|
TTE W OR W/O FOL W/CONT COM
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
4480103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$762.88 |
| 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: 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 CHIP/Family Health Plus/Medicaid |
$762.88
|
| 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
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
OP
|
$22.92
|
|
| Hospital Charge Code |
4400064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna of NY Commercial |
$16.04
|
| Rate for Payer: Aetna of NY Medicare |
$10.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.46
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: CDPHP Commercial |
$18.45
|
| Rate for Payer: CDPHP Medicare |
$8.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.34
|
| Rate for Payer: EmblemHealth Medicaid |
$18.34
|
| Rate for Payer: EmblemHealth Medicare |
$7.79
|
| Rate for Payer: EmblemHealth Select Care |
$16.50
|
| Rate for Payer: Fidelis Medicare |
$8.73
|
| Rate for Payer: Galaxy Health Commercial |
$14.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.48
|
| Rate for Payer: Humana Medicare |
$8.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.19
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.90
|
| Rate for Payer: United Healthcare Medicare |
$8.48
|
| Rate for Payer: WellCare Medicare |
$12.61
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
OP
|
$17.77
|
|
| Hospital Charge Code |
4400065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.44
|
| Rate for Payer: Aetna of NY Medicare |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.88
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: CDPHP Commercial |
$14.30
|
| Rate for Payer: CDPHP Medicare |
$6.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.22
|
| Rate for Payer: EmblemHealth Medicaid |
$14.22
|
| Rate for Payer: EmblemHealth Medicare |
$6.04
|
| Rate for Payer: EmblemHealth Select Care |
$12.79
|
| Rate for Payer: Fidelis Medicare |
$6.77
|
| Rate for Payer: Galaxy Health Commercial |
$11.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.57
|
| Rate for Payer: Humana Medicare |
$6.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.33
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.90
|
| Rate for Payer: United Healthcare Medicare |
$6.57
|
| Rate for Payer: WellCare Medicare |
$9.77
|
|
|
TUBING FLOWTRON
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
4471654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$22.50
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
TUBING OXYGEN 7FT CRSH RESIS
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4472139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
TUMOR LOCALIZED SPECT
|
Facility
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
4211235
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.15 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$2,844.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,868.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,503.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,031.50
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: CDPHP Commercial |
$3,270.72
|
| Rate for Payer: CDPHP Medicare |
$1,503.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,381.42
|
| Rate for Payer: Fidelis Medicare |
$1,548.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,503.31
|
| Rate for Payer: Humana Medicare |
$1,503.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,844.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,868.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,047.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,287.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,578.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.15
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
TUNNELING TOOL
|
Facility
OP
|
$978.00
|
|
| Hospital Charge Code |
4479096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.52 |
| Max. Negotiated Rate |
$787.29 |
| Rate for Payer: Aetna of NY Commercial |
$684.60
|
| Rate for Payer: Aetna of NY Medicare |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$733.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$733.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$361.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$489.00
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: CDPHP Commercial |
$787.29
|
| Rate for Payer: CDPHP Medicare |
$361.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$782.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$782.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$782.40
|
| Rate for Payer: EmblemHealth Medicaid |
$782.40
|
| Rate for Payer: EmblemHealth Medicare |
$332.52
|
| Rate for Payer: EmblemHealth Select Care |
$704.16
|
| Rate for Payer: Fidelis Medicare |
$372.72
|
| Rate for Payer: Galaxy Health Commercial |
$635.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$361.86
|
| Rate for Payer: Humana Medicare |
$361.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$684.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$449.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$733.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$550.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$379.95
|
| Rate for Payer: United Healthcare Medicare |
$361.86
|
| Rate for Payer: WellCare Medicare |
$537.90
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
4450108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$45.26 |
| Max. Negotiated Rate |
$400.55 |
| Rate for Payer: Aetna of NY Commercial |
$105.00
|
| Rate for Payer: Aetna of NY Medicare |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$55.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$75.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: CDPHP Commercial |
$120.75
|
| Rate for Payer: CDPHP Medicare |
$55.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$120.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.00
|
| Rate for Payer: EmblemHealth Medicaid |
$120.00
|
| Rate for Payer: EmblemHealth Medicare |
$51.00
|
| Rate for Payer: EmblemHealth Select Care |
$108.00
|
| Rate for Payer: Fidelis Medicare |
$57.16
|
| Rate for Payer: Galaxy Health Commercial |
$97.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$55.50
|
| Rate for Payer: Humana Medicare |
$55.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$69.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$84.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$112.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.26
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Medicare |
$55.50
|
| Rate for Payer: WellCare Medicare |
$82.50
|
|
|
TX/PROPH/DG ADDL
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4451250
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$400.55 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$161.60
|
| Rate for Payer: EmblemHealth Medicaid |
$161.60
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$151.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
4670260
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59)
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59
|
| Hospital Charge Code |
4670298
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: WellCare Medicare |
$46.75
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59 W KX)
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59,KX
|
| Hospital Charge Code |
4670314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (W/ KX)
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,KX
|
| Hospital Charge Code |
4670276
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX TARSAL BONE FX; W MANIP
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
4850163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
TYLENOL (APAP) EXTRA STRENGTH 500MG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4401278
|
|
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
|
|
|
UGI W BX. SGL/MULTIPLE
|
Facility
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
4851925
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$863.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,193.24
|
| 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 |
$959.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: CDPHP Commercial |
$2,088.17
|
| Rate for Payer: CDPHP Medicare |
$959.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$881.96
|
| Rate for Payer: Fidelis Medicare |
$988.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$959.78
|
| Rate for Payer: Humana Medicare |
$959.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,193.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,945.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,460.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,007.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$959.78
|
| Rate for Payer: WellCare Medicare |
$1,426.70
|
|
|
ULTRASONIC GUIDANCE, INTRAOPERATIVE
|
Facility
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 76998
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.95
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Hospital Charge Code |
4201086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$161.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$115.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: CDPHP Commercial |
$185.15
|
| Rate for Payer: CDPHP Medicare |
$85.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.00
|
| Rate for Payer: EmblemHealth Medicaid |
$184.00
|
| Rate for Payer: EmblemHealth Medicare |
$78.20
|
| Rate for Payer: Fidelis Medicare |
$87.65
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.10
|
| Rate for Payer: Humana Medicare |
$85.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$129.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$85.10
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
|
ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Hospital Charge Code |
4201085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76981 TC
|
| Hospital Charge Code |
4201084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
ULTRASOUND THERAPY EA 15 MINS
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP
|
| Hospital Charge Code |
4650041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| 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 |
$24.48
|
| 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 |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59)
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59
|
| Hospital Charge Code |
4650378
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: WellCare Medicare |
$34.65
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| 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 |
$24.48
|
| 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 |
$23.31
|
|
|
ULTRASOUND THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,59,KX
|
| Hospital Charge Code |
4650430
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| 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 |
$24.48
|
| 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 |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND THERAPY EA 15 MINS (W/ KX)
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97035 GP,KX
|
| Hospital Charge Code |
4650323
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$45.36
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| 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 |
$24.48
|
| 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 |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 76978 TC
|
| Hospital Charge Code |
4201087
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$178.84 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$368.20
|
| Rate for Payer: Aetna of NY Medicare |
$241.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$194.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$263.00
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: CDPHP Commercial |
$423.43
|
| Rate for Payer: CDPHP Medicare |
$194.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$420.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$420.80
|
| Rate for Payer: EmblemHealth Medicaid |
$420.80
|
| Rate for Payer: EmblemHealth Medicare |
$178.84
|
| Rate for Payer: Fidelis Medicare |
$200.46
|
| Rate for Payer: Galaxy Health Commercial |
$341.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$194.62
|
| Rate for Payer: Humana Medicare |
$194.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$368.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$241.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$296.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$204.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$194.62
|
| Rate for Payer: WellCare Medicare |
$289.30
|
|
