|
ANGLED TOMCAT 4.5MM 3805451
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
4479299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of NY Commercial |
$143.50
|
| Rate for Payer: Aetna of NY Medicare |
$94.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.50
|
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: CDPHP Commercial |
$165.02
|
| Rate for Payer: CDPHP Medicare |
$75.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$164.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.00
|
| Rate for Payer: EmblemHealth Medicaid |
$164.00
|
| Rate for Payer: EmblemHealth Medicare |
$69.70
|
| Rate for Payer: EmblemHealth Select Care |
$147.60
|
| Rate for Payer: Fidelis Medicare |
$78.13
|
| Rate for Payer: Galaxy Health Commercial |
$133.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.85
|
| Rate for Payer: Humana Medicare |
$75.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$143.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$115.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.64
|
| Rate for Payer: United Healthcare Medicare |
$75.85
|
| Rate for Payer: WellCare Medicare |
$112.75
|
|
|
ANGLED TOMCAT 4.5MM 3805451
|
Facility
|
IP
|
$205.00
|
|
| Hospital Charge Code |
4479299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Galaxy Health Commercial |
$133.25
|
|
|
ANORO ELLIPTA 62.5-25 MCG INH 14 ea, 14 eaches
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
4401425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$292.22 |
| Rate for Payer: Aetna of NY Commercial |
$254.10
|
| Rate for Payer: Aetna of NY Medicare |
$166.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$134.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$181.50
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: CDPHP Commercial |
$292.22
|
| Rate for Payer: CDPHP Medicare |
$134.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$290.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$290.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$290.40
|
| Rate for Payer: EmblemHealth Medicaid |
$290.40
|
| Rate for Payer: EmblemHealth Medicare |
$123.42
|
| Rate for Payer: EmblemHealth Select Care |
$261.36
|
| Rate for Payer: Fidelis Medicare |
$138.34
|
| Rate for Payer: Galaxy Health Commercial |
$235.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$134.31
|
| Rate for Payer: Humana Medicare |
$134.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$254.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$204.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.03
|
| Rate for Payer: United Healthcare Medicare |
$134.31
|
| Rate for Payer: WellCare Medicare |
$199.65
|
|
|
ANORO ELLIPTA 62.5-25 MCG INH 14 ea, 14 eaches
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
4401425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$199.65 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Galaxy Health Commercial |
$235.95
|
| Rate for Payer: WellCare Medicare |
$199.65
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Facility
|
OP
|
$14,232.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
4002041
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$11,456.76 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,546.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,265.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: CDPHP Commercial |
$11,456.76
|
| Rate for Payer: CDPHP Medicare |
$5,265.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,385.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,385.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,385.60
|
| Rate for Payer: EmblemHealth Medicaid |
$11,385.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,838.88
|
| Rate for Payer: EmblemHealth Select Care |
$10,247.04
|
| Rate for Payer: Fidelis Medicare |
$5,423.82
|
| Rate for Payer: Galaxy Health Commercial |
$9,250.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,265.84
|
| Rate for Payer: Humana Medicare |
$5,265.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,546.72
|
| Rate for Payer: Multiplan Commercial |
$11,385.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,674.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,012.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,529.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,739.10
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,265.84
|
| Rate for Payer: WellCare Medicare |
$7,827.60
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Facility
|
IP
|
$14,232.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
4002041
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,250.80 |
| Max. Negotiated Rate |
$9,250.80 |
| Rate for Payer: Cash Price |
$10,674.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,250.80
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4304866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4301136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.66
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4301136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4301087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4301087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.66
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
ANTIBIOTIC SENSITIVITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
4304866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.66
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
4302023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
4302023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$34.20
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
4302018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
4302018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna of NY Commercial |
$30.55
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.50
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Commercial |
$37.84
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: EmblemHealth Select Care |
$28.20
|
| Rate for Payer: Fidelis Medicare |
$17.91
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.39
|
| Rate for Payer: Humana Medicare |
$17.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$35.25
|
| Rate for Payer: United Healthcare Medicare |
$17.39
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
ANTIBODY; RICKETTSIA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
4302009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Aetna of NY Commercial |
$44.20
|
| Rate for Payer: Aetna of NY Medicare |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: CDPHP Commercial |
$54.74
|
| Rate for Payer: CDPHP Medicare |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$54.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.40
|
| Rate for Payer: EmblemHealth Medicaid |
$54.40
|
| Rate for Payer: EmblemHealth Medicare |
$23.12
|
| Rate for Payer: EmblemHealth Select Care |
$40.80
|
| Rate for Payer: Fidelis Medicare |
$25.91
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.16
|
| Rate for Payer: Humana Medicare |
$25.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$51.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Medicare |
$25.16
|
| Rate for Payer: WellCare Medicare |
$37.40
|
|
|
ANTIBODY; RICKETTSIA
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
4302009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
|
|
ANTIBODY SCREEN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
4300064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| 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: 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 CHIP/Family Health Plus/Medicaid |
$5.61
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
ANTIBODY SCREEN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
4300064
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
ANTICARDIOLIPIN AB IGM QN
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
4300067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Galaxy Health Commercial |
$92.95
|
|
|
ANTICARDIOLIPIN AB IGM QN
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
4300067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Aetna of NY Commercial |
$92.95
|
| Rate for Payer: Aetna of NY Medicare |
$65.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$71.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: CDPHP Commercial |
$115.12
|
| Rate for Payer: CDPHP Medicare |
$52.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$114.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.40
|
| Rate for Payer: EmblemHealth Medicaid |
$114.40
|
| Rate for Payer: EmblemHealth Medicare |
$48.62
|
| Rate for Payer: EmblemHealth Select Care |
$85.80
|
| Rate for Payer: Fidelis Medicare |
$54.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.91
|
| Rate for Payer: Humana Medicare |
$52.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$92.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$107.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$107.25
|
| Rate for Payer: United Healthcare Medicare |
$52.91
|
| Rate for Payer: WellCare Medicare |
$78.65
|
|
|
ANTI-DNA ANTIBODY DBLE S
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
4300072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna of NY Commercial |
$51.35
|
| Rate for Payer: Aetna of NY Medicare |
$36.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: CDPHP Commercial |
$63.60
|
| Rate for Payer: CDPHP Medicare |
$29.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
| Rate for Payer: EmblemHealth Medicaid |
$63.20
|
| Rate for Payer: EmblemHealth Medicare |
$26.86
|
| Rate for Payer: EmblemHealth Select Care |
$47.40
|
| Rate for Payer: Fidelis Medicare |
$30.11
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$59.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$59.25
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
ANTI-DNA ANTIBODY DBLE S
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
4300072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
IP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of NY Commercial |
$30.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.57
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Galaxy Health Commercial |
$35.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.02
|
| Rate for Payer: WellCare Medicare |
$30.02
|
|
