: Aetna of NY Medicare |
$347.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$339.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$279.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$377.50
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: Cash Price |
$566.25
|
| Rate for Payer: CDPHP Commercial |
$607.78
|
| Rate for Payer: CDPHP Medicare |
$279.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$377.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.00
|
| Rate for Payer: EmblemHealth Medicaid |
$604.00
|
| Rate for Payer: EmblemHealth Medicare |
$256.70
|
| Rate for Payer: EmblemHealth Select Care |
$377.50
|
| Rate for Payer: Fidelis Medicare |
$287.73
|
| Rate for Payer: Galaxy Health Commercial |
$490.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$279.35
|
| Rate for Payer: Humana Medicare |
$279.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$528.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$425.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$293.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$263.38
|
| Rate for Payer: United Healthcare Medicare |
$279.35
|
| Rate for Payer: WellCare Medicare |
$415.25
|
|
|
HIV-1 AG W/HIV-1 & HIV-2 AB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
4305529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$99.82 |
| Rate for Payer: Aetna of NY Commercial |
$80.60
|
| Rate for Payer: Aetna of NY Medicare |
$57.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$62.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: CDPHP Commercial |
$99.82
|
| Rate for Payer: CDPHP Medicare |
$45.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$99.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$99.20
|
| Rate for Payer: EmblemHealth Medicaid |
$99.20
|
| Rate for Payer: EmblemHealth Medicare |
$42.16
|
| Rate for Payer: EmblemHealth Select Care |
$74.40
|
| Rate for Payer: Fidelis Medicare |
$47.26
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.88
|
| Rate for Payer: Humana Medicare |
$45.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$80.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$69.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$93.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$93.00
|
| Rate for Payer: United Healthcare Medicare |
$45.88
|
| Rate for Payer: WellCare Medicare |
$68.20
|
|
