|
QUANT BORDITELLA PERTUSSIS IGA IGM IGG
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
4301177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Cash Price |
$201.75
|
| Rate for Payer: Galaxy Health Commercial |
$174.85
|
|
|
QUETIAPINE FUMARATE 100MG TABS 10X10EA
|
Facility
|
OP
|
$21.12
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
4400693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of NY Commercial |
$14.78
|
| Rate for Payer: Aetna of NY Medicare |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.56
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: CDPHP Commercial |
$17.00
|
| Rate for Payer: CDPHP Medicare |
$7.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.90
|
| Rate for Payer: EmblemHealth Medicaid |
$16.90
|
| Rate for Payer: EmblemHealth Medicare |
$7.18
|
| Rate for Payer: EmblemHealth Select Care |
$15.21
|
| Rate for Payer: Fidelis Medicare |
$8.05
|
| Rate for Payer: Galaxy Health Commercial |
$13.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.81
|
| Rate for Payer: Humana Medicare |
$7.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.21
|
| Rate for Payer: United Healthcare Medicare |
$7.81
|
| Rate for Payer: WellCare Medicare |
$11.62
|
|
|
QUETIAPINE FUMARATE 100MG TABS 10X10EA
|
Facility
|
IP
|
$21.12
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
4400693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Galaxy Health Commercial |
$13.73
|
| Rate for Payer: WellCare Medicare |
$11.62
|
|
|
QUETIAPINE FUMARATE 25MG TABS 10X10EA
|
Facility
|
IP
|
$14.42
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
4400694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
QUETIAPINE FUMARATE 25MG TABS 10X10EA
|
Facility
|
OP
|
$14.42
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
4400694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.21
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: CDPHP Commercial |
$11.61
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.34
|
| Rate for Payer: Humana Medicare |
$5.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.60
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
QUICK STREP
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300680
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
QUICK STREP
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300680
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
RACEPINEPHRINE 0.0225 AMIH 30X.5ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
4400686
|
|
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
|
|
|
RACEPINEPHRINE 0.0225 AMIH 30X.5ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
4400686
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
RADIATION REDUCTION GLOVES 8.5
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
4479176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Commercial |
$136.85
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: EmblemHealth Select Care |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$64.79
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.90
|
| Rate for Payer: Humana Medicare |
$62.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.04
|
| Rate for Payer: United Healthcare Medicare |
$62.90
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
RADIATION REDUCTION GLOVES 8.5
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
4479176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
|
|
RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 73525
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
|
|
RADIO-OPAQUE EPIDURAL CATHETER
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
4479108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Galaxy Health Commercial |
$117.00
|
|
|
RADIO-OPAQUE EPIDURAL CATHETER
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
4479108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of NY Commercial |
$126.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$90.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: CDPHP Commercial |
$144.90
|
| Rate for Payer: CDPHP Medicare |
$66.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.00
|
| Rate for Payer: EmblemHealth Medicaid |
$144.00
|
| Rate for Payer: EmblemHealth Medicare |
$61.20
|
| Rate for Payer: EmblemHealth Select Care |
$129.60
|
| Rate for Payer: Fidelis Medicare |
$68.60
|
| Rate for Payer: Galaxy Health Commercial |
$117.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.60
|
| Rate for Payer: Humana Medicare |
$66.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.93
|
| Rate for Payer: United Healthcare Medicare |
$66.60
|
| Rate for Payer: WellCare Medicare |
$99.00
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, 1 AREA , 1 DAY
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
4211258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| 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 CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| 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: EmblemHealth Select Care |
$767.00
|
| 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 |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, 1 AREA , 1 DAY
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
4211258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, 2 OR > AREAS 2 OR > DAYS
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
4211259
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| 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 CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| 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: EmblemHealth Select Care |
$767.00
|
| 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 |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, 2 OR > AREAS 2 OR > DAYS
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
4211259
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, WHOLE BODY, 1 DAY
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
4211260
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| 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 CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| 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: EmblemHealth Select Care |
$2,640.95
|
| 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 |
$60.60
|
| 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
|
|
|
RADIOPHARM LOC TUMOR ; PLANAR, WHOLE BODY, 1 DAY
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
4211260
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
RADIOPHARM LOC TUMOR ; TOMOGRAPHIC (SPECT), 2 OR > AREAS 2 OR > DAYS
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
4211262
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
RADIOPHARM LOC TUMOR ; TOMOGRAPHIC (SPECT), 2 OR > AREAS 2 OR > DAYS
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
4211262
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$199.34 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| 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: 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 CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| 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: EmblemHealth Select Care |
$2,640.95
|
| 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 |
$1,036.00
|
| 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 |
$199.34
|
| 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
|
|
|
RADIOPHARM LOC TUMOR ; TOMOGRAPHIC (SPECT) W CT, 1 AREA, 1 DAY
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
4211261
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$135.39 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| 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: 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 CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| 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: EmblemHealth Select Care |
$2,640.95
|
| 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 |
$1,036.00
|
| 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 |
$135.39
|
| 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
|
|
|
RADIOPHARM LOC TUMOR ; TOMOGRAPHIC (SPECT) W CT, 1 AREA, 1 DAY
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
4211261
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
RAD. REDUCING GLOVES SIZE 7.5
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
4471683
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: Galaxy Health Commercial |
$98.15
|
|
