|
TRANEXAMIC ACID 100 MG / ML INJECTION, 1
|
Facility
OP
|
$113.82
|
|
| Hospital Charge Code |
4409212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$91.63 |
| Rate for Payer: Aetna of NY Commercial |
$79.67
|
| Rate for Payer: Aetna of NY Medicare |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$56.91
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: CDPHP Commercial |
$91.63
|
| Rate for Payer: CDPHP Medicare |
$42.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$91.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$91.06
|
| Rate for Payer: EmblemHealth Medicaid |
$91.06
|
| Rate for Payer: EmblemHealth Medicare |
$38.70
|
| Rate for Payer: EmblemHealth Select Care |
$81.95
|
| Rate for Payer: Fidelis Medicare |
$43.38
|
| Rate for Payer: Galaxy Health Commercial |
$73.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.11
|
| Rate for Payer: Humana Medicare |
$42.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.67
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.22
|
| Rate for Payer: United Healthcare Medicare |
$42.11
|
| Rate for Payer: WellCare Medicare |
$62.60
|
|
|
TRANSCUTANEOUS PACING TEMPORAR
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
4600172
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
TRANSDISCAL INTRODUCER TDIB-17-150
|
Facility
OP
|
$406.00
|
|
| Hospital Charge Code |
4479254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$326.83 |
| Rate for Payer: Aetna of NY Commercial |
$284.20
|
| Rate for Payer: Aetna of NY Medicare |
$186.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$304.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$304.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.00
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: CDPHP Commercial |
$326.83
|
| Rate for Payer: CDPHP Medicare |
$150.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$324.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$324.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$324.80
|
| Rate for Payer: EmblemHealth Medicaid |
$324.80
|
| Rate for Payer: EmblemHealth Medicare |
$138.04
|
| Rate for Payer: EmblemHealth Select Care |
$292.32
|
| Rate for Payer: Fidelis Medicare |
$154.73
|
| Rate for Payer: Galaxy Health Commercial |
$263.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.22
|
| Rate for Payer: Humana Medicare |
$150.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$186.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$228.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$157.73
|
| Rate for Payer: United Healthcare Medicare |
$150.22
|
| Rate for Payer: WellCare Medicare |
$223.30
|
|
|
TRANSDISCAL PROBE KIT TDK2-17-150-6
|
Facility
OP
|
$5,066.00
|
|
| Hospital Charge Code |
4479251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,722.44 |
| Max. Negotiated Rate |
$4,078.13 |
| Rate for Payer: Aetna of NY Commercial |
$3,546.20
|
| Rate for Payer: Aetna of NY Medicare |
$2,330.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,799.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,799.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,874.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,533.00
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: CDPHP Commercial |
$4,078.13
|
| Rate for Payer: CDPHP Medicare |
$1,874.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,052.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,052.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,052.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4,052.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,722.44
|
| Rate for Payer: EmblemHealth Select Care |
$3,647.52
|
| Rate for Payer: Fidelis Medicare |
$1,930.65
|
| Rate for Payer: Galaxy Health Commercial |
$3,292.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,874.42
|
| Rate for Payer: Humana Medicare |
$1,874.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,546.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,330.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,799.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,852.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,968.14
|
| Rate for Payer: United Healthcare Medicare |
$1,874.42
|
| Rate for Payer: WellCare Medicare |
$2,786.30
|
|
|
TRANSDISCAL PROBETIP TDP-17-150-6
|
Facility
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
TRANSDISCAL + SINERGYCABLE TDX-Y-TSW-TDP
|
Facility
OP
|
$1,722.00
|
|
| Hospital Charge Code |
4479253
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$585.48 |
| Max. Negotiated Rate |
$1,386.21 |
| Rate for Payer: Aetna of NY Commercial |
$1,205.40
|
| Rate for Payer: Aetna of NY Medicare |
$792.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,291.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,291.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$637.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$861.00
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: CDPHP Commercial |
$1,386.21
|
| Rate for Payer: CDPHP Medicare |
$637.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,377.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,377.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,377.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,377.60
|
| Rate for Payer: EmblemHealth Medicare |
$585.48
|
| Rate for Payer: EmblemHealth Select Care |
$1,239.84
|
| Rate for Payer: Fidelis Medicare |
$656.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,119.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$637.14
|
| Rate for Payer: Humana Medicare |
$637.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,205.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$792.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,291.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$969.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$669.00
|
| Rate for Payer: United Healthcare Medicare |
$637.14
|
| Rate for Payer: WellCare Medicare |
$947.10
|
|
|
TRANSDISCAL TUBING+BURETTE KIT TDA-TBK-1
|
Facility
OP
|
$488.00
|
|
| Hospital Charge Code |
4479255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.92 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna of NY Commercial |
$341.60
|
| Rate for Payer: Aetna of NY Medicare |
$224.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: CDPHP Commercial |
$392.84
|
| Rate for Payer: CDPHP Medicare |
$180.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$390.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$390.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$390.40
|
| Rate for Payer: EmblemHealth Medicaid |
$390.40
|
| Rate for Payer: EmblemHealth Medicare |
$165.92
|
| Rate for Payer: EmblemHealth Select Care |
$351.36
|
| Rate for Payer: Fidelis Medicare |
$185.98
|
| Rate for Payer: Galaxy Health Commercial |
$317.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.56
|
| Rate for Payer: Humana Medicare |
$180.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$274.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.59
|
| Rate for Payer: United Healthcare Medicare |
$180.56
|
| Rate for Payer: WellCare Medicare |
$268.40
|
|
|
TRANSFERRIN
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
4300790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Commercial |
$57.96
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$27.44
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.64
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.97
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
TRANSFUSION-BLOOD OVER 4 HRS
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4300791
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 2 HOURS
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450110
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 4 HOURS
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450111
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 6 HOURS
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450112
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOODUP TO 8 HOURS
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSURETHRAL INCISION PROSTATE
|
Facility
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
4002032
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
TRAVATAN Z OS
|
Facility
OP
|
$555.94
|
|
| Hospital Charge Code |
4409003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$447.53 |
| Rate for Payer: Aetna of NY Commercial |
$389.16
|
| Rate for Payer: Aetna of NY Medicare |
$255.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$416.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$416.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$205.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$277.97
|
| Rate for Payer: Cash Price |
$416.96
|
| Rate for Payer: CDPHP Commercial |
$447.53
|
| Rate for Payer: CDPHP Medicare |
$205.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$444.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$444.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$444.75
|
| Rate for Payer: EmblemHealth Medicaid |
$444.75
|
| Rate for Payer: EmblemHealth Medicare |
$189.02
|
| Rate for Payer: EmblemHealth Select Care |
$400.28
|
| Rate for Payer: Fidelis Medicare |
$211.87
|
| Rate for Payer: Galaxy Health Commercial |
$361.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$205.70
|
| Rate for Payer: Humana Medicare |
$205.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$389.16
|
| Rate for Payer: Local 1199SEIU Medicare |
$255.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$416.96
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$312.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$215.98
|
| Rate for Payer: United Healthcare Medicare |
$205.70
|
| Rate for Payer: WellCare Medicare |
$305.77
|
|
|
TRAY,IRRIGATION W/60 CC BULB
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
4471628
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of NY Commercial |
$2.80
|
| Rate for Payer: Aetna of NY Medicare |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: CDPHP Commercial |
$3.22
|
| Rate for Payer: CDPHP Medicare |
$1.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3.20
|
| Rate for Payer: EmblemHealth Medicare |
$1.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.88
|
| Rate for Payer: Fidelis Medicare |
$1.52
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.55
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
TRAZODONE HCL 50MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400770
|
|
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
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4850304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN
|
| Hospital Charge Code |
4670084
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59)
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59
|
| Hospital Charge Code |
4670292
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59 W KX)
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59,KX
|
| Hospital Charge Code |
4670308
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (W/ KX)
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,KX
|
| Hospital Charge Code |
4670270
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN
|
| Hospital Charge Code |
4670019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59)
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59
|
| Hospital Charge Code |
4670285
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59 W KX)
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59,KX
|
| Hospital Charge Code |
4670301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
