|
SURGIPRO 4/0 18IN BLUE FS-2 C-
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
4472083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
SURG PATH LVL 2
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 88302 TC
|
| Hospital Charge Code |
4008302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Aetna of NY Commercial |
$55.25
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$42.50
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$63.75
|
| Rate for Payer: United Healthcare Medicare |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
SUTURE ETHILON 6/0 18IN BLAC
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
4471170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
SUTURELESS CATH
|
Facility
OP
|
$2,415.00
|
|
| Hospital Charge Code |
4471642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$821.10 |
| Max. Negotiated Rate |
$1,944.08 |
| Rate for Payer: Aetna of NY Commercial |
$1,690.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,110.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,811.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,811.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$893.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,207.50
|
| Rate for Payer: Cash Price |
$1,811.25
|
| Rate for Payer: CDPHP Commercial |
$1,944.08
|
| Rate for Payer: CDPHP Medicare |
$893.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,932.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,932.00
|
| Rate for Payer: EmblemHealth Medicare |
$821.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,738.80
|
| Rate for Payer: Fidelis Medicare |
$920.36
|
| Rate for Payer: Galaxy Health Commercial |
$1,569.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$893.55
|
| Rate for Payer: Humana Medicare |
$893.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,690.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,110.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,811.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,359.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$938.23
|
| Rate for Payer: United Healthcare Medicare |
$893.55
|
| Rate for Payer: WellCare Medicare |
$1,328.25
|
|
|
SUTURE LOOP GUIDE RODS
|
Facility
OP
|
$695.00
|
|
| Hospital Charge Code |
4471640
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$236.30 |
| Max. Negotiated Rate |
$559.48 |
| Rate for Payer: Aetna of NY Commercial |
$486.50
|
| Rate for Payer: Aetna of NY Medicare |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$521.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$521.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$257.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$347.50
|
| Rate for Payer: Cash Price |
$521.25
|
| Rate for Payer: CDPHP Commercial |
$559.48
|
| Rate for Payer: CDPHP Medicare |
$257.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$556.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$556.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$556.00
|
| Rate for Payer: EmblemHealth Medicaid |
$556.00
|
| Rate for Payer: EmblemHealth Medicare |
$236.30
|
| Rate for Payer: EmblemHealth Select Care |
$500.40
|
| Rate for Payer: Fidelis Medicare |
$264.86
|
| Rate for Payer: Galaxy Health Commercial |
$451.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$257.15
|
| Rate for Payer: Humana Medicare |
$257.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$486.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$319.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$391.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$270.01
|
| Rate for Payer: United Healthcare Medicare |
$257.15
|
| Rate for Payer: WellCare Medicare |
$382.25
|
|
|
SUTURE POLYSORB 0 6X18IN VIO
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
4471969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
SUTURE/REPAIR TESTICULAR INJURY
|
Facility
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54670
|
| Hospital Charge Code |
4002054
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
SUTURES POLYSORB
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
4472186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
SUTURE SURGILON 1 5X18IN BLAC
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
4471183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
SUTURE TRAY ER
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
4609638
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
SUTURE VICRYL 0 18IN VIOLET
|
Facility
OP
|
$489.00
|
|
| Hospital Charge Code |
4471860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$342.30
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: EmblemHealth Select Care |
$352.08
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$342.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
SWALLOWING FCN W CINE/VIDEO
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Hospital Charge Code |
4150350
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.84 |
| Max. Negotiated Rate |
$423.43 |
| Rate for Payer: Aetna of NY Commercial |
$315.60
|
| Rate for Payer: Aetna of NY Medicare |
$241.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$194.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$263.00
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: CDPHP Commercial |
$423.43
|
| Rate for Payer: CDPHP Medicare |
$194.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$420.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$420.80
|
| Rate for Payer: EmblemHealth Medicaid |
$420.80
|
| Rate for Payer: EmblemHealth Medicare |
$178.84
|
| Rate for Payer: Fidelis Medicare |
$200.46
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$194.62
|
| Rate for Payer: Humana Medicare |
$194.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$241.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$296.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$204.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$194.62
|
| Rate for Payer: WellCare Medicare |
$289.30
|
|
|
SYMBICORT 80-4.5 MCG INHALER 1 ea, 6.9 g
|
Facility
OP
|
$772.00
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
4401469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.48 |
| Max. Negotiated Rate |
$621.46 |
| Rate for Payer: Aetna of NY Commercial |
$424.60
|
| Rate for Payer: Aetna of NY Medicare |
$355.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$285.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$386.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: CDPHP Commercial |
$621.46
|
| Rate for Payer: CDPHP Medicare |
$285.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$617.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$617.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$617.60
|
| Rate for Payer: EmblemHealth Medicaid |
$617.60
|
| Rate for Payer: EmblemHealth Medicare |
$262.48
|
| Rate for Payer: EmblemHealth Select Care |
$555.84
|
| Rate for Payer: Fidelis Medicare |
$294.21
|
| Rate for Payer: Galaxy Health Commercial |
$501.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$285.64
|
| Rate for Payer: Humana Medicare |
$285.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$424.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$355.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$579.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$434.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$299.92
|
| Rate for Payer: United Healthcare Medicare |
$285.64
|
| Rate for Payer: WellCare Medicare |
$424.60
|
|
|
SYNCHROMED II PUMP
|
Facility
OP
|
$41,864.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
4471639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,233.76 |
| Max. Negotiated Rate |
$33,700.52 |
| Rate for Payer: Aetna of NY Commercial |
$29,304.80
|
| Rate for Payer: Aetna of NY Medicare |
$19,257.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18,838.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18,838.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15,489.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20,932.00
|
| Rate for Payer: Cash Price |
$31,398.00
|
| Rate for Payer: CDPHP Commercial |
$33,700.52
|
| Rate for Payer: CDPHP Medicare |
$15,489.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20,932.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33,491.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33,491.20
|
| Rate for Payer: EmblemHealth Medicaid |
$33,491.20
|
| Rate for Payer: EmblemHealth Medicare |
$14,233.76
|
| Rate for Payer: EmblemHealth Select Care |
$20,932.00
|
| Rate for Payer: Fidelis Medicare |
$15,954.37
|
| Rate for Payer: Galaxy Health Commercial |
$27,211.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$15,489.68
|
| Rate for Payer: Humana Medicare |
$15,489.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29,304.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$19,257.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27,211.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27,211.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16,264.16
|
| Rate for Payer: United Healthcare Medicare |
$15,489.68
|
| Rate for Payer: WellCare Medicare |
$23,025.20
|
|
|
SYPHLIS (RPR-STS) SCREEN
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
4300749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna of NY Commercial |
$19.50
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Commercial |
$24.15
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$11.43
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.10
|
| Rate for Payer: Humana Medicare |
$11.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$22.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
T3 FREE
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
4300755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna of NY Commercial |
$148.85
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$114.50
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Commercial |
$184.34
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$183.20
|
| Rate for Payer: EmblemHealth Medicaid |
$183.20
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: Fidelis Medicare |
$87.27
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.73
|
| Rate for Payer: Humana Medicare |
$84.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$148.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$128.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.97
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$171.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$171.75
|
| Rate for Payer: United Healthcare Medicare |
$84.73
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
T3 UPTAKE
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
4300754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
T4 (THYROXINE)
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
4300756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.76
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
tacrolimus 0.5 MG CAPSULE 0.5 mg, 100 eaches
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$3.85
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
tacrolimus 1 MG CAPSULE (IR) 1 mg, 100 eaches
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$26.40
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
TACROLIMUS-BLOOD
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
4300760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna of NY Commercial |
$120.90
|
| Rate for Payer: Aetna of NY Medicare |
$85.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: CDPHP Commercial |
$149.73
|
| Rate for Payer: CDPHP Medicare |
$68.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.80
|
| Rate for Payer: EmblemHealth Medicaid |
$148.80
|
| Rate for Payer: EmblemHealth Medicare |
$63.24
|
| Rate for Payer: Fidelis Medicare |
$70.88
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.82
|
| Rate for Payer: Humana Medicare |
$68.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$139.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
| Rate for Payer: United Healthcare Medicare |
$68.82
|
| Rate for Payer: WellCare Medicare |
$102.30
|
|
|
TAMIFLU 30 MG CAPSULE 30 mg, 10 eaches
|
Facility
OP
|
$51.00
|
|
| Hospital Charge Code |
4401311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
TAMOXIFEN 20 MG TABLET 20 mg, 30 eaches
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4401418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
TAMSULOSIN HCL 0.4MG CAPS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
4853026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$66.50
|
| Rate for Payer: Aetna of NY Medicare |
$43.70
|
| 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 |
$35.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$47.50
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: CDPHP Commercial |
$76.48
|
| Rate for Payer: CDPHP Medicare |
$35.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$76.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$76.00
|
| Rate for Payer: EmblemHealth Medicaid |
$76.00
|
| Rate for Payer: EmblemHealth Medicare |
$32.30
|
| Rate for Payer: Fidelis Medicare |
$36.20
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.15
|
| Rate for Payer: Humana Medicare |
$35.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$66.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
| Rate for Payer: WellCare Medicare |
$52.25
|
|
