|
LUMBAR RF KIT_LUK-17-150-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
LUNG PERF W VENTIL; RB W WO
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210095
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.61
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
LUNG PERF W VENTIL; RB W WO
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210095
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
LUNG PERF W VENTIL; SGL BRTH
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210096
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
LUNG PERF W VENTIL; SGL BRTH
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210096
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.61
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
LUNG VENT AEROSOL ; MULTIPLE
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.61
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
LUNG VENT AEROSOL ; MULTIPLE
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
LUNG VENTILATION/PERFUSION STUDY
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.55 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
|
LUNG VENTILATION/PERFUSION STUDY
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
4210032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.61
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
LVAD DRIVELINE KIT
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
4473008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
|
|
LVAD DRIVELINE KIT
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
4473008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
LWR XTR VASC STDY BILAT
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
4201053
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
LWR XTR VASC STDY BILAT
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
4201053
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$290.55
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$223.50
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$312.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$290.55
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$290.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$72.72
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
L XL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4471583
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
L XL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4471583
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
L XS WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
4471579
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
|
|
L XS WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
4471579
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$46.69 |
| Rate for Payer: Aetna of NY Commercial |
$40.60
|
| Rate for Payer: Aetna of NY Medicare |
$26.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.00
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: CDPHP Commercial |
$46.69
|
| Rate for Payer: CDPHP Medicare |
$21.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.40
|
| Rate for Payer: EmblemHealth Medicaid |
$46.40
|
| Rate for Payer: EmblemHealth Medicare |
$19.72
|
| Rate for Payer: EmblemHealth Select Care |
$41.76
|
| Rate for Payer: Fidelis Medicare |
$22.10
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.46
|
| Rate for Payer: Humana Medicare |
$21.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.53
|
| Rate for Payer: United Healthcare Medicare |
$21.46
|
| Rate for Payer: WellCare Medicare |
$31.90
|
|
|
LYME DIS TOT ABS REF BLOT
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
|
|
LYME DIS TOT ABS REF BLOT
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$123.16 |
| Rate for Payer: Aetna of NY Commercial |
$99.45
|
| Rate for Payer: Aetna of NY Medicare |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$76.50
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: CDPHP Commercial |
$123.16
|
| Rate for Payer: CDPHP Medicare |
$56.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$122.40
|
| Rate for Payer: EmblemHealth Medicare |
$52.02
|
| Rate for Payer: EmblemHealth Select Care |
$91.80
|
| Rate for Payer: Fidelis Medicare |
$58.31
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.61
|
| Rate for Payer: Humana Medicare |
$56.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$99.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$114.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.49
|
| Rate for Payer: United Healthcare Commercial |
$114.75
|
| Rate for Payer: United Healthcare Medicare |
$56.61
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
LYMES AMPLIFIED NA PROBE
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
4304880
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Galaxy Health Commercial |
$119.60
|
|
|
LYMES AMPLIFIED NA PROBE
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
4304880
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$148.12 |
| Rate for Payer: Aetna of NY Commercial |
$119.60
|
| Rate for Payer: Aetna of NY Medicare |
$84.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.08
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$92.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: CDPHP Commercial |
$148.12
|
| Rate for Payer: CDPHP Medicare |
$68.08
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$110.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$147.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.20
|
| Rate for Payer: EmblemHealth Medicaid |
$147.20
|
| Rate for Payer: EmblemHealth Medicare |
$62.56
|
| Rate for Payer: EmblemHealth Select Care |
$110.40
|
| Rate for Payer: Fidelis Medicare |
$70.12
|
| Rate for Payer: Galaxy Health Commercial |
$119.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.08
|
| Rate for Payer: Humana Medicare |
$68.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$84.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$103.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$138.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$138.00
|
| Rate for Payer: United Healthcare Medicare |
$68.08
|
| Rate for Payer: WellCare Medicare |
$101.20
|
|
|
LYME SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
4301036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna of NY Commercial |
$56.55
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.50
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$52.20
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$65.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
LYME SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
4301036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
LYMPH SUBSET CD4-CD8
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
4301048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$282.75 |
| Max. Negotiated Rate |
$282.75 |
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Galaxy Health Commercial |
$282.75
|
|
|
LYMPH SUBSET CD4-CD8
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
4301048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$350.18 |
| Rate for Payer: Aetna of NY Commercial |
$282.75
|
| Rate for Payer: Aetna of NY Medicare |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$217.50
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: CDPHP Commercial |
$350.18
|
| Rate for Payer: CDPHP Medicare |
$160.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$261.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$348.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$348.00
|
| Rate for Payer: EmblemHealth Medicaid |
$348.00
|
| Rate for Payer: EmblemHealth Medicare |
$147.90
|
| Rate for Payer: EmblemHealth Select Care |
$261.00
|
| Rate for Payer: Fidelis Medicare |
$165.78
|
| Rate for Payer: Galaxy Health Commercial |
$282.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.95
|
| Rate for Payer: Humana Medicare |
$160.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$282.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$200.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$244.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$169.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$326.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$160.95
|
| Rate for Payer: WellCare Medicare |
$239.25
|
|
