|
CARBIDOPA-LEVODOPA 25-250 TAB 1 ea, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CARBIDOPA-LEVO ER 25-100 TAB 1 ea, 1 each
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401432
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CARBIDOPE/LEVODOPA EXTENDED RELEASE 25/1
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409221
|
|
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
|
|
|
CARBOGEN PER RX UNLSTD PULM PROCEDURE
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
4530007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$312.90
|
| 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 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: 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 |
$312.90
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.83
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
CARBON DIOXIDE (CO2)
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4300151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
CARBOXYHEMOGLOBIN; QUANTITATIVE
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
4302010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Aetna of NY Commercial |
$28.60
|
| Rate for Payer: Aetna of NY Medicare |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: CDPHP Commercial |
$35.42
|
| Rate for Payer: CDPHP Medicare |
$16.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.20
|
| Rate for Payer: EmblemHealth Medicaid |
$35.20
|
| Rate for Payer: EmblemHealth Medicare |
$14.96
|
| Rate for Payer: Fidelis Medicare |
$16.77
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.28
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.11
|
| Rate for Payer: United Healthcare Commercial |
$33.00
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WellCare Medicare |
$24.20
|
|
|
CARBOXY HGB
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4301017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
CARDENE IV SOLUTION 20 MG / 200 ML
|
Facility
OP
|
$352.26
|
|
| Hospital Charge Code |
4409163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$283.57 |
| Rate for Payer: Aetna of NY Commercial |
$246.58
|
| Rate for Payer: Aetna of NY Medicare |
$162.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$264.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$264.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$130.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$176.13
|
| Rate for Payer: Cash Price |
$264.20
|
| Rate for Payer: CDPHP Commercial |
$283.57
|
| Rate for Payer: CDPHP Medicare |
$130.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$281.81
|
| Rate for Payer: EmblemHealth Medicaid |
$281.81
|
| Rate for Payer: EmblemHealth Medicare |
$119.77
|
| Rate for Payer: EmblemHealth Select Care |
$253.63
|
| Rate for Payer: Fidelis Medicare |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$228.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$130.34
|
| Rate for Payer: Humana Medicare |
$130.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$246.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$198.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$136.85
|
| Rate for Payer: United Healthcare Medicare |
$130.34
|
| Rate for Payer: WellCare Medicare |
$193.74
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4210009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
CARDIAC REHAB W/ MONITOR
|
Facility
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
4660001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna of NY Commercial |
$296.80
|
| Rate for Payer: Aetna of NY Medicare |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$156.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$212.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: CDPHP Commercial |
$341.32
|
| Rate for Payer: CDPHP Medicare |
$156.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$339.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$339.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$339.20
|
| Rate for Payer: EmblemHealth Medicaid |
$339.20
|
| Rate for Payer: EmblemHealth Medicare |
$144.16
|
| Rate for Payer: EmblemHealth Select Care |
$305.28
|
| Rate for Payer: Fidelis Medicare |
$161.59
|
| Rate for Payer: Galaxy Health Commercial |
$275.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$156.88
|
| Rate for Payer: Humana Medicare |
$156.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$296.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$195.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$238.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$164.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$224.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$224.00
|
| Rate for Payer: United Healthcare Medicare |
$156.88
|
| Rate for Payer: WellCare Medicare |
$233.20
|
|
|
CARDIAC REHAB W/O MONITOR
|
Facility
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
4660002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: United Healthcare Medicare |
$142.08
|
| Rate for Payer: WellCare Medicare |
$211.20
|
| Rate for Payer: Aetna of NY Commercial |
$268.80
|
| Rate for Payer: Aetna of NY Medicare |
$176.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$142.08
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$192.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: CDPHP Commercial |
$309.12
|
| Rate for Payer: CDPHP Medicare |
$142.08
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$307.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$307.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$307.20
|
| Rate for Payer: EmblemHealth Medicaid |
$307.20
|
| Rate for Payer: EmblemHealth Medicare |
$130.56
|
| Rate for Payer: EmblemHealth Select Care |
$276.48
|
| Rate for Payer: Fidelis Medicare |
$146.34
|
| Rate for Payer: Galaxy Health Commercial |
$249.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$142.08
|
| Rate for Payer: Humana Medicare |
$142.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$268.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$176.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$288.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$216.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$149.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$224.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.68
|
| Rate for Payer: United Healthcare Commercial |
$224.00
|
|
|
CARDIAC RHYTHM MONITORING 1-3 LEADS
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
4601723
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$113.75
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
CARDIAC SPECT MULTI
|
Facility
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Hospital Charge Code |
4210027
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,381.42 |
| 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 Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
CARDIAC SPECT SINGLE
|
Facility
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
4210028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.52 |
| 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 |
$140.52
|
| 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
|
|
|
CARDIO CRP
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
4301033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna of NY Commercial |
$55.90
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$64.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$64.50
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
CARDIOLITE UNIT DOSE
|
Facility
OP
|
$223.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
4211240
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$743.46 |
| Rate for Payer: Aetna of NY Medicare |
$102.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$111.50
|
| Rate for Payer: Cash Price |
$167.25
|
| Rate for Payer: Cash Price |
$167.25
|
| Rate for Payer: CDPHP Commercial |
$179.52
|
| Rate for Payer: CDPHP Medicare |
$82.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$178.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$178.40
|
| Rate for Payer: EmblemHealth Medicaid |
$178.40
|
| Rate for Payer: EmblemHealth Medicare |
$75.82
|
| Rate for Payer: EmblemHealth Select Care |
$160.56
|
| Rate for Payer: Fidelis Medicare |
$84.99
|
| Rate for Payer: Galaxy Health Commercial |
$144.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.51
|
| Rate for Payer: Humana Medicare |
$82.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$102.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$125.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$86.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$743.46
|
| Rate for Payer: United Healthcare Commercial |
$743.46
|
| Rate for Payer: United Healthcare Medicare |
$82.51
|
| Rate for Payer: WellCare Medicare |
$122.65
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480085
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$583.70
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$583.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$673.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$673.50
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
CARDIOVASCULAR STRESS TEST; TRACING
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4480026
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$583.70
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$583.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$673.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$673.50
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
CARDIOVERSION ELECTIVE; INT
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92961
|
| Hospital Charge Code |
4602201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4480003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$620.10 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$1,303.40
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,303.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,396.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,396.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
CARPAL TUNNEL INJECTION
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
4850025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
CARVEDILOL 12.5MG TABS 10X10EA
|
Facility
OP
|
$6.70
|
|
| Hospital Charge Code |
4400134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
CARVEDILOL 25MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400135
|
|
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
|
|
|
CARVEDILOL 3.125MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400136
|
|
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
|
|
