|
TITER EACH ANTIBODY
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
4300083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna of NY Commercial |
$121.55
|
| Rate for Payer: Aetna of NY Medicare |
$86.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.50
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: CDPHP Commercial |
$150.54
|
| Rate for Payer: CDPHP Medicare |
$69.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.60
|
| Rate for Payer: EmblemHealth Medicaid |
$149.60
|
| Rate for Payer: EmblemHealth Medicare |
$63.58
|
| Rate for Payer: Fidelis Medicare |
$71.27
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.19
|
| Rate for Payer: Humana Medicare |
$69.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$140.25
|
| Rate for Payer: United Healthcare Commercial |
$140.25
|
| Rate for Payer: United Healthcare Medicare |
$69.19
|
| Rate for Payer: WellCare Medicare |
$102.85
|
|
|
tiZANidine HCL 4 MG TABLET 4 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
TL201 THALLIUM PER 1 MCI
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
4210055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.06 |
| Max. Negotiated Rate |
$166.06 |
| Rate for Payer: Aetna of NY Medicare |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$79.50
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: CDPHP Commercial |
$128.00
|
| Rate for Payer: CDPHP Medicare |
$58.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$127.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$127.20
|
| Rate for Payer: EmblemHealth Medicaid |
$127.20
|
| Rate for Payer: EmblemHealth Medicare |
$54.06
|
| Rate for Payer: EmblemHealth Select Care |
$114.48
|
| Rate for Payer: Fidelis Medicare |
$60.59
|
| Rate for Payer: Galaxy Health Commercial |
$103.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.83
|
| Rate for Payer: Humana Medicare |
$58.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$89.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$166.06
|
| Rate for Payer: United Healthcare Commercial |
$166.06
|
| Rate for Payer: United Healthcare Medicare |
$58.83
|
| Rate for Payer: WellCare Medicare |
$87.45
|
|
|
TOBRADEX OO
|
Facility
OP
|
$726.15
|
|
| Hospital Charge Code |
4408998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$246.89 |
| Max. Negotiated Rate |
$584.55 |
| Rate for Payer: Aetna of NY Commercial |
$508.30
|
| Rate for Payer: Aetna of NY Medicare |
$334.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$544.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$544.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$268.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$363.08
|
| Rate for Payer: Cash Price |
$544.61
|
| Rate for Payer: CDPHP Commercial |
$584.55
|
| Rate for Payer: CDPHP Medicare |
$268.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.92
|
| Rate for Payer: EmblemHealth Medicaid |
$580.92
|
| Rate for Payer: EmblemHealth Medicare |
$246.89
|
| Rate for Payer: EmblemHealth Select Care |
$522.83
|
| Rate for Payer: Fidelis Medicare |
$276.74
|
| Rate for Payer: Galaxy Health Commercial |
$472.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$268.68
|
| Rate for Payer: Humana Medicare |
$268.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$508.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$334.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$282.11
|
| Rate for Payer: United Healthcare Medicare |
$268.68
|
| Rate for Payer: WellCare Medicare |
$399.38
|
|
|
TOBRAMYCIN/DEXAMETHASONE 0.3-0.1% DROP 5
|
Facility
OP
|
$80.86
|
|
| Hospital Charge Code |
4400763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$65.09 |
| Rate for Payer: Aetna of NY Commercial |
$56.60
|
| Rate for Payer: Aetna of NY Medicare |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.43
|
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: CDPHP Commercial |
$65.09
|
| Rate for Payer: CDPHP Medicare |
$29.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.69
|
| Rate for Payer: EmblemHealth Medicaid |
$64.69
|
| Rate for Payer: EmblemHealth Medicare |
$27.49
|
| Rate for Payer: EmblemHealth Select Care |
$58.22
|
| Rate for Payer: Fidelis Medicare |
$30.82
|
| Rate for Payer: Galaxy Health Commercial |
$52.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.92
|
| Rate for Payer: Humana Medicare |
$29.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.41
|
| Rate for Payer: United Healthcare Medicare |
$29.92
|
| Rate for Payer: WellCare Medicare |
$44.47
|
|
|
TOBRAMYCIN OS
|
Facility
OP
|
$45.06
|
|
| Hospital Charge Code |
4409000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$36.27 |
| Rate for Payer: Aetna of NY Commercial |
$31.54
|
| Rate for Payer: Aetna of NY Medicare |
$20.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.53
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: CDPHP Commercial |
$36.27
|
| Rate for Payer: CDPHP Medicare |
$16.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.05
|
| Rate for Payer: EmblemHealth Medicaid |
$36.05
|
| Rate for Payer: EmblemHealth Medicare |
$15.32
|
| Rate for Payer: EmblemHealth Select Care |
$32.44
|
| Rate for Payer: Fidelis Medicare |
$17.17
|
| Rate for Payer: Galaxy Health Commercial |
$29.29
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.67
|
| Rate for Payer: Humana Medicare |
$16.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.51
|
| Rate for Payer: United Healthcare Medicare |
$16.67
|
| Rate for Payer: WellCare Medicare |
$24.78
|
|
|
TOBREX OO
|
Facility
OP
|
$714.05
|
|
| Hospital Charge Code |
4408999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$242.78 |
| Max. Negotiated Rate |
$574.81 |
| Rate for Payer: Aetna of NY Commercial |
$499.84
|
| Rate for Payer: Aetna of NY Medicare |
$328.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$535.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$535.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$264.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$357.02
|
| Rate for Payer: Cash Price |
$535.54
|
| Rate for Payer: CDPHP Commercial |
$574.81
|
| Rate for Payer: CDPHP Medicare |
$264.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$571.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$571.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$571.24
|
| Rate for Payer: EmblemHealth Medicaid |
$571.24
|
| Rate for Payer: EmblemHealth Medicare |
$242.78
|
| Rate for Payer: EmblemHealth Select Care |
$514.12
|
| Rate for Payer: Fidelis Medicare |
$272.12
|
| Rate for Payer: Galaxy Health Commercial |
$464.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$264.20
|
| Rate for Payer: Humana Medicare |
$264.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$499.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$328.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$535.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$402.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$277.41
|
| Rate for Payer: United Healthcare Medicare |
$264.20
|
| Rate for Payer: WellCare Medicare |
$392.73
|
|
|
TOMOSYNTHESIS, MAMMO
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 TC
|
| Hospital Charge Code |
4150404
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$116.40
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.00
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Commercial |
$156.17
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: Fidelis Medicare |
$73.93
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.78
|
| Rate for Payer: Humana Medicare |
$71.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$71.78
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
TOMOSYNTHESIS, MAMMO, LEFT
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 LT,TC
|
| Hospital Charge Code |
4150410
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$116.40
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.00
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Commercial |
$156.17
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: Fidelis Medicare |
$73.93
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.78
|
| Rate for Payer: Humana Medicare |
$71.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$71.78
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
TOMOSYNTHESIS, MAMMO, RIGHT
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 RT,TC
|
| Hospital Charge Code |
4150411
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$116.40
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.00
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Commercial |
$156.17
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: Fidelis Medicare |
$73.93
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.78
|
| Rate for Payer: Humana Medicare |
$71.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$71.78
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
TOPAMAX (TOPIRAMATE)
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
4301167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$136.04 |
| Rate for Payer: Aetna of NY Commercial |
$109.85
|
| Rate for Payer: Aetna of NY Medicare |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$126.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$126.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$84.50
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: CDPHP Commercial |
$136.04
|
| Rate for Payer: CDPHP Medicare |
$62.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$135.20
|
| Rate for Payer: EmblemHealth Medicare |
$57.46
|
| Rate for Payer: Fidelis Medicare |
$64.41
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.53
|
| Rate for Payer: Humana Medicare |
$62.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$126.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$126.75
|
| Rate for Payer: United Healthcare Medicare |
$62.53
|
| Rate for Payer: WellCare Medicare |
$92.95
|
|
|
TOPIRAMATE 25MG TABS 10X10EA
|
Facility
OP
|
$6.44
|
|
| Hospital Charge Code |
4400764
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna of NY Commercial |
$4.51
|
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.22
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Commercial |
$5.18
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.15
|
| Rate for Payer: EmblemHealth Medicaid |
$5.15
|
| Rate for Payer: EmblemHealth Medicare |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$4.64
|
| Rate for Payer: Fidelis Medicare |
$2.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.38
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
TORSEMIDE 20 MG PO
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409054
|
|
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
|
|
|
TORSEMIDE TABLET 5 MG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400842
|
|
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
|
|
|
TOTAL PROTEIN OTHER SPECIMEN
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
4300894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$39.44 |
| Rate for Payer: Aetna of NY Commercial |
$31.85
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.50
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Commercial |
$39.44
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: Fidelis Medicare |
$18.67
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.13
|
| Rate for Payer: Humana Medicare |
$18.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$36.75
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
TOXIN ASSAY TISSUE CULTURE
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 87230
|
| Hospital Charge Code |
4301205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$82.92 |
| Rate for Payer: Aetna of NY Commercial |
$66.95
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| Rate for Payer: Fidelis Medicare |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$66.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$77.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$77.25
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
TPN, > 1 LITER, <= 2 LITER PER DAY, ALL SUPPLIES/EQUIPMENT
|
Facility
OP
|
$449.00
|
|
| Hospital Charge Code |
1050101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.66 |
| Max. Negotiated Rate |
$361.44 |
| Rate for Payer: MVP Health Care of NY Medicare |
$174.44
|
| Rate for Payer: Aetna of NY Commercial |
$314.30
|
| Rate for Payer: Aetna of NY Medicare |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$224.50
|
| Rate for Payer: Cash Price |
$336.75
|
| Rate for Payer: CDPHP Commercial |
$361.44
|
| Rate for Payer: CDPHP Medicare |
$166.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$359.20
|
| Rate for Payer: EmblemHealth Medicaid |
$359.20
|
| Rate for Payer: EmblemHealth Medicare |
$152.66
|
| Rate for Payer: EmblemHealth Select Care |
$323.28
|
| Rate for Payer: Fidelis Medicare |
$171.11
|
| Rate for Payer: Galaxy Health Commercial |
$291.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.13
|
| Rate for Payer: Humana Medicare |
$166.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$314.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$206.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$336.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$252.79
|
| Rate for Payer: United Healthcare Medicare |
$166.13
|
| Rate for Payer: WellCare Medicare |
$246.95
|
|
|
TPN, > 2, <=3 LITERS PER DAY, ALL SUPPLIES/EQUIPMENT
|
Facility
OP
|
$479.00
|
|
| Hospital Charge Code |
1050102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.86 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna of NY Commercial |
$335.30
|
| Rate for Payer: Aetna of NY Medicare |
$220.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$359.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$359.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$177.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$239.50
|
| Rate for Payer: Cash Price |
$359.25
|
| Rate for Payer: CDPHP Commercial |
$385.60
|
| Rate for Payer: CDPHP Medicare |
$177.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$383.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$383.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$383.20
|
| Rate for Payer: EmblemHealth Medicaid |
$383.20
|
| Rate for Payer: EmblemHealth Medicare |
$162.86
|
| Rate for Payer: EmblemHealth Select Care |
$344.88
|
| Rate for Payer: Fidelis Medicare |
$182.55
|
| Rate for Payer: Galaxy Health Commercial |
$311.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$177.23
|
| Rate for Payer: Humana Medicare |
$177.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$335.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$220.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$269.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$186.09
|
| Rate for Payer: United Healthcare Medicare |
$177.23
|
| Rate for Payer: WellCare Medicare |
$263.45
|
|
|
TPN, > 3 LITERS PER DAY, ALL SUPPLIES/EQUIPMENT
|
Facility
OP
|
$513.00
|
|
| Hospital Charge Code |
1050103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna of NY Commercial |
$359.10
|
| 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 Aetna Signature Administrators |
$359.10
|
| 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
|
|
|
TPN, UP TO ONE LITER PER DAY, ALL SUPPLIES/EQUIPMENT
|
Facility
OP
|
$413.00
|
|
| Hospital Charge Code |
1050100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.42 |
| Max. Negotiated Rate |
$332.46 |
| Rate for Payer: Aetna of NY Commercial |
$289.10
|
| Rate for Payer: Aetna of NY Medicare |
$189.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$309.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$309.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$152.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$206.50
|
| Rate for Payer: Cash Price |
$309.75
|
| Rate for Payer: CDPHP Commercial |
$332.46
|
| Rate for Payer: CDPHP Medicare |
$152.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$330.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$330.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$330.40
|
| Rate for Payer: EmblemHealth Medicaid |
$330.40
|
| Rate for Payer: EmblemHealth Medicare |
$140.42
|
| Rate for Payer: EmblemHealth Select Care |
$297.36
|
| Rate for Payer: Fidelis Medicare |
$157.39
|
| Rate for Payer: Galaxy Health Commercial |
$268.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$152.81
|
| Rate for Payer: Humana Medicare |
$152.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$289.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$189.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$232.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$160.45
|
| Rate for Payer: United Healthcare Medicare |
$152.81
|
| Rate for Payer: WellCare Medicare |
$227.15
|
|
|
TRADJENTA 5 MG TABLET 1 ea, 30 eaches
|
Facility
OP
|
$56.00
|
|
| Hospital Charge Code |
4401417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$39.20
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$40.32
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
TRAECHEOSTOMY SET 3.5MM
|
Facility
OP
|
$577.00
|
|
| Hospital Charge Code |
4471105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.18 |
| Max. Negotiated Rate |
$464.48 |
| Rate for Payer: Aetna of NY Commercial |
$403.90
|
| Rate for Payer: Aetna of NY Medicare |
$265.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$213.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$288.50
|
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: CDPHP Commercial |
$464.48
|
| Rate for Payer: CDPHP Medicare |
$213.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$461.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$461.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$461.60
|
| Rate for Payer: EmblemHealth Medicaid |
$461.60
|
| Rate for Payer: EmblemHealth Medicare |
$196.18
|
| Rate for Payer: EmblemHealth Select Care |
$415.44
|
| Rate for Payer: Fidelis Medicare |
$219.89
|
| Rate for Payer: Galaxy Health Commercial |
$375.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$213.49
|
| Rate for Payer: Humana Medicare |
$213.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$403.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$265.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$324.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$224.16
|
| Rate for Payer: United Healthcare Medicare |
$213.49
|
| Rate for Payer: WellCare Medicare |
$317.35
|
|
|
TRAECHEOSTOMY SET 4.0MM
|
Facility
OP
|
$577.00
|
|
| Hospital Charge Code |
4471106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.18 |
| Max. Negotiated Rate |
$464.48 |
| Rate for Payer: Aetna of NY Commercial |
$403.90
|
| Rate for Payer: Aetna of NY Medicare |
$265.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$213.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$288.50
|
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: CDPHP Commercial |
$464.48
|
| Rate for Payer: CDPHP Medicare |
$213.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$461.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$461.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$461.60
|
| Rate for Payer: EmblemHealth Medicaid |
$461.60
|
| Rate for Payer: EmblemHealth Medicare |
$196.18
|
| Rate for Payer: EmblemHealth Select Care |
$415.44
|
| Rate for Payer: Fidelis Medicare |
$219.89
|
| Rate for Payer: Galaxy Health Commercial |
$375.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$213.49
|
| Rate for Payer: Humana Medicare |
$213.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$403.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$265.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$324.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$224.16
|
| Rate for Payer: United Healthcare Medicare |
$213.49
|
| Rate for Payer: WellCare Medicare |
$317.35
|
|
|
TRAECHEOSTOMY SET 6MM
|
Facility
OP
|
$583.00
|
|
| Hospital Charge Code |
4471820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.22 |
| Max. Negotiated Rate |
$469.32 |
| Rate for Payer: Aetna of NY Commercial |
$408.10
|
| Rate for Payer: Aetna of NY Medicare |
$268.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$215.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$291.50
|
| Rate for Payer: Cash Price |
$437.25
|
| Rate for Payer: CDPHP Commercial |
$469.32
|
| Rate for Payer: CDPHP Medicare |
$215.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$466.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$466.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$466.40
|
| Rate for Payer: EmblemHealth Medicaid |
$466.40
|
| Rate for Payer: EmblemHealth Medicare |
$198.22
|
| Rate for Payer: EmblemHealth Select Care |
$419.76
|
| Rate for Payer: Fidelis Medicare |
$222.18
|
| Rate for Payer: Galaxy Health Commercial |
$378.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$215.71
|
| Rate for Payer: Humana Medicare |
$215.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$408.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$268.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$328.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$226.50
|
| Rate for Payer: United Healthcare Medicare |
$215.71
|
| Rate for Payer: WellCare Medicare |
$320.65
|
|
|
TRAMADOL HCL 50MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400768
|
|
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
|
|
