|
TANGNTL BX SKIN SINGLE LES
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
4853025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| 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 |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
TARGET CATH ACCESSORIES KI
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
4472107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna of NY Commercial |
$65.10
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.50
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Commercial |
$74.86
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: EmblemHealth Select Care |
$66.96
|
| Rate for Payer: Fidelis Medicare |
$35.44
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.41
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.13
|
| Rate for Payer: United Healthcare Medicare |
$34.41
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
TB TEST CELL IMMUN MEASURE
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
4304879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.06 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: Aetna of NY Commercial |
$210.60
|
| Rate for Payer: Aetna of NY Medicare |
$149.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$119.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$162.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$70.47
|
| Rate for Payer: CDPHP Commercial |
$260.82
|
| Rate for Payer: CDPHP Essential Plan |
$158.56
|
| Rate for Payer: CDPHP Medicare |
$119.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.47
|
| Rate for Payer: EmblemHealth Medicaid |
$70.47
|
| Rate for Payer: EmblemHealth Medicare |
$110.16
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$158.56
|
| Rate for Payer: Fidelis Medicare |
$123.48
|
| Rate for Payer: Galaxy Health Commercial |
$210.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$69.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7,047.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$119.88
|
| Rate for Payer: Humana Medicare |
$119.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$210.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$149.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7,047.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$182.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$125.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$243.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.47
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Medicare |
$119.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$73.99
|
| Rate for Payer: WellCare Medicare |
$178.20
|
|
|
TC99M CHOLETEC =< 15 MCI MEBROFENIN
|
Facility
OP
|
$494.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
4210060
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$167.96 |
| Max. Negotiated Rate |
$397.67 |
| Rate for Payer: Aetna of NY Medicare |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$182.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$247.00
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: CDPHP Commercial |
$397.67
|
| Rate for Payer: CDPHP Medicare |
$182.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$395.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$395.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$395.20
|
| Rate for Payer: EmblemHealth Medicaid |
$395.20
|
| Rate for Payer: EmblemHealth Medicare |
$167.96
|
| Rate for Payer: EmblemHealth Select Care |
$355.68
|
| Rate for Payer: Fidelis Medicare |
$188.26
|
| Rate for Payer: Galaxy Health Commercial |
$321.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$182.78
|
| Rate for Payer: Humana Medicare |
$182.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$227.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$278.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$191.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$187.21
|
| Rate for Payer: United Healthcare Commercial |
$187.21
|
| Rate for Payer: United Healthcare Medicare |
$182.78
|
| Rate for Payer: WellCare Medicare |
$271.70
|
|
|
TC99M EXAMETAZIME =< 25 MCI
|
Facility
OP
|
$2,610.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
4210059
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$887.40 |
| Max. Negotiated Rate |
$2,535.14 |
| Rate for Payer: Aetna of NY Medicare |
$1,200.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,957.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,957.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$965.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,305.00
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: CDPHP Commercial |
$2,101.05
|
| Rate for Payer: CDPHP Medicare |
$965.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,088.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,088.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,088.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,088.00
|
| Rate for Payer: EmblemHealth Medicare |
$887.40
|
| Rate for Payer: EmblemHealth Select Care |
$1,879.20
|
| Rate for Payer: Fidelis Medicare |
$994.67
|
| Rate for Payer: Galaxy Health Commercial |
$1,696.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$965.70
|
| Rate for Payer: Humana Medicare |
$965.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,200.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,469.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,013.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,535.14
|
| Rate for Payer: United Healthcare Commercial |
$2,535.14
|
| Rate for Payer: United Healthcare Medicare |
$965.70
|
| Rate for Payer: WellCare Medicare |
$1,435.50
|
|
|
TC99M HEPATOLITE
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
4211214
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$118.54 |
| Rate for Payer: Aetna of NY Medicare |
$63.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$51.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$69.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: CDPHP Commercial |
$111.09
|
| Rate for Payer: CDPHP Medicare |
$51.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: EmblemHealth Medicare |
$46.92
|
| Rate for Payer: EmblemHealth Select Care |
$99.36
|
| Rate for Payer: Fidelis Medicare |
$52.59
|
| Rate for Payer: Galaxy Health Commercial |
$89.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$51.06
|
| Rate for Payer: Humana Medicare |
$51.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$118.54
|
| Rate for Payer: United Healthcare Commercial |
$118.54
|
| Rate for Payer: United Healthcare Medicare |
$51.06
|
| Rate for Payer: WellCare Medicare |
$75.90
|
|
|
TC99M LABELED RBC =< 30 MCI
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4210066
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$135.32 |
| Max. Negotiated Rate |
$320.39 |
| Rate for Payer: United Healthcare Commercial |
$172.21
|
| Rate for Payer: Aetna of NY Medicare |
$183.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$147.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$199.00
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: CDPHP Commercial |
$320.39
|
| Rate for Payer: CDPHP Medicare |
$147.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$318.40
|
| Rate for Payer: EmblemHealth Medicaid |
$318.40
|
| Rate for Payer: EmblemHealth Medicare |
$135.32
|
| Rate for Payer: EmblemHealth Select Care |
$286.56
|
| Rate for Payer: Fidelis Medicare |
$151.68
|
| Rate for Payer: Galaxy Health Commercial |
$258.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$147.26
|
| Rate for Payer: Humana Medicare |
$147.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$183.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$224.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$154.62
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$172.21
|
| Rate for Payer: United Healthcare Medicare |
$147.26
|
| Rate for Payer: WellCare Medicare |
$218.90
|
|
|
TC99M MAA =< 10 MCI
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
4210062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$252.77 |
| Rate for Payer: Aetna of NY Medicare |
$144.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$235.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$235.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.00
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: CDPHP Commercial |
$252.77
|
| Rate for Payer: CDPHP Medicare |
$116.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$251.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$251.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$251.20
|
| Rate for Payer: EmblemHealth Medicaid |
$251.20
|
| Rate for Payer: EmblemHealth Medicare |
$106.76
|
| Rate for Payer: EmblemHealth Select Care |
$226.08
|
| Rate for Payer: Fidelis Medicare |
$119.67
|
| Rate for Payer: Galaxy Health Commercial |
$204.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.18
|
| Rate for Payer: Humana Medicare |
$116.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$176.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$121.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.80
|
| Rate for Payer: United Healthcare Commercial |
$54.80
|
| Rate for Payer: United Healthcare Medicare |
$116.18
|
| Rate for Payer: WellCare Medicare |
$172.70
|
|
|
TC99M MAG 3 =< 15 MCI MERTIATIDE
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
4210067
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna of NY Medicare |
$235.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$189.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$256.50
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: CDPHP Commercial |
$412.96
|
| Rate for Payer: CDPHP Medicare |
$189.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$410.40
|
| Rate for Payer: EmblemHealth Medicaid |
$410.40
|
| Rate for Payer: EmblemHealth Medicare |
$174.42
|
| Rate for Payer: EmblemHealth Select Care |
$369.36
|
| Rate for Payer: Fidelis Medicare |
$195.50
|
| Rate for Payer: Galaxy Health Commercial |
$333.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$189.81
|
| Rate for Payer: Humana Medicare |
$189.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$235.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$288.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$199.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,327.95
|
| Rate for Payer: United Healthcare Commercial |
$1,327.95
|
| Rate for Payer: United Healthcare Medicare |
$189.81
|
| Rate for Payer: WellCare Medicare |
$282.15
|
|
|
TC99M MDP =< 30 MCI
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
4210054
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$352.59 |
| Rate for Payer: Aetna of NY Medicare |
$201.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$328.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$328.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$162.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$219.00
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: CDPHP Commercial |
$352.59
|
| Rate for Payer: CDPHP Medicare |
$162.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$350.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$350.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$350.40
|
| Rate for Payer: EmblemHealth Medicaid |
$350.40
|
| Rate for Payer: EmblemHealth Medicare |
$148.92
|
| Rate for Payer: EmblemHealth Select Care |
$315.36
|
| Rate for Payer: Fidelis Medicare |
$166.92
|
| Rate for Payer: Galaxy Health Commercial |
$284.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$162.06
|
| Rate for Payer: Humana Medicare |
$162.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$201.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$246.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$170.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$50.89
|
| Rate for Payer: United Healthcare Commercial |
$50.89
|
| Rate for Payer: United Healthcare Medicare |
$162.06
|
| Rate for Payer: WellCare Medicare |
$240.90
|
|
|
TC99M PENTETATE =< 25 MCI
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
4210061
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$448.38 |
| Rate for Payer: Aetna of NY Medicare |
$256.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$417.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$417.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$206.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$278.50
|
| Rate for Payer: Cash Price |
$417.75
|
| Rate for Payer: Cash Price |
$417.75
|
| Rate for Payer: CDPHP Commercial |
$448.38
|
| Rate for Payer: CDPHP Medicare |
$206.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$445.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$445.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$445.60
|
| Rate for Payer: EmblemHealth Medicaid |
$445.60
|
| Rate for Payer: EmblemHealth Medicare |
$189.38
|
| Rate for Payer: EmblemHealth Select Care |
$401.04
|
| Rate for Payer: Fidelis Medicare |
$212.27
|
| Rate for Payer: Galaxy Health Commercial |
$362.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$206.09
|
| Rate for Payer: Humana Medicare |
$206.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$256.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$313.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$216.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$50.89
|
| Rate for Payer: United Healthcare Commercial |
$50.89
|
| Rate for Payer: United Healthcare Medicare |
$206.09
|
| Rate for Payer: WellCare Medicare |
$306.35
|
|
|
TC99M PERTECHNETATE
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
4211242
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$111.09 |
| Rate for Payer: Aetna of NY Medicare |
$63.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$51.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$69.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: CDPHP Commercial |
$111.09
|
| Rate for Payer: CDPHP Medicare |
$51.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: EmblemHealth Medicare |
$46.92
|
| Rate for Payer: EmblemHealth Select Care |
$99.36
|
| Rate for Payer: Fidelis Medicare |
$52.59
|
| Rate for Payer: Galaxy Health Commercial |
$89.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$51.06
|
| Rate for Payer: Humana Medicare |
$51.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.38
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$51.06
|
| Rate for Payer: WellCare Medicare |
$75.90
|
|
|
TC99M SULFUR COLLOID =< 20 MCI
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
4210063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$135.32 |
| Max. Negotiated Rate |
$566.97 |
| Rate for Payer: Aetna of NY Medicare |
$183.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$147.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$199.00
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: CDPHP Commercial |
$320.39
|
| Rate for Payer: CDPHP Medicare |
$147.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$318.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$318.40
|
| Rate for Payer: EmblemHealth Medicaid |
$318.40
|
| Rate for Payer: EmblemHealth Medicare |
$135.32
|
| Rate for Payer: EmblemHealth Select Care |
$286.56
|
| Rate for Payer: Fidelis Medicare |
$151.68
|
| Rate for Payer: Galaxy Health Commercial |
$258.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$147.26
|
| Rate for Payer: Humana Medicare |
$147.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$183.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$224.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$154.62
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$566.97
|
| Rate for Payer: United Healthcare Commercial |
$566.97
|
| Rate for Payer: United Healthcare Medicare |
$147.26
|
| Rate for Payer: WellCare Medicare |
$218.90
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4211248
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.23
|
| Rate for Payer: United Healthcare Commercial |
$35.23
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
TECHNETIUM TC99M AEROSOL =< 75 MCI
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
4210068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.23
|
| Rate for Payer: United Healthcare Commercial |
$35.23
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
TECHNETIUM TC99M AUTO WBC EXAME PER DOSE
|
Facility
OP
|
$370.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
4210085
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$2,851.61 |
| Rate for Payer: Aetna of NY Medicare |
$170.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$136.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$185.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: CDPHP Commercial |
$297.85
|
| Rate for Payer: CDPHP Medicare |
$136.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$296.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$296.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$296.00
|
| Rate for Payer: EmblemHealth Medicaid |
$296.00
|
| Rate for Payer: EmblemHealth Medicare |
$125.80
|
| Rate for Payer: EmblemHealth Select Care |
$266.40
|
| Rate for Payer: Fidelis Medicare |
$141.01
|
| Rate for Payer: Galaxy Health Commercial |
$240.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$136.90
|
| Rate for Payer: Humana Medicare |
$136.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$170.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$277.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$208.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$143.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,851.61
|
| Rate for Payer: United Healthcare Commercial |
$2,851.61
|
| Rate for Payer: United Healthcare Medicare |
$136.90
|
| Rate for Payer: WellCare Medicare |
$203.50
|
|
|
TECHNETIUM TC99M TEBOROXIME PER DOSE
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
HCPCS A9501
|
| Hospital Charge Code |
4210086
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna of NY Medicare |
$235.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$189.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$256.50
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: CDPHP Commercial |
$412.96
|
| Rate for Payer: CDPHP Medicare |
$189.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$410.40
|
| Rate for Payer: EmblemHealth Medicaid |
$410.40
|
| Rate for Payer: EmblemHealth Medicare |
$174.42
|
| Rate for Payer: EmblemHealth Select Care |
$369.36
|
| Rate for Payer: Fidelis Medicare |
$195.50
|
| Rate for Payer: Galaxy Health Commercial |
$333.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$189.81
|
| Rate for Payer: Humana Medicare |
$189.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$235.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$288.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$199.30
|
| Rate for Payer: United Healthcare Medicare |
$189.81
|
| Rate for Payer: WellCare Medicare |
$282.15
|
|
|
TEGADERM DRESSING
|
Facility
OP
|
$195.00
|
|
| Hospital Charge Code |
4479239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna of NY Commercial |
$136.50
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$140.40
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$136.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.76
|
| Rate for Payer: United Healthcare Medicare |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
TEGRETOL (CARBAMAZEPINE)
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
4300761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
TEMAZEPAM 15MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400747
|
|
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
|
|
|
TEMP STABILIOZE PIN
|
Facility
OP
|
$419.00
|
|
| Hospital Charge Code |
4473003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$337.30 |
| Rate for Payer: Aetna of NY Commercial |
$293.30
|
| Rate for Payer: Aetna of NY Medicare |
$192.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$155.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$209.50
|
| Rate for Payer: Cash Price |
$314.25
|
| Rate for Payer: CDPHP Commercial |
$337.30
|
| Rate for Payer: CDPHP Medicare |
$155.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$335.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$335.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$335.20
|
| Rate for Payer: EmblemHealth Medicaid |
$335.20
|
| Rate for Payer: EmblemHealth Medicare |
$142.46
|
| Rate for Payer: EmblemHealth Select Care |
$301.68
|
| Rate for Payer: Fidelis Medicare |
$159.68
|
| Rate for Payer: Galaxy Health Commercial |
$272.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$155.03
|
| Rate for Payer: Humana Medicare |
$155.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$293.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$192.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$235.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$162.78
|
| Rate for Payer: United Healthcare Medicare |
$155.03
|
| Rate for Payer: WellCare Medicare |
$230.45
|
|
|
TEMP THERAPY PAD
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
4478238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
TENDON ORIGIN INJECTION
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
4850027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
TENDON SHETH/LIGAMENT/CYST INJECTION
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4850026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
TENECTEPLASE INJECTION 1 MG
|
Facility
OP
|
$531.23
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
4400762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$427.64 |
| Rate for Payer: Aetna of NY Commercial |
$292.18
|
| Rate for Payer: Aetna of NY Medicare |
$244.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$196.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$265.62
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: CDPHP Commercial |
$427.64
|
| Rate for Payer: CDPHP Medicare |
$196.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$424.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$424.98
|
| Rate for Payer: EmblemHealth Medicaid |
$424.98
|
| Rate for Payer: EmblemHealth Medicare |
$180.62
|
| Rate for Payer: EmblemHealth Select Care |
$153.11
|
| Rate for Payer: Fidelis Medicare |
$202.45
|
| Rate for Payer: Galaxy Health Commercial |
$345.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$196.56
|
| Rate for Payer: Humana Medicare |
$196.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$292.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$244.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$299.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$206.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$251.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$153.11
|
| Rate for Payer: United Healthcare Commercial |
$251.96
|
| Rate for Payer: United Healthcare Medicare |
$196.56
|
| Rate for Payer: WellCare Medicare |
$292.18
|
|
