|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (W/ KX)
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,KX
|
| Hospital Charge Code |
4670263
|
|
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
|
|
|
TRELEGY ELLIPTA 100-62.5-25 1 ea, 28 eaches
|
Facility
OP
|
$920.00
|
|
| Hospital Charge Code |
4401375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: Aetna of NY Commercial |
$644.00
|
| Rate for Payer: Aetna of NY Medicare |
$423.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$340.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$460.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: CDPHP Commercial |
$740.60
|
| Rate for Payer: CDPHP Medicare |
$340.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$736.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$736.00
|
| Rate for Payer: EmblemHealth Medicare |
$312.80
|
| Rate for Payer: EmblemHealth Select Care |
$662.40
|
| Rate for Payer: Fidelis Medicare |
$350.61
|
| Rate for Payer: Galaxy Health Commercial |
$598.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$340.40
|
| Rate for Payer: Humana Medicare |
$340.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$644.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$423.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$690.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$517.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$357.42
|
| Rate for Payer: United Healthcare Medicare |
$340.40
|
| Rate for Payer: WellCare Medicare |
$506.00
|
|
|
TRELEGY ELLIPTA 200-62.5-25 200 mcg, 28 eaches
|
Facility
OP
|
$1,071.00
|
|
| Hospital Charge Code |
4401531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$364.14 |
| Max. Negotiated Rate |
$862.16 |
| Rate for Payer: Aetna of NY Commercial |
$749.70
|
| Rate for Payer: Aetna of NY Medicare |
$492.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$803.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$803.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$396.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$535.50
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: CDPHP Commercial |
$862.16
|
| Rate for Payer: CDPHP Medicare |
$396.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$856.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$856.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$856.80
|
| Rate for Payer: EmblemHealth Medicaid |
$856.80
|
| Rate for Payer: EmblemHealth Medicare |
$364.14
|
| Rate for Payer: EmblemHealth Select Care |
$771.12
|
| Rate for Payer: Fidelis Medicare |
$408.16
|
| Rate for Payer: Galaxy Health Commercial |
$696.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$396.27
|
| Rate for Payer: Humana Medicare |
$396.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$749.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$492.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$803.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$602.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$416.08
|
| Rate for Payer: United Healthcare Medicare |
$396.27
|
| Rate for Payer: WellCare Medicare |
$589.05
|
|
|
TRIAMCINOLONE ACET 40 MG/ML VL 40 mg, 1 mL
|
Facility
OP
|
$31.00
|
|
| Hospital Charge Code |
4401335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
OP
|
$31.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna of NY Commercial |
$17.42
|
| Rate for Payer: Aetna of NY Medicare |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.84
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: CDPHP Commercial |
$25.49
|
| Rate for Payer: CDPHP Medicare |
$11.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.34
|
| Rate for Payer: EmblemHealth Medicaid |
$25.34
|
| Rate for Payer: EmblemHealth Medicare |
$10.77
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$12.07
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.72
|
| Rate for Payer: Humana Medicare |
$11.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$11.72
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
OP
|
$32.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna of NY Commercial |
$17.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.10
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: CDPHP Commercial |
$25.91
|
| Rate for Payer: CDPHP Medicare |
$11.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.75
|
| Rate for Payer: EmblemHealth Medicaid |
$25.75
|
| Rate for Payer: EmblemHealth Medicare |
$10.94
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$12.27
|
| Rate for Payer: Galaxy Health Commercial |
$20.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.91
|
| Rate for Payer: Humana Medicare |
$11.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$11.91
|
| Rate for Payer: WellCare Medicare |
$17.70
|
|
|
TRIAMCINOLONE ACETONIDE 0.005 OINT 15 GM
|
Facility
OP
|
$31.16
|
|
| Hospital Charge Code |
4400772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: Aetna of NY Commercial |
$21.81
|
| Rate for Payer: Aetna of NY Medicare |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.58
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: CDPHP Commercial |
$25.08
|
| Rate for Payer: CDPHP Medicare |
$11.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.93
|
| Rate for Payer: EmblemHealth Medicaid |
$24.93
|
| Rate for Payer: EmblemHealth Medicare |
$10.59
|
| Rate for Payer: EmblemHealth Select Care |
$22.44
|
| Rate for Payer: Fidelis Medicare |
$11.88
|
| Rate for Payer: Galaxy Health Commercial |
$20.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare Medicare |
$11.53
|
| Rate for Payer: WellCare Medicare |
$17.14
|
|
|
TRIAMCINOLONE CR 0.1% 30 G
|
Facility
OP
|
$36.05
|
|
| Hospital Charge Code |
4408970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna of NY Commercial |
$25.24
|
| Rate for Payer: Aetna of NY Medicare |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.02
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: CDPHP Commercial |
$29.02
|
| Rate for Payer: CDPHP Medicare |
$13.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.84
|
| Rate for Payer: EmblemHealth Medicaid |
$28.84
|
| Rate for Payer: EmblemHealth Medicare |
$12.26
|
| Rate for Payer: EmblemHealth Select Care |
$25.96
|
| Rate for Payer: Fidelis Medicare |
$13.74
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.34
|
| Rate for Payer: Humana Medicare |
$13.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.24
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WellCare Medicare |
$19.83
|
|
|
TRIAMCINOLONE DENTAL PASTE
|
Facility
OP
|
$249.00
|
|
| Hospital Charge Code |
4408971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.66 |
| Max. Negotiated Rate |
$200.44 |
| Rate for Payer: Aetna of NY Commercial |
$174.30
|
| Rate for Payer: Aetna of NY Medicare |
$114.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$186.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$186.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$124.50
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: CDPHP Commercial |
$200.44
|
| Rate for Payer: CDPHP Medicare |
$92.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$199.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$199.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$199.20
|
| Rate for Payer: EmblemHealth Medicaid |
$199.20
|
| Rate for Payer: EmblemHealth Medicare |
$84.66
|
| Rate for Payer: EmblemHealth Select Care |
$179.28
|
| Rate for Payer: Fidelis Medicare |
$94.89
|
| Rate for Payer: Galaxy Health Commercial |
$161.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.13
|
| Rate for Payer: Humana Medicare |
$92.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$174.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$114.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$140.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.74
|
| Rate for Payer: United Healthcare Medicare |
$92.13
|
| Rate for Payer: WellCare Medicare |
$136.95
|
|
|
TRIAMTERENE/HCTZ 37.5-25MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400773
|
|
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
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
4302006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Aetna of NY Commercial |
$79.30
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$61.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$91.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$91.50
|
| Rate for Payer: United Healthcare Medicare |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
TRICOR 145 MG
|
Facility
OP
|
$15.97
|
|
| Hospital Charge Code |
4409040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna of NY Commercial |
$11.18
|
| Rate for Payer: Aetna of NY Medicare |
$7.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: CDPHP Commercial |
$12.86
|
| Rate for Payer: CDPHP Medicare |
$5.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.78
|
| Rate for Payer: EmblemHealth Medicaid |
$12.78
|
| Rate for Payer: EmblemHealth Medicare |
$5.43
|
| Rate for Payer: EmblemHealth Select Care |
$11.50
|
| Rate for Payer: Fidelis Medicare |
$6.09
|
| Rate for Payer: Galaxy Health Commercial |
$10.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.91
|
| Rate for Payer: Humana Medicare |
$5.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.98
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.20
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WellCare Medicare |
$8.78
|
|
|
TRIGLYCERIDE
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
4300796
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
TRIHEXYPHENIDYL HCL 2MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400774
|
|
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
|
|
|
TRIM ND NAILS
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4856656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| 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 |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
4856667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
TRINTELLIX 10 MG TABLET 10 mg, 30 eaches
|
Facility
OP
|
$59.00
|
|
| Hospital Charge Code |
4401561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
TRIPLE LUMEN TRAY
|
Facility
OP
|
$377.00
|
|
| Hospital Charge Code |
4471822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.18 |
| Max. Negotiated Rate |
$303.48 |
| Rate for Payer: Aetna of NY Commercial |
$263.90
|
| Rate for Payer: Aetna of NY Medicare |
$173.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$188.50
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: CDPHP Commercial |
$303.48
|
| Rate for Payer: CDPHP Medicare |
$139.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$188.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$301.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$301.60
|
| Rate for Payer: EmblemHealth Medicaid |
$301.60
|
| Rate for Payer: EmblemHealth Medicare |
$128.18
|
| Rate for Payer: EmblemHealth Select Care |
$188.50
|
| Rate for Payer: Fidelis Medicare |
$143.67
|
| Rate for Payer: Galaxy Health Commercial |
$245.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.49
|
| Rate for Payer: Humana Medicare |
$139.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$263.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.46
|
| Rate for Payer: United Healthcare Medicare |
$139.49
|
| Rate for Payer: WellCare Medicare |
$207.35
|
|
|
TROCAR BALLOON KIT
|
Facility
OP
|
$346.00
|
|
| Hospital Charge Code |
4479184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$278.53 |
| Rate for Payer: Aetna of NY Commercial |
$242.20
|
| Rate for Payer: Aetna of NY Medicare |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$173.00
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: CDPHP Commercial |
$278.53
|
| Rate for Payer: CDPHP Medicare |
$128.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$276.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.80
|
| Rate for Payer: EmblemHealth Medicaid |
$276.80
|
| Rate for Payer: EmblemHealth Medicare |
$117.64
|
| Rate for Payer: EmblemHealth Select Care |
$249.12
|
| Rate for Payer: Fidelis Medicare |
$131.86
|
| Rate for Payer: Galaxy Health Commercial |
$224.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.02
|
| Rate for Payer: Humana Medicare |
$128.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$242.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$159.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$259.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.42
|
| Rate for Payer: United Healthcare Medicare |
$128.02
|
| Rate for Payer: WellCare Medicare |
$190.30
|
|
|
TROCAR ENDO BLUNT 12MM THREA
|
Facility
OP
|
$767.00
|
|
| Hospital Charge Code |
4471761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$617.44 |
| Rate for Payer: Aetna of NY Commercial |
$536.90
|
| Rate for Payer: Aetna of NY Medicare |
$352.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$575.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$575.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$283.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$383.50
|
| Rate for Payer: Cash Price |
$575.25
|
| Rate for Payer: CDPHP Commercial |
$617.44
|
| Rate for Payer: CDPHP Medicare |
$283.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$613.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$613.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$613.60
|
| Rate for Payer: EmblemHealth Medicaid |
$613.60
|
| Rate for Payer: EmblemHealth Medicare |
$260.78
|
| Rate for Payer: EmblemHealth Select Care |
$552.24
|
| Rate for Payer: Fidelis Medicare |
$292.30
|
| Rate for Payer: Galaxy Health Commercial |
$498.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$283.79
|
| Rate for Payer: Humana Medicare |
$283.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$575.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$297.98
|
| Rate for Payer: United Healthcare Medicare |
$283.79
|
| Rate for Payer: WellCare Medicare |
$421.85
|
|
|
TROPONIN QUAN
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
4300798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$97.40 |
| Rate for Payer: Aetna of NY Commercial |
$78.65
|
| Rate for Payer: Aetna of NY Medicare |
$55.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$60.50
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: CDPHP Commercial |
$97.40
|
| Rate for Payer: CDPHP Medicare |
$44.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$96.80
|
| Rate for Payer: EmblemHealth Medicaid |
$96.80
|
| Rate for Payer: EmblemHealth Medicare |
$41.14
|
| Rate for Payer: Fidelis Medicare |
$46.11
|
| Rate for Payer: Galaxy Health Commercial |
$78.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.77
|
| Rate for Payer: Humana Medicare |
$44.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$78.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$55.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$90.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.13
|
| Rate for Payer: United Healthcare Commercial |
$90.75
|
| Rate for Payer: United Healthcare Medicare |
$44.77
|
| Rate for Payer: WellCare Medicare |
$66.55
|
|
|
TRULICITY 1.5 MG/0.5 ML PEN 0.5 ML, 0.5 ML
|
Facility
OP
|
$718.00
|
|
| Hospital Charge Code |
4404330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$577.99 |
| Rate for Payer: Aetna of NY Commercial |
$502.60
|
| Rate for Payer: Aetna of NY Medicare |
$330.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$538.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$538.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$265.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$359.00
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: CDPHP Commercial |
$577.99
|
| Rate for Payer: CDPHP Medicare |
$265.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$574.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$574.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$574.40
|
| Rate for Payer: EmblemHealth Medicaid |
$574.40
|
| Rate for Payer: EmblemHealth Medicare |
$244.12
|
| Rate for Payer: EmblemHealth Select Care |
$516.96
|
| Rate for Payer: Fidelis Medicare |
$273.63
|
| Rate for Payer: Galaxy Health Commercial |
$466.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$265.66
|
| Rate for Payer: Humana Medicare |
$265.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$502.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$330.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$404.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$278.94
|
| Rate for Payer: United Healthcare Medicare |
$265.66
|
| Rate for Payer: WellCare Medicare |
$394.90
|
|
|
TRUVADA 200/300 TABLET
|
Facility
OP
|
$201.00
|
|
| Hospital Charge Code |
4401290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna of NY Commercial |
$140.70
|
| Rate for Payer: Aetna of NY Medicare |
$92.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.50
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: CDPHP Commercial |
$161.80
|
| Rate for Payer: CDPHP Medicare |
$74.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.80
|
| Rate for Payer: EmblemHealth Medicaid |
$160.80
|
| Rate for Payer: EmblemHealth Medicare |
$68.34
|
| Rate for Payer: EmblemHealth Select Care |
$144.72
|
| Rate for Payer: Fidelis Medicare |
$76.60
|
| Rate for Payer: Galaxy Health Commercial |
$130.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.37
|
| Rate for Payer: Humana Medicare |
$74.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$140.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.09
|
| Rate for Payer: United Healthcare Medicare |
$74.37
|
| Rate for Payer: WellCare Medicare |
$110.55
|
|
|
TTE CONG ABN; LIMITED/F-UP
|
Facility
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4480110
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
TTE W OR WO FOL WCON DOPPLER
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8929 TC
|
| Hospital Charge Code |
4480106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$778.94 |
| Max. Negotiated Rate |
$1,844.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,603.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,603.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,289.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$890.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,718.25
|
| Rate for Payer: United Healthcare Commercial |
$1,718.25
|
| Rate for Payer: United Healthcare Medicare |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
