|
SM 153 LEXIDRONAM =< 150 MCI THERA
|
Facility
|
OP
|
$51,780.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
4210084
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$17,605.20 |
| Max. Negotiated Rate |
$41,682.90 |
| Rate for Payer: Aetna of NY Commercial |
$36,246.00
|
| Rate for Payer: Aetna of NY Medicare |
$23,818.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19,158.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25,890.00
|
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: Cash Price |
$38,835.00
|
| Rate for Payer: CDPHP Commercial |
$41,682.90
|
| Rate for Payer: CDPHP Medicare |
$19,158.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41,424.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41,424.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41,424.00
|
| Rate for Payer: EmblemHealth Medicaid |
$41,424.00
|
| Rate for Payer: EmblemHealth Medicare |
$17,605.20
|
| Rate for Payer: EmblemHealth Select Care |
$37,281.60
|
| Rate for Payer: Fidelis Medicare |
$19,733.36
|
| Rate for Payer: Galaxy Health Commercial |
$33,657.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$19,158.60
|
| Rate for Payer: Humana Medicare |
$19,158.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36,246.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23,818.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38,835.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29,152.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20,116.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28,478.75
|
| Rate for Payer: United Healthcare Commercial |
$28,478.75
|
| Rate for Payer: United Healthcare Medicare |
$19,158.60
|
| Rate for Payer: WellCare Medicare |
$28,479.00
|
|
|
SMALL JOINT/BURSA INJ OR ASPIR
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4850029
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$677.60
|
| 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: EmblemHealth Select Care |
$609.84
|
| 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
|
|
|
SMALL JOINT/BURSA INJ OR ASPIR
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4850029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
SMALL JOINT INJECTION/ASPIRATION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4609574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
SMALL JOINT INJECTION/ASPIRATION
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
4609574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$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: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| 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: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| 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 |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
SMALL LEFT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4471570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
SMALL LEFT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4471570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
SMALL RIGHT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4471565
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
SMALL RIGHT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4471565
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
SMALL SPECIALTY ARM SLING
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4471556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
SMALL SPECIALTY ARM SLING
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4471556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
SMALL STOCKING ANTI-EMB THIGH
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
4471180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
SMALL STOCKING ANTI-EMB THIGH
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
4471180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.70
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$29.52
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
SMALL WASHER
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
4472235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna of NY Commercial |
$60.90
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.15
|
| 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: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.50
|
| 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 |
$43.50
|
| 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 |
$60.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.80
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
SMALL WASHER
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
4472235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.15 |
| Max. Negotiated Rate |
$60.90 |
| Rate for Payer: Aetna of NY Commercial |
$60.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.15
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.50
|
| Rate for Payer: EmblemHealth Select Care |
$43.50
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$39.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.55
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
SMARK-CELERO
|
Facility
|
IP
|
$224.00
|
|
| Hospital Charge Code |
4473015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Galaxy Health Commercial |
$145.60
|
|
|
SMARK-CELERO
|
Facility
|
OP
|
$224.00
|
|
| Hospital Charge Code |
4473015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna of NY Commercial |
$156.80
|
| Rate for Payer: Aetna of NY Medicare |
$103.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: CDPHP Commercial |
$180.32
|
| Rate for Payer: CDPHP Medicare |
$82.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$179.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$179.20
|
| Rate for Payer: EmblemHealth Medicaid |
$179.20
|
| Rate for Payer: EmblemHealth Medicare |
$76.16
|
| Rate for Payer: EmblemHealth Select Care |
$161.28
|
| Rate for Payer: Fidelis Medicare |
$85.37
|
| Rate for Payer: Galaxy Health Commercial |
$145.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.88
|
| Rate for Payer: Humana Medicare |
$82.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.02
|
| Rate for Payer: United Healthcare Medicare |
$82.88
|
| Rate for Payer: WellCare Medicare |
$123.20
|
|
|
SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
4302024
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
4302024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| 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: 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 |
$34.20
|
| 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 |
$34.20
|
| 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 |
$37.05
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
4300301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$10.40
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$9.60
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.43
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
4300301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
SMR PRIM SRC SPEC STAIN BODIES/PARASITS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
4300549
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$50.72 |
| Rate for Payer: Aetna of NY Commercial |
$40.95
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$37.80
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$47.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$47.25
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
SMR PRIM SRC SPEC STAIN BODIES/PARASITS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
4300549
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
SMZ-TMP CONCENTRATE (M.D.V.) 80 MG/ML-16 MG/ML
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4409186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.70
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
SMZ-TMP CONCENTRATE (M.D.V.) 80 MG/ML-16 MG/ML
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4409186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.70
|
| 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 |
$3.30
|
| 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
|
|
