|
TENEX - BONE PROCEDURE PACK
|
Facility
OP
|
$4,074.00
|
|
| Hospital Charge Code |
4473018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,385.16 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: Aetna of NY Commercial |
$2,851.80
|
| Rate for Payer: Aetna of NY Medicare |
$1,874.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,507.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,037.00
|
| Rate for Payer: Cash Price |
$3,055.50
|
| Rate for Payer: CDPHP Commercial |
$3,279.57
|
| Rate for Payer: CDPHP Medicare |
$1,507.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,259.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,259.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,385.16
|
| Rate for Payer: EmblemHealth Select Care |
$2,933.28
|
| Rate for Payer: Fidelis Medicare |
$1,552.60
|
| Rate for Payer: Galaxy Health Commercial |
$2,648.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,507.38
|
| Rate for Payer: Humana Medicare |
$1,507.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,851.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,874.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,055.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,293.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,582.75
|
| Rate for Payer: United Healthcare Medicare |
$1,507.38
|
| Rate for Payer: WellCare Medicare |
$2,240.70
|
|
|
TENIVAC 5-2 LFU INJ(TETANUS, DIPTHERIA)
|
Facility
OP
|
$118.71
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
4409170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$95.56 |
| Rate for Payer: Aetna of NY Commercial |
$65.29
|
| Rate for Payer: Aetna of NY Medicare |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$59.36
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: CDPHP Commercial |
$95.56
|
| Rate for Payer: CDPHP Medicare |
$43.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.97
|
| Rate for Payer: EmblemHealth Medicaid |
$94.97
|
| Rate for Payer: EmblemHealth Medicare |
$40.36
|
| Rate for Payer: EmblemHealth Select Care |
$18.83
|
| Rate for Payer: Fidelis Medicare |
$45.24
|
| Rate for Payer: Galaxy Health Commercial |
$77.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.92
|
| Rate for Payer: Humana Medicare |
$43.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.29
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$51.23
|
| Rate for Payer: United Healthcare Medicare |
$43.92
|
| Rate for Payer: WellCare Medicare |
$65.29
|
|
|
TENJET HYDROTENOTOMY SET
|
Facility
OP
|
$2,359.00
|
|
| Hospital Charge Code |
4473017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.06 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,651.30
|
| Rate for Payer: Aetna of NY Medicare |
$1,085.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,769.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,769.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$872.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,179.50
|
| Rate for Payer: Cash Price |
$1,769.25
|
| Rate for Payer: CDPHP Commercial |
$1,899.00
|
| Rate for Payer: CDPHP Medicare |
$872.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,887.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,887.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,887.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,887.20
|
| Rate for Payer: EmblemHealth Medicare |
$802.06
|
| Rate for Payer: EmblemHealth Select Care |
$1,698.48
|
| Rate for Payer: Fidelis Medicare |
$899.01
|
| Rate for Payer: Galaxy Health Commercial |
$1,533.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$872.83
|
| Rate for Payer: Humana Medicare |
$872.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,651.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,085.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,769.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,328.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$916.47
|
| Rate for Payer: United Healthcare Medicare |
$872.83
|
| Rate for Payer: WellCare Medicare |
$1,297.45
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
OP
|
$3,084.03
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$3,084.03 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,084.03
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); PERCUTANEOUS
|
Facility
OP
|
$3,084.03
|
|
|
Service Code
|
CPT 24357
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$3,084.03 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,084.03
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON
|
Facility
OP
|
$3,084.03
|
|
|
Service Code
|
CPT 24310
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$3,084.03 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,084.03
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
TENSION BAND WIRE
|
Facility
OP
|
$31.00
|
|
| Hospital Charge Code |
4479271
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TENSOGRIP STOCKINETTE 3 1/2" E
|
Facility
OP
|
$134.00
|
|
| Hospital Charge Code |
4471698
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.56 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna of NY Commercial |
$93.80
|
| Rate for Payer: Aetna of NY Medicare |
$61.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.00
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: CDPHP Commercial |
$107.87
|
| Rate for Payer: CDPHP Medicare |
$49.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$107.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$107.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.20
|
| Rate for Payer: EmblemHealth Medicaid |
$107.20
|
| Rate for Payer: EmblemHealth Medicare |
$45.56
|
| Rate for Payer: EmblemHealth Select Care |
$96.48
|
| Rate for Payer: Fidelis Medicare |
$51.07
|
| Rate for Payer: Galaxy Health Commercial |
$87.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.58
|
| Rate for Payer: Humana Medicare |
$49.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$93.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$61.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$75.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.06
|
| Rate for Payer: United Healthcare Medicare |
$49.58
|
| Rate for Payer: WellCare Medicare |
$73.70
|
|
|
TENSOGRIP STOCKINETTE 3 1/2" F
|
Facility
OP
|
$145.00
|
|
| Hospital Charge Code |
4471699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Aetna of NY Commercial |
$101.50
|
| Rate for Payer: Aetna of NY Medicare |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$108.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$108.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$53.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$72.50
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: CDPHP Commercial |
$116.72
|
| Rate for Payer: CDPHP Medicare |
$53.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$116.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.00
|
| Rate for Payer: EmblemHealth Medicaid |
$116.00
|
| Rate for Payer: EmblemHealth Medicare |
$49.30
|
| Rate for Payer: EmblemHealth Select Care |
$104.40
|
| Rate for Payer: Fidelis Medicare |
$55.26
|
| Rate for Payer: Galaxy Health Commercial |
$94.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$53.65
|
| Rate for Payer: Humana Medicare |
$53.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$101.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$81.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.33
|
| Rate for Payer: United Healthcare Medicare |
$53.65
|
| Rate for Payer: WellCare Medicare |
$79.75
|
|
|
TENSOGRIP STOCKINETTE 3" D
|
Facility
OP
|
$106.00
|
|
| Hospital Charge Code |
4471701
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$85.33 |
| Rate for Payer: Aetna of NY Commercial |
$74.20
|
| Rate for Payer: Aetna of NY Medicare |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.00
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: CDPHP Commercial |
$85.33
|
| Rate for Payer: CDPHP Medicare |
$39.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.80
|
| Rate for Payer: EmblemHealth Medicaid |
$84.80
|
| Rate for Payer: EmblemHealth Medicare |
$36.04
|
| Rate for Payer: EmblemHealth Select Care |
$76.32
|
| Rate for Payer: Fidelis Medicare |
$40.40
|
| Rate for Payer: Galaxy Health Commercial |
$68.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.22
|
| Rate for Payer: Humana Medicare |
$39.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.18
|
| Rate for Payer: United Healthcare Medicare |
$39.22
|
| Rate for Payer: WellCare Medicare |
$58.30
|
|
|
TENSOGRIP STOCKINETTE 4.5" G
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
4471700
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Commercial |
$136.85
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: EmblemHealth Select Care |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$64.79
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.90
|
| Rate for Payer: Humana Medicare |
$62.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.04
|
| Rate for Payer: United Healthcare Medicare |
$62.90
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
TERAZOSIN 1 MG CAP
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409049
|
|
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
|
|
|
TERAZOSIN 5 MG CAPSULE
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409095
|
|
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
|
|
|
TERBINAFINE CR 1%
|
Facility
OP
|
$24.72
|
|
| Hospital Charge Code |
4408969
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.36
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Commercial |
$19.90
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.42
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.15
|
| Rate for Payer: Humana Medicare |
$9.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.60
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
TERBUTALINE SULFATE INJ TO 1 MG
|
Facility
OP
|
$66.69
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
4400748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$53.69 |
| Rate for Payer: Aetna of NY Commercial |
$36.68
|
| Rate for Payer: Aetna of NY Medicare |
$30.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.34
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: CDPHP Commercial |
$53.69
|
| Rate for Payer: CDPHP Medicare |
$24.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.35
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.35
|
| Rate for Payer: EmblemHealth Medicaid |
$53.35
|
| Rate for Payer: EmblemHealth Medicare |
$22.67
|
| Rate for Payer: EmblemHealth Select Care |
$6.09
|
| Rate for Payer: Fidelis Medicare |
$25.42
|
| Rate for Payer: Galaxy Health Commercial |
$43.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.68
|
| Rate for Payer: Humana Medicare |
$24.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare |
$24.68
|
| Rate for Payer: WellCare Medicare |
$36.68
|
|
|
TEST FOR ACETONE/KETONES
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 82009
|
| Hospital Charge Code |
4302008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$13.65
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.50
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Commercial |
$16.90
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$15.75
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
TESTICULAR SCAN W/ FLOW
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78761
|
| Hospital Charge Code |
4210036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
TETRACAINE 0.5% 4 ML OPHTHALMIC DROPS
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
4409239
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
TETRACAINE HCL 0.005 DROP 2 ML
|
Facility
OP
|
$33.99
|
|
| Hospital Charge Code |
4400749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.36 |
| Rate for Payer: Aetna of NY Commercial |
$23.79
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.49
|
| 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 |
$25.49
|
| Rate for Payer: CDPHP Commercial |
$27.36
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.19
|
| Rate for Payer: EmblemHealth Medicaid |
$27.19
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.47
|
| Rate for Payer: Fidelis Medicare |
$12.95
|
| Rate for Payer: Galaxy Health Commercial |
$22.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.79
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.49
|
| 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 |
$18.69
|
|
|
TETRACYC HCL/BIS SC/METRONID 125-140-125
|
Facility
OP
|
$17.00
|
|
| Hospital Charge Code |
4400670
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
THEOPHYLLINE
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 80198
|
| Hospital Charge Code |
4300767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
THEOPHYLLINE ER 300 MG TAB 300 mg, 100 eaches
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4401318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
THEOPHYLLINE ER 400 MG TABLET 400 mg, 100 eaches
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
4401555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.50
|
| Rate for Payer: Aetna of NY Medicare |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.50
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: CDPHP Commercial |
$4.02
|
| Rate for Payer: CDPHP Medicare |
$1.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4.00
|
| Rate for Payer: EmblemHealth Medicare |
$1.70
|
| Rate for Payer: EmblemHealth Select Care |
$3.60
|
| Rate for Payer: Fidelis Medicare |
$1.91
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.85
|
| Rate for Payer: Humana Medicare |
$1.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.94
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
THERACATH EPIDURAL CATHETER EC-05000
|
Facility
OP
|
$100.00
|
|
| Hospital Charge Code |
4479083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of NY Commercial |
$70.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Commercial |
$80.50
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: EmblemHealth Select Care |
$72.00
|
| Rate for Payer: Fidelis Medicare |
$38.11
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.00
|
| Rate for Payer: Humana Medicare |
$37.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.85
|
| Rate for Payer: United Healthcare Medicare |
$37.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
THERA-COOL INTRODUCER THI-17-75-5.5
|
Facility
OP
|
$204.00
|
|
| Hospital Charge Code |
4479244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.36 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna of NY Commercial |
$142.80
|
| Rate for Payer: Aetna of NY Medicare |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: CDPHP Commercial |
$164.22
|
| Rate for Payer: CDPHP Medicare |
$75.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.20
|
| Rate for Payer: EmblemHealth Medicaid |
$163.20
|
| Rate for Payer: EmblemHealth Medicare |
$69.36
|
| Rate for Payer: EmblemHealth Select Care |
$146.88
|
| Rate for Payer: Fidelis Medicare |
$77.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.48
|
| Rate for Payer: Humana Medicare |
$75.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.25
|
| Rate for Payer: United Healthcare Medicare |
$75.48
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
