|
US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
4200100
|
|
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
|
|
|
US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Facility
OP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 76811 TC
|
| Hospital Charge Code |
4200088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$341.36 |
| Max. Negotiated Rate |
$808.22 |
| Rate for Payer: Aetna of NY Commercial |
$702.80
|
| Rate for Payer: Aetna of NY Medicare |
$461.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$753.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$753.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$371.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$502.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: CDPHP Commercial |
$808.22
|
| Rate for Payer: CDPHP Medicare |
$371.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$803.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$803.20
|
| Rate for Payer: EmblemHealth Medicaid |
$803.20
|
| Rate for Payer: EmblemHealth Medicare |
$341.36
|
| Rate for Payer: Fidelis Medicare |
$382.62
|
| Rate for Payer: Galaxy Health Commercial |
$652.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$371.48
|
| Rate for Payer: Humana Medicare |
$371.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$702.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$461.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$565.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$390.05
|
| 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 |
$371.48
|
| Rate for Payer: WellCare Medicare |
$552.20
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Facility
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
4200001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$507.96 |
| Rate for Payer: Aetna of NY Commercial |
$441.70
|
| Rate for Payer: Aetna of NY Medicare |
$290.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$473.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$473.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$233.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$315.50
|
| Rate for Payer: Cash Price |
$473.25
|
| Rate for Payer: Cash Price |
$473.25
|
| Rate for Payer: CDPHP Commercial |
$507.96
|
| Rate for Payer: CDPHP Medicare |
$233.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$504.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$504.80
|
| Rate for Payer: EmblemHealth Medicaid |
$504.80
|
| Rate for Payer: EmblemHealth Medicare |
$214.54
|
| Rate for Payer: Fidelis Medicare |
$240.47
|
| Rate for Payer: Galaxy Health Commercial |
$410.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$233.47
|
| Rate for Payer: Humana Medicare |
$233.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$441.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$290.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$355.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$245.14
|
| 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 |
$233.47
|
| Rate for Payer: WellCare Medicare |
$347.05
|
|
|
US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
4200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$350.00
|
| Rate for Payer: Aetna of NY Medicare |
$230.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$250.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: CDPHP Commercial |
$402.50
|
| Rate for Payer: CDPHP Medicare |
$185.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$400.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$400.00
|
| Rate for Payer: EmblemHealth Medicaid |
$400.00
|
| Rate for Payer: EmblemHealth Medicare |
$170.00
|
| Rate for Payer: Fidelis Medicare |
$190.55
|
| Rate for Payer: Galaxy Health Commercial |
$325.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$185.00
|
| Rate for Payer: Humana Medicare |
$185.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$350.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$375.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$281.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$194.25
|
| 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 |
$185.00
|
| Rate for Payer: WellCare Medicare |
$275.00
|
|
|
US SCROTUM & CONTENTS
|
Facility
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
4200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.02 |
| Max. Negotiated Rate |
$525.66 |
| Rate for Payer: Aetna of NY Commercial |
$457.10
|
| Rate for Payer: Aetna of NY Medicare |
$300.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$489.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$489.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$241.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$326.50
|
| Rate for Payer: Cash Price |
$489.75
|
| Rate for Payer: Cash Price |
$489.75
|
| Rate for Payer: CDPHP Commercial |
$525.66
|
| Rate for Payer: CDPHP Medicare |
$241.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$522.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$522.40
|
| Rate for Payer: EmblemHealth Medicaid |
$522.40
|
| Rate for Payer: EmblemHealth Medicare |
$222.02
|
| Rate for Payer: Fidelis Medicare |
$248.86
|
| Rate for Payer: Galaxy Health Commercial |
$424.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$241.61
|
| Rate for Payer: Humana Medicare |
$241.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$457.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$300.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$367.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$253.69
|
| 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 |
$241.61
|
| Rate for Payer: WellCare Medicare |
$359.15
|
|
|
US STRESS ECHOGARDIOGRAM
|
Facility
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4201029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| 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 |
$143.42
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
US TRANSRECTAL
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4200089
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$60.60 |
| 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 CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US TRANSVAGINAL
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Hospital Charge Code |
4201043
|
|
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
|
|
|
US VEIN ETREMITY LOWER LEFT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4201030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of NY Commercial |
$204.75
|
| 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 |
$204.75
|
| 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 |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.93
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US VEIN EXTREMITY LOWER RIGHT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4201031
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of NY Commercial |
$204.75
|
| 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 |
$204.75
|
| 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 |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.93
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US VEIN EXTREMITY UPPER BILATERAL
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970 50
|
| Hospital Charge Code |
4201032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
US VEIN EXTREMITY UPPER LEFT
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970 LT
|
| Hospital Charge Code |
4201033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
US VEIN EXTREMITY UPPER RIGHT
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970 RT
|
| Hospital Charge Code |
4201034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
US VEIN EXTREMITY UPPER UNILAT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
4200030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of NY Commercial |
$204.75
|
| 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 |
$204.75
|
| 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 |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.93
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US XTR NON-VASC LMTD
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4201046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$9.97 |
| 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 CHIP/Family Health Plus/Medicaid |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Facility
OP
|
$8,946.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
4601198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,201.53 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.00
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: CDPHP Commercial |
$7,201.53
|
| Rate for Payer: CDPHP Medicare |
$3,310.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,156.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,156.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,156.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$3,409.32
|
| Rate for Payer: Galaxy Health Commercial |
$5,814.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.02
|
| Rate for Payer: Humana Medicare |
$3,310.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,978.77
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,310.02
|
| Rate for Payer: WellCare Medicare |
$4,920.30
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
OP
|
$8,946.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
4609613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$7,201.53 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.00
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: CDPHP Commercial |
$7,201.53
|
| Rate for Payer: CDPHP Medicare |
$3,310.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,156.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,156.80
|
| Rate for Payer: EmblemHealth Medicaid |
$7,156.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$3,409.32
|
| Rate for Payer: Galaxy Health Commercial |
$5,814.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.02
|
| Rate for Payer: Humana Medicare |
$3,310.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,978.77
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$3,310.02
|
| Rate for Payer: WellCare Medicare |
$4,920.30
|
|
|
VALACYCLOVIR HCL 500MG TABS 30 EA
|
Facility
OP
|
$22.40
|
|
| Hospital Charge Code |
4400785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna of NY Commercial |
$15.68
|
| Rate for Payer: Aetna of NY Medicare |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.20
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: CDPHP Commercial |
$18.03
|
| Rate for Payer: CDPHP Medicare |
$8.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.92
|
| Rate for Payer: EmblemHealth Medicaid |
$17.92
|
| Rate for Payer: EmblemHealth Medicare |
$7.62
|
| Rate for Payer: EmblemHealth Select Care |
$16.13
|
| Rate for Payer: Fidelis Medicare |
$8.54
|
| Rate for Payer: Galaxy Health Commercial |
$14.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.29
|
| Rate for Payer: Humana Medicare |
$8.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.70
|
| Rate for Payer: United Healthcare Medicare |
$8.29
|
| Rate for Payer: WellCare Medicare |
$12.32
|
|
|
valGANciclovir 450 MG TABLET 450 mg, 60 eaches
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
4401483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$8.40
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
VALPOIC ACID SYP 250 MG / 5 ML
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4408974
|
|
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
|
|
|
VALPROATE SODIUM INJECTABLE 100MG/ML SDV
|
Facility
OP
|
$13.39
|
|
| Hospital Charge Code |
4400786
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.70
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Commercial |
$10.78
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.10
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.95
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.20
|
| Rate for Payer: United Healthcare Medicare |
$4.95
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
VALVE F/SALEM SUMP ANTI-REFLU
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
4471341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
VANCOMUCIN PEAK
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4300821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
OP
|
$96.82
|
|
| Hospital Charge Code |
4409112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$77.94 |
| Rate for Payer: Aetna of NY Commercial |
$67.77
|
| Rate for Payer: Aetna of NY Medicare |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$48.41
|
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: CDPHP Commercial |
$77.94
|
| Rate for Payer: CDPHP Medicare |
$35.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.46
|
| Rate for Payer: EmblemHealth Medicaid |
$77.46
|
| Rate for Payer: EmblemHealth Medicare |
$32.92
|
| Rate for Payer: EmblemHealth Select Care |
$69.71
|
| Rate for Payer: Fidelis Medicare |
$36.90
|
| Rate for Payer: Galaxy Health Commercial |
$62.93
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.82
|
| Rate for Payer: Humana Medicare |
$35.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$67.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.61
|
| Rate for Payer: United Healthcare Medicare |
$35.82
|
| Rate for Payer: WellCare Medicare |
$53.25
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML BAG 1.5 g, 300 mL
|
Facility
OP
|
$162.00
|
|
| Hospital Charge Code |
4401369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna of NY Commercial |
$113.40
|
| Rate for Payer: Aetna of NY Medicare |
$74.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$81.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: CDPHP Commercial |
$130.41
|
| Rate for Payer: CDPHP Medicare |
$59.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.60
|
| Rate for Payer: EmblemHealth Medicaid |
$129.60
|
| Rate for Payer: EmblemHealth Medicare |
$55.08
|
| Rate for Payer: EmblemHealth Select Care |
$116.64
|
| Rate for Payer: Fidelis Medicare |
$61.74
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.94
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.94
|
| Rate for Payer: United Healthcare Medicare |
$59.94
|
| Rate for Payer: WellCare Medicare |
$89.10
|
|
