|
THYROID STIM HORM (TSH)
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
4300771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna of NY Commercial |
$57.85
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.50
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Commercial |
$71.64
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: EmblemHealth Select Care |
$53.40
|
| Rate for Payer: Fidelis Medicare |
$33.92
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.93
|
| Rate for Payer: Humana Medicare |
$32.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$57.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$66.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$66.75
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
THYROID UPTAKE MULTIPLE
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
4210039
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$26.60 |
| 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 |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
THYROID UPTAKE MULTIPLE
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
4210039
|
|
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
|
|
|
TICRON BLUE 5 X 18" GS-22 TAPER
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
4472214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
TICRON BLUE 5 X 18" GS-22 TAPER
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4472214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
TIMOLOL MALEATE 0.005 DROP 5 ML
|
Facility
|
OP
|
$55.62
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
4400761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$44.77 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$41.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$41.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.81
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Commercial |
$44.77
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$21.20
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.58
|
| Rate for Payer: Humana Medicare |
$20.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.61
|
| Rate for Payer: United Healthcare Medicare |
$20.58
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
TIMOLOL MALEATE 0.005 DROP 5 ML
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
4400761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
4302026
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.23 |
| Max. Negotiated Rate |
$350.18 |
| Rate for Payer: Aetna of NY Commercial |
$282.75
|
| Rate for Payer: Aetna of NY Medicare |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$217.50
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: CDPHP Commercial |
$350.18
|
| Rate for Payer: CDPHP Medicare |
$160.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$261.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$348.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$348.00
|
| Rate for Payer: EmblemHealth Medicaid |
$348.00
|
| Rate for Payer: EmblemHealth Medicare |
$147.90
|
| Rate for Payer: EmblemHealth Select Care |
$261.00
|
| Rate for Payer: Fidelis Medicare |
$165.78
|
| Rate for Payer: Galaxy Health Commercial |
$282.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.95
|
| Rate for Payer: Humana Medicare |
$160.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$282.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$200.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$244.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$169.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$326.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$133.23
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$160.95
|
| Rate for Payer: WellCare Medicare |
$239.25
|
|
|
TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
4302026
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$282.75 |
| Max. Negotiated Rate |
$282.75 |
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Galaxy Health Commercial |
$282.75
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 3
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88304 TC
|
| Hospital Charge Code |
4008304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 3
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88304 TC
|
| Hospital Charge Code |
4008304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 4
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4008305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 4
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4008305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 5
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
HCPCS 88307 TC
|
| Hospital Charge Code |
4008307
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$668.20 |
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Galaxy Health Commercial |
$668.20
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 5
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
HCPCS 88307 TC
|
| Hospital Charge Code |
4008307
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$349.52 |
| Max. Negotiated Rate |
$827.54 |
| Rate for Payer: Aetna of NY Commercial |
$668.20
|
| Rate for Payer: Aetna of NY Medicare |
$472.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$771.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$771.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$380.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$514.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: CDPHP Commercial |
$827.54
|
| Rate for Payer: CDPHP Medicare |
$380.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$616.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$822.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$822.40
|
| Rate for Payer: EmblemHealth Medicaid |
$822.40
|
| Rate for Payer: EmblemHealth Medicare |
$349.52
|
| Rate for Payer: EmblemHealth Select Care |
$616.80
|
| Rate for Payer: Fidelis Medicare |
$391.77
|
| Rate for Payer: Galaxy Health Commercial |
$668.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$380.36
|
| Rate for Payer: Humana Medicare |
$380.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$668.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$472.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$771.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$578.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$399.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$771.00
|
| Rate for Payer: United Healthcare Commercial |
$771.00
|
| Rate for Payer: United Healthcare Medicare |
$380.36
|
| Rate for Payer: WellCare Medicare |
$565.40
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 6
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
HCPCS 88309 TC
|
| Hospital Charge Code |
4008309
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$836.40 |
| Max. Negotiated Rate |
$1,980.30 |
| Rate for Payer: Aetna of NY Commercial |
$1,599.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,131.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$910.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,230.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: CDPHP Commercial |
$1,980.30
|
| Rate for Payer: CDPHP Medicare |
$910.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,476.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,968.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,968.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,968.00
|
| Rate for Payer: EmblemHealth Medicare |
$836.40
|
| Rate for Payer: EmblemHealth Select Care |
$1,476.00
|
| Rate for Payer: Fidelis Medicare |
$937.51
|
| Rate for Payer: Galaxy Health Commercial |
$1,599.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$910.20
|
| Rate for Payer: Humana Medicare |
$910.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,599.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,131.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,845.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,384.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$955.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,845.00
|
| Rate for Payer: United Healthcare Commercial |
$1,845.00
|
| Rate for Payer: United Healthcare Medicare |
$910.20
|
| Rate for Payer: WellCare Medicare |
$1,353.00
|
|
|
TISSUE EXAM BY PATHOLOGIST LVL 6
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
HCPCS 88309 TC
|
| Hospital Charge Code |
4008309
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,599.00 |
| Max. Negotiated Rate |
$1,599.00 |
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,599.00
|
|
|
TISSUE PATHOLOGY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4301113
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
TISSUE PATHOLOGY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4301113
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
TITER EACH ANTIBODY
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
4300083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna of NY Commercial |
$121.55
|
| Rate for Payer: Aetna of NY Medicare |
$86.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.50
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: CDPHP Commercial |
$150.54
|
| Rate for Payer: CDPHP Medicare |
$69.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.60
|
| Rate for Payer: EmblemHealth Medicaid |
$149.60
|
| Rate for Payer: EmblemHealth Medicare |
$63.58
|
| Rate for Payer: EmblemHealth Select Care |
$112.20
|
| Rate for Payer: Fidelis Medicare |
$71.27
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.19
|
| Rate for Payer: Humana Medicare |
$69.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$140.25
|
| Rate for Payer: United Healthcare Commercial |
$140.25
|
| Rate for Payer: United Healthcare Medicare |
$69.19
|
| Rate for Payer: WellCare Medicare |
$102.85
|
|
|
TITER EACH ANTIBODY
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
4300083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
|
|
tiZANidine HCL 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
4401485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
tiZANidine HCL 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
4401485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
TL201 THALLIUM PER 1 MCI
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
4210055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.06 |
| Max. Negotiated Rate |
$166.06 |
| Rate for Payer: Aetna of NY Medicare |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$79.50
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: CDPHP Commercial |
$128.00
|
| Rate for Payer: CDPHP Medicare |
$58.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$127.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$127.20
|
| Rate for Payer: EmblemHealth Medicaid |
$127.20
|
| Rate for Payer: EmblemHealth Medicare |
$54.06
|
| Rate for Payer: EmblemHealth Select Care |
$114.48
|
| Rate for Payer: Fidelis Medicare |
$60.59
|
| Rate for Payer: Galaxy Health Commercial |
$103.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.83
|
| Rate for Payer: Humana Medicare |
$58.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$89.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$166.06
|
| Rate for Payer: United Healthcare Commercial |
$166.06
|
| Rate for Payer: United Healthcare Medicare |
$58.83
|
| Rate for Payer: WellCare Medicare |
$87.45
|
|
|
TL201 THALLIUM PER 1 MCI
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
4210055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Galaxy Health Commercial |
$103.35
|
|
