|
TRANSDISCAL PROBE KIT TDK2-17-150-6
|
Facility
|
OP
|
$5,066.00
|
|
| Hospital Charge Code |
4479251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,722.44 |
| Max. Negotiated Rate |
$4,078.13 |
| Rate for Payer: Aetna of NY Commercial |
$3,546.20
|
| Rate for Payer: Aetna of NY Medicare |
$2,330.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,799.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,799.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,874.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,533.00
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: CDPHP Commercial |
$4,078.13
|
| Rate for Payer: CDPHP Medicare |
$1,874.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,052.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,052.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,052.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4,052.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,722.44
|
| Rate for Payer: EmblemHealth Select Care |
$3,647.52
|
| Rate for Payer: Fidelis Medicare |
$1,930.65
|
| Rate for Payer: Galaxy Health Commercial |
$3,292.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,874.42
|
| Rate for Payer: Humana Medicare |
$1,874.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,546.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,330.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,799.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,852.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,968.14
|
| Rate for Payer: United Healthcare Medicare |
$1,874.42
|
| Rate for Payer: WellCare Medicare |
$2,786.30
|
|
|
TRANSDISCAL PROBE KIT TDK2-17-150-6
|
Facility
|
IP
|
$5,066.00
|
|
| Hospital Charge Code |
4479251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,292.90 |
| Max. Negotiated Rate |
$3,292.90 |
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,292.90
|
|
|
TRANSDISCAL PROBETIP TDP-17-150-6
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
TRANSDISCAL PROBETIP TDP-17-150-6
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
TRANSDISCAL + SINERGYCABLE TDX-Y-TSW-TDP
|
Facility
|
IP
|
$1,722.00
|
|
| Hospital Charge Code |
4479253
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,119.30
|
|
|
TRANSDISCAL + SINERGYCABLE TDX-Y-TSW-TDP
|
Facility
|
OP
|
$1,722.00
|
|
| Hospital Charge Code |
4479253
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$585.48 |
| Max. Negotiated Rate |
$1,386.21 |
| Rate for Payer: Aetna of NY Commercial |
$1,205.40
|
| Rate for Payer: Aetna of NY Medicare |
$792.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,291.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,291.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$637.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$861.00
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: CDPHP Commercial |
$1,386.21
|
| Rate for Payer: CDPHP Medicare |
$637.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,377.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,377.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,377.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,377.60
|
| Rate for Payer: EmblemHealth Medicare |
$585.48
|
| Rate for Payer: EmblemHealth Select Care |
$1,239.84
|
| Rate for Payer: Fidelis Medicare |
$656.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,119.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$637.14
|
| Rate for Payer: Humana Medicare |
$637.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,205.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$792.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,291.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$969.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$669.00
|
| Rate for Payer: United Healthcare Medicare |
$637.14
|
| Rate for Payer: WellCare Medicare |
$947.10
|
|
|
TRANSDISCAL TUBING+BURETTE KIT TDA-TBK-1
|
Facility
|
OP
|
$488.00
|
|
| Hospital Charge Code |
4479255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.92 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna of NY Commercial |
$341.60
|
| Rate for Payer: Aetna of NY Medicare |
$224.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: CDPHP Commercial |
$392.84
|
| Rate for Payer: CDPHP Medicare |
$180.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$390.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$390.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$390.40
|
| Rate for Payer: EmblemHealth Medicaid |
$390.40
|
| Rate for Payer: EmblemHealth Medicare |
$165.92
|
| Rate for Payer: EmblemHealth Select Care |
$351.36
|
| Rate for Payer: Fidelis Medicare |
$185.98
|
| Rate for Payer: Galaxy Health Commercial |
$317.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.56
|
| Rate for Payer: Humana Medicare |
$180.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$274.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.59
|
| Rate for Payer: United Healthcare Medicare |
$180.56
|
| Rate for Payer: WellCare Medicare |
$268.40
|
|
|
TRANSDISCAL TUBING+BURETTE KIT TDA-TBK-1
|
Facility
|
IP
|
$488.00
|
|
| Hospital Charge Code |
4479255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Galaxy Health Commercial |
$317.20
|
|
|
TRANSFERRIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
4300790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
TRANSFERRIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
4300790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of NY Commercial |
$46.80
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Commercial |
$57.96
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: EmblemHealth Select Care |
$43.20
|
| Rate for Payer: Fidelis Medicare |
$27.44
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.64
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.97
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
TRANSFUSION-BLOOD OVER 4 HRS
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4300791
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION-BLOOD OVER 4 HRS
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4300791
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 2 HOURS
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450110
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 2 HOURS
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450110
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 4 HOURS
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450111
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 4 HOURS
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450111
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 6 HOURS
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450112
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOOD UP TO 6 HOURS
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450112
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOODUP TO 8 HOURS
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$558.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$558.90
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSFUSION BLOODUP TO 8 HOURS
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
4450113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$999.81 |
| Rate for Payer: Aetna of NY Commercial |
$869.40
|
| Rate for Payer: Aetna of NY Medicare |
$571.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$459.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$621.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: CDPHP Commercial |
$999.81
|
| Rate for Payer: CDPHP Medicare |
$459.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$621.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$993.60
|
| Rate for Payer: EmblemHealth Medicare |
$422.28
|
| Rate for Payer: EmblemHealth Select Care |
$621.00
|
| Rate for Payer: Fidelis Medicare |
$473.33
|
| Rate for Payer: Galaxy Health Commercial |
$807.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$459.54
|
| Rate for Payer: Humana Medicare |
$459.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$869.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$571.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$699.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$482.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$931.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Medicare |
$459.54
|
| Rate for Payer: WellCare Medicare |
$683.10
|
|
|
TRANSURETHRAL INCISION PROSTATE
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
4002032
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
TRANSURETHRAL INCISION PROSTATE
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
4002032
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
TRAY,IRRIGATION W/60 CC BULB
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
4471628
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
|
|
TRAY,IRRIGATION W/60 CC BULB
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
4471628
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of NY Commercial |
$2.80
|
| Rate for Payer: Aetna of NY Medicare |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: CDPHP Commercial |
$3.22
|
| Rate for Payer: CDPHP Medicare |
$1.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3.20
|
| Rate for Payer: EmblemHealth Medicare |
$1.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.88
|
| Rate for Payer: Fidelis Medicare |
$1.52
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.55
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
TRAZODONE HCL 50MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50111043301
|
| Hospital Charge Code |
4400770
|
|
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
|
|
