|
TRAZODONE HCL 50MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50111043301
|
| Hospital Charge Code |
4400770
|
|
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
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4850304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4850304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN
|
| Hospital Charge Code |
4670084
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN
|
| Hospital Charge Code |
4670084
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59)
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59
|
| Hospital Charge Code |
4670292
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59)
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59
|
| Hospital Charge Code |
4670292
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59 W KX)
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59,KX
|
| Hospital Charge Code |
4670308
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59 W KX)
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59,KX
|
| Hospital Charge Code |
4670308
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (W/ KX)
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,KX
|
| Hospital Charge Code |
4670270
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (W/ KX)
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,KX
|
| Hospital Charge Code |
4670270
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$255.99 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Commercial |
$255.99
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$121.19
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.66
|
| Rate for Payer: Humana Medicare |
$117.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$117.66
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN
|
| Hospital Charge Code |
4670019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN
|
| Hospital Charge Code |
4670019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59
|
| Hospital Charge Code |
4670285
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59
|
| Hospital Charge Code |
4670285
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59 W KX)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59,KX
|
| Hospital Charge Code |
4670301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59 W KX)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59,KX
|
| Hospital Charge Code |
4670301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (W/ KX)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,KX
|
| Hospital Charge Code |
4670263
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (W/ KX)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,KX
|
| Hospital Charge Code |
4670263
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TRIAMCINOLONE ACET 40 MG/ML VL 40 mg, 1 mL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 70121104901
|
| Hospital Charge Code |
4401335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TRIAMCINOLONE ACET 40 MG/ML VL 40 mg, 1 mL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 70121104901
|
| Hospital Charge Code |
4401335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
OP
|
$31.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna of NY Commercial |
$17.42
|
| Rate for Payer: Aetna of NY Medicare |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.84
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: CDPHP Commercial |
$25.49
|
| Rate for Payer: CDPHP Medicare |
$11.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.34
|
| Rate for Payer: EmblemHealth Medicaid |
$25.34
|
| Rate for Payer: EmblemHealth Medicare |
$10.77
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$12.07
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.72
|
| Rate for Payer: Humana Medicare |
$11.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$11.72
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
IP
|
$32.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of NY Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Galaxy Health Commercial |
$20.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.70
|
| Rate for Payer: WellCare Medicare |
$17.70
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
OP
|
$32.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna of NY Commercial |
$17.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.10
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: CDPHP Commercial |
$25.91
|
| Rate for Payer: CDPHP Medicare |
$11.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.75
|
| Rate for Payer: EmblemHealth Medicaid |
$25.75
|
| Rate for Payer: EmblemHealth Medicare |
$10.94
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$12.27
|
| Rate for Payer: Galaxy Health Commercial |
$20.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.91
|
| Rate for Payer: Humana Medicare |
$11.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$11.91
|
| Rate for Payer: WellCare Medicare |
$17.70
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
IP
|
$31.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Aetna of NY Commercial |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.42
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
