|
TECHNETIUM TC99M AUTO WBC EXAME PER DOSE
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
4210085
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$2,851.61 |
| Rate for Payer: Aetna of NY Medicare |
$170.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$136.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$185.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: CDPHP Commercial |
$297.85
|
| Rate for Payer: CDPHP Medicare |
$136.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$296.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$296.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$296.00
|
| Rate for Payer: EmblemHealth Medicaid |
$296.00
|
| Rate for Payer: EmblemHealth Medicare |
$125.80
|
| Rate for Payer: EmblemHealth Select Care |
$266.40
|
| Rate for Payer: Fidelis Medicare |
$141.01
|
| Rate for Payer: Galaxy Health Commercial |
$240.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$136.90
|
| Rate for Payer: Humana Medicare |
$136.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$170.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$277.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$208.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$143.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,851.61
|
| Rate for Payer: United Healthcare Commercial |
$2,851.61
|
| Rate for Payer: United Healthcare Medicare |
$136.90
|
| Rate for Payer: WellCare Medicare |
$203.50
|
|
|
TECHNETIUM TC99M AUTO WBC EXAME PER DOSE
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
4210085
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Galaxy Health Commercial |
$240.50
|
|
|
TECHNETIUM TC99M TEBOROXIME PER DOSE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS A9501
|
| Hospital Charge Code |
4210086
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna of NY Medicare |
$235.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$189.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$256.50
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: CDPHP Commercial |
$412.96
|
| Rate for Payer: CDPHP Medicare |
$189.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$410.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$410.40
|
| Rate for Payer: EmblemHealth Medicaid |
$410.40
|
| Rate for Payer: EmblemHealth Medicare |
$174.42
|
| Rate for Payer: EmblemHealth Select Care |
$369.36
|
| Rate for Payer: Fidelis Medicare |
$195.50
|
| Rate for Payer: Galaxy Health Commercial |
$333.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$189.81
|
| Rate for Payer: Humana Medicare |
$189.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$235.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$288.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$199.30
|
| Rate for Payer: United Healthcare Medicare |
$189.81
|
| Rate for Payer: WellCare Medicare |
$282.15
|
|
|
TECHNETIUM TC99M TEBOROXIME PER DOSE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS A9501
|
| Hospital Charge Code |
4210086
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$333.45 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Galaxy Health Commercial |
$333.45
|
|
|
TEGADERM DRESSING
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
4479239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
TEGADERM DRESSING
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
4479239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna of NY Commercial |
$136.50
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$97.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$140.40
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$136.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.76
|
| Rate for Payer: United Healthcare Medicare |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
TEGRETOL (CARBAMAZEPINE)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
4300761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| 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 |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
TEGRETOL (CARBAMAZEPINE)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
4300761
|
|
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
|
|
|
TEMAZEPAM 15MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739087710
|
| Hospital Charge Code |
4400747
|
|
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
|
|
|
TEMAZEPAM 15MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739087710
|
| Hospital Charge Code |
4400747
|
|
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
|
|
|
TEMAZEPAM 7.5 MG CAPSULE 7.5 mg, 30 eaches
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
4401575
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
TEMAZEPAM 7.5 MG CAPSULE 7.5 mg, 30 eaches
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
4401575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
TEMP STABILIOZE PIN
|
Facility
|
OP
|
$419.00
|
|
| Hospital Charge Code |
4473003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$337.30 |
| Rate for Payer: Aetna of NY Commercial |
$293.30
|
| Rate for Payer: Aetna of NY Medicare |
$192.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$155.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$209.50
|
| Rate for Payer: Cash Price |
$314.25
|
| Rate for Payer: CDPHP Commercial |
$337.30
|
| Rate for Payer: CDPHP Medicare |
$155.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$335.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$335.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$335.20
|
| Rate for Payer: EmblemHealth Medicaid |
$335.20
|
| Rate for Payer: EmblemHealth Medicare |
$142.46
|
| Rate for Payer: EmblemHealth Select Care |
$301.68
|
| Rate for Payer: Fidelis Medicare |
$159.68
|
| Rate for Payer: Galaxy Health Commercial |
$272.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$155.03
|
| Rate for Payer: Humana Medicare |
$155.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$293.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$192.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$235.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$162.78
|
| Rate for Payer: United Healthcare Medicare |
$155.03
|
| Rate for Payer: WellCare Medicare |
$230.45
|
|
|
TEMP STABILIOZE PIN
|
Facility
|
IP
|
$419.00
|
|
| Hospital Charge Code |
4473003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$272.35 |
| Rate for Payer: Cash Price |
$314.25
|
| Rate for Payer: Galaxy Health Commercial |
$272.35
|
|
|
TEMP THERAPY PAD
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4478238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| 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: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| 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 |
$11.52
|
| 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 |
$11.20
|
| 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: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
TEMP THERAPY PAD
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4478238
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
TENDON ORIGIN INJECTION
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
4850027
|
|
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
|
|
|
TENDON ORIGIN INJECTION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
4850027
|
|
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
|
|
|
TENDON SHETH/LIGAMENT/CYST INJECTION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4850026
|
|
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
|
|
|
TENDON SHETH/LIGAMENT/CYST INJECTION
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
4850026
|
|
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
|
|
|
TENECTEPLASE INJECTION 1 MG
|
Facility
|
OP
|
$531.23
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
4400762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$427.64 |
| Rate for Payer: Aetna of NY Commercial |
$292.18
|
| Rate for Payer: Aetna of NY Medicare |
$244.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$196.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$265.62
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: CDPHP Commercial |
$427.64
|
| Rate for Payer: CDPHP Medicare |
$196.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$424.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$424.98
|
| Rate for Payer: EmblemHealth Medicaid |
$424.98
|
| Rate for Payer: EmblemHealth Medicare |
$180.62
|
| Rate for Payer: EmblemHealth Select Care |
$153.11
|
| Rate for Payer: Fidelis Medicare |
$202.45
|
| Rate for Payer: Galaxy Health Commercial |
$345.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$196.56
|
| Rate for Payer: Humana Medicare |
$196.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$292.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$244.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$299.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$206.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$251.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$153.11
|
| Rate for Payer: United Healthcare Commercial |
$251.96
|
| Rate for Payer: United Healthcare Medicare |
$196.56
|
| Rate for Payer: WellCare Medicare |
$292.18
|
|
|
TENECTEPLASE INJECTION 1 MG
|
Facility
|
IP
|
$531.23
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
4400762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$345.30 |
| Rate for Payer: Aetna of NY Commercial |
$292.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.11
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: Cash Price |
$398.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.11
|
| Rate for Payer: EmblemHealth Select Care |
$153.11
|
| Rate for Payer: Galaxy Health Commercial |
$345.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$292.18
|
| Rate for Payer: WellCare Medicare |
$292.18
|
|
|
TENEX - BONE PROCEDURE PACK
|
Facility
|
OP
|
$4,074.00
|
|
| Hospital Charge Code |
4473018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,385.16 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: Aetna of NY Commercial |
$2,851.80
|
| Rate for Payer: Aetna of NY Medicare |
$1,874.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,507.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,037.00
|
| Rate for Payer: Cash Price |
$3,055.50
|
| Rate for Payer: CDPHP Commercial |
$3,279.57
|
| Rate for Payer: CDPHP Medicare |
$1,507.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,259.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,259.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,385.16
|
| Rate for Payer: EmblemHealth Select Care |
$2,933.28
|
| Rate for Payer: Fidelis Medicare |
$1,552.60
|
| Rate for Payer: Galaxy Health Commercial |
$2,648.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,507.38
|
| Rate for Payer: Humana Medicare |
$1,507.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,851.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,874.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,055.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,293.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,582.75
|
| Rate for Payer: United Healthcare Medicare |
$1,507.38
|
| Rate for Payer: WellCare Medicare |
$2,240.70
|
|
|
TENEX - BONE PROCEDURE PACK
|
Facility
|
IP
|
$4,074.00
|
|
| Hospital Charge Code |
4473018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,648.10 |
| Max. Negotiated Rate |
$2,648.10 |
| Rate for Payer: Cash Price |
$3,055.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,648.10
|
|
|
TENIVAC 5-2 LFU INJ(TETANUS, DIPTHERIA)
|
Facility
|
IP
|
$118.71
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
4409170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$77.16 |
| Rate for Payer: Aetna of NY Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.83
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.83
|
| Rate for Payer: EmblemHealth Select Care |
$18.83
|
| Rate for Payer: Galaxy Health Commercial |
$77.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.29
|
| Rate for Payer: WellCare Medicare |
$65.29
|
|
