|
THER/PROPH/DIAG IV INF INIT =<1 HR
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
4450105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$398.45 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Galaxy Health Commercial |
$398.45
|
|
|
THER/PROPH/DIAG IV INF INIT =<1 HR
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
4450105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$493.46 |
| Rate for Payer: Aetna of NY Commercial |
$429.10
|
| Rate for Payer: Aetna of NY Medicare |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$226.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$306.50
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: CDPHP Commercial |
$493.46
|
| Rate for Payer: CDPHP Medicare |
$226.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$490.40
|
| Rate for Payer: EmblemHealth Medicaid |
$490.40
|
| Rate for Payer: EmblemHealth Medicare |
$208.42
|
| Rate for Payer: EmblemHealth Select Care |
$441.36
|
| Rate for Payer: Fidelis Medicare |
$233.61
|
| Rate for Payer: Galaxy Health Commercial |
$398.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$226.81
|
| Rate for Payer: Humana Medicare |
$226.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$429.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$281.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$345.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$238.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$459.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
| Rate for Payer: United Healthcare Medicare |
$226.81
|
| Rate for Payer: WellCare Medicare |
$337.15
|
|
|
THIAMINE HCL 100 MG INJ
|
Facility
|
IP
|
$38.37
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
4400756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$24.94 |
| Rate for Payer: Aetna of NY Commercial |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.26
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.26
|
| Rate for Payer: EmblemHealth Select Care |
$2.26
|
| Rate for Payer: Galaxy Health Commercial |
$24.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.10
|
| Rate for Payer: WellCare Medicare |
$21.10
|
|
|
THIAMINE HCL 100 MG INJ
|
Facility
|
OP
|
$38.37
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
4400756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$30.89 |
| Rate for Payer: Aetna of NY Commercial |
$21.10
|
| Rate for Payer: Aetna of NY Medicare |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.18
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: CDPHP Commercial |
$30.89
|
| Rate for Payer: CDPHP Medicare |
$14.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.70
|
| Rate for Payer: EmblemHealth Medicaid |
$30.70
|
| Rate for Payer: EmblemHealth Medicare |
$13.05
|
| Rate for Payer: EmblemHealth Select Care |
$2.26
|
| Rate for Payer: Fidelis Medicare |
$14.62
|
| Rate for Payer: Galaxy Health Commercial |
$24.94
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.20
|
| Rate for Payer: Humana Medicare |
$14.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$14.20
|
| Rate for Payer: WellCare Medicare |
$21.10
|
|
|
THORACENTESIS ASPIRATE PLEURA WO IMAGING
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
4602224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,447.39 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$827.08
|
| 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 |
$665.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$899.00
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: CDPHP Commercial |
$1,447.39
|
| Rate for Payer: CDPHP Medicare |
$665.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,438.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicare |
$611.32
|
| 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 |
$685.22
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.26
|
| Rate for Payer: Humana Medicare |
$665.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$827.08
|
| 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 |
$698.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.55
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$665.26
|
| Rate for Payer: WellCare Medicare |
$988.90
|
|
|
THORACENTESIS ASPIRATE PLEURA WO IMAGING
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
4602224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,168.70 |
| Max. Negotiated Rate |
$1,168.70 |
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
|
|
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
4201082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,447.39 |
| Rate for Payer: Aetna of NY Commercial |
$1,258.60
|
| Rate for Payer: Aetna of NY Medicare |
$827.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,348.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,348.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$665.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$899.00
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: CDPHP Commercial |
$1,447.39
|
| Rate for Payer: CDPHP Medicare |
$665.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,258.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,438.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,438.40
|
| Rate for Payer: EmblemHealth Medicare |
$611.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,168.70
|
| Rate for Payer: Fidelis Medicare |
$685.22
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$665.26
|
| Rate for Payer: Humana Medicare |
$665.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,258.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$827.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,012.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.55
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$665.26
|
| Rate for Payer: WellCare Medicare |
$988.90
|
|
|
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
4201082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,168.70 |
| Max. Negotiated Rate |
$1,168.70 |
| Rate for Payer: Cash Price |
$1,348.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.70
|
|
|
THORACENTESIS TRAY 16GAX3
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
4471224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
|
|
THORACENTESIS TRAY 16GAX3
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
4471224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
THORACIC RF KIT:THK-17-75
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
THORACIC RF KIT:THK-17-75
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
THREE PHASE BONE SCAN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
4210037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$80.80 |
| 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 |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
THREE PHASE BONE SCAN
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
4210037
|
|
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
|
|
|
THROMBIN 5MU PWVL 1 EA
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
4400758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Galaxy Health Commercial |
$172.90
|
| Rate for Payer: WellCare Medicare |
$146.30
|
|
|
THROMBIN 5MU PWVL 1 EA
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
4400758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.44 |
| Max. Negotiated Rate |
$214.13 |
| Rate for Payer: Aetna of NY Commercial |
$186.20
|
| Rate for Payer: Aetna of NY Medicare |
$122.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$133.00
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: CDPHP Commercial |
$214.13
|
| Rate for Payer: CDPHP Medicare |
$98.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$212.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.80
|
| Rate for Payer: EmblemHealth Medicaid |
$212.80
|
| Rate for Payer: EmblemHealth Medicare |
$90.44
|
| Rate for Payer: EmblemHealth Select Care |
$191.52
|
| Rate for Payer: Fidelis Medicare |
$101.37
|
| Rate for Payer: Galaxy Health Commercial |
$172.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.42
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$186.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.34
|
| Rate for Payer: United Healthcare Medicare |
$98.42
|
| Rate for Payer: WellCare Medicare |
$146.30
|
|
|
THROMBIN TIME
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
4300770
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$31.20
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$28.80
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
THROMBIN TIME
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
4300770
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
|
|
THYROID 15MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00456045701
|
| Hospital Charge Code |
4400071
|
|
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
|
|
|
THYROID 15MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00456045701
|
| Hospital Charge Code |
4400071
|
|
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
|
|
|
THYROID ANTIMICROSOMAL AB
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
4300774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| 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 |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
THYROID ANTIMICROSOMAL AB
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
4300774
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
THYROID METS UPTAKE
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 78020
|
| Hospital Charge Code |
4210101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$406.25 |
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Galaxy Health Commercial |
$406.25
|
|
|
THYROID METS UPTAKE
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 78020
|
| Hospital Charge Code |
4210101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$437.50
|
| Rate for Payer: Aetna of NY Medicare |
$287.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$468.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$468.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$231.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$312.50
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: CDPHP Commercial |
$503.12
|
| Rate for Payer: CDPHP Medicare |
$231.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$437.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$500.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.00
|
| Rate for Payer: EmblemHealth Medicaid |
$500.00
|
| Rate for Payer: EmblemHealth Medicare |
$212.50
|
| Rate for Payer: EmblemHealth Select Care |
$406.25
|
| Rate for Payer: Fidelis Medicare |
$238.19
|
| Rate for Payer: Galaxy Health Commercial |
$406.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$231.25
|
| Rate for Payer: Humana Medicare |
$231.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$437.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$287.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$351.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$242.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$231.25
|
| Rate for Payer: WellCare Medicare |
$343.75
|
|
|
THYROID STIM HORM (TSH)
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
4300771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
|
