|
TRIPLE LUMEN TRAY
|
Facility
|
IP
|
$377.00
|
|
| Hospital Charge Code |
4471822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Aetna of NY Commercial |
$263.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$169.65
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$188.50
|
| Rate for Payer: EmblemHealth Select Care |
$188.50
|
| Rate for Payer: Galaxy Health Commercial |
$245.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$169.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.05
|
| Rate for Payer: WellCare Medicare |
$207.35
|
|
|
TROCAR BALLOON KIT
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
4479184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$278.53 |
| Rate for Payer: Aetna of NY Commercial |
$242.20
|
| Rate for Payer: Aetna of NY Medicare |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$173.00
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: CDPHP Commercial |
$278.53
|
| Rate for Payer: CDPHP Medicare |
$128.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$276.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.80
|
| Rate for Payer: EmblemHealth Medicaid |
$276.80
|
| Rate for Payer: EmblemHealth Medicare |
$117.64
|
| Rate for Payer: EmblemHealth Select Care |
$249.12
|
| Rate for Payer: Fidelis Medicare |
$131.86
|
| Rate for Payer: Galaxy Health Commercial |
$224.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.02
|
| Rate for Payer: Humana Medicare |
$128.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$242.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$159.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$259.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.42
|
| Rate for Payer: United Healthcare Medicare |
$128.02
|
| Rate for Payer: WellCare Medicare |
$190.30
|
|
|
TROCAR BALLOON KIT
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
4479184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.90 |
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Galaxy Health Commercial |
$224.90
|
|
|
TROCAR ENDO BLUNT 12MM THREA
|
Facility
|
IP
|
$767.00
|
|
| Hospital Charge Code |
4471761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.55 |
| Max. Negotiated Rate |
$498.55 |
| Rate for Payer: Cash Price |
$575.25
|
| Rate for Payer: Galaxy Health Commercial |
$498.55
|
|
|
TROCAR ENDO BLUNT 12MM THREA
|
Facility
|
OP
|
$767.00
|
|
| Hospital Charge Code |
4471761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$617.44 |
| Rate for Payer: Aetna of NY Commercial |
$536.90
|
| Rate for Payer: Aetna of NY Medicare |
$352.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$575.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$575.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$283.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$383.50
|
| Rate for Payer: Cash Price |
$575.25
|
| Rate for Payer: CDPHP Commercial |
$617.44
|
| Rate for Payer: CDPHP Medicare |
$283.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$613.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$613.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$613.60
|
| Rate for Payer: EmblemHealth Medicaid |
$613.60
|
| Rate for Payer: EmblemHealth Medicare |
$260.78
|
| Rate for Payer: EmblemHealth Select Care |
$552.24
|
| Rate for Payer: Fidelis Medicare |
$292.30
|
| Rate for Payer: Galaxy Health Commercial |
$498.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$283.79
|
| Rate for Payer: Humana Medicare |
$283.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$536.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$575.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$297.98
|
| Rate for Payer: United Healthcare Medicare |
$283.79
|
| Rate for Payer: WellCare Medicare |
$421.85
|
|
|
TROPONIN QUAN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
4300798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$97.40 |
| Rate for Payer: Aetna of NY Commercial |
$78.65
|
| Rate for Payer: Aetna of NY Medicare |
$55.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$60.50
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: CDPHP Commercial |
$97.40
|
| Rate for Payer: CDPHP Medicare |
$44.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$96.80
|
| Rate for Payer: EmblemHealth Medicaid |
$96.80
|
| Rate for Payer: EmblemHealth Medicare |
$41.14
|
| Rate for Payer: EmblemHealth Select Care |
$72.60
|
| Rate for Payer: Fidelis Medicare |
$46.11
|
| Rate for Payer: Galaxy Health Commercial |
$78.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.77
|
| Rate for Payer: Humana Medicare |
$44.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$78.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$55.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$90.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.13
|
| Rate for Payer: United Healthcare Commercial |
$90.75
|
| Rate for Payer: United Healthcare Medicare |
$44.77
|
| Rate for Payer: WellCare Medicare |
$66.55
|
|
|
TROPONIN QUAN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
4300798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Galaxy Health Commercial |
$78.65
|
|
|
TRULICITY 1.5 MG/0.5 ML PEN 0.5 ML, 0.5 ML
|
Facility
|
OP
|
$718.00
|
|
| Hospital Charge Code |
4404330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$577.99 |
| Rate for Payer: Aetna of NY Commercial |
$502.60
|
| Rate for Payer: Aetna of NY Medicare |
$330.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$538.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$538.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$265.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$359.00
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: CDPHP Commercial |
$577.99
|
| Rate for Payer: CDPHP Medicare |
$265.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$574.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$574.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$574.40
|
| Rate for Payer: EmblemHealth Medicaid |
$574.40
|
| Rate for Payer: EmblemHealth Medicare |
$244.12
|
| Rate for Payer: EmblemHealth Select Care |
$516.96
|
| Rate for Payer: Fidelis Medicare |
$273.63
|
| Rate for Payer: Galaxy Health Commercial |
$466.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$265.66
|
| Rate for Payer: Humana Medicare |
$265.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$502.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$330.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$404.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$278.94
|
| Rate for Payer: United Healthcare Medicare |
$265.66
|
| Rate for Payer: WellCare Medicare |
$394.90
|
|
|
TRULICITY 1.5 MG/0.5 ML PEN 0.5 ML, 0.5 ML
|
Facility
|
IP
|
$718.00
|
|
| Hospital Charge Code |
4404330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$394.90 |
| Max. Negotiated Rate |
$466.70 |
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Galaxy Health Commercial |
$466.70
|
| Rate for Payer: WellCare Medicare |
$394.90
|
|
|
TRUVADA 200/300 TABLET
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
4401290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna of NY Commercial |
$140.70
|
| Rate for Payer: Aetna of NY Medicare |
$92.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.50
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: CDPHP Commercial |
$161.80
|
| Rate for Payer: CDPHP Medicare |
$74.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.80
|
| Rate for Payer: EmblemHealth Medicaid |
$160.80
|
| Rate for Payer: EmblemHealth Medicare |
$68.34
|
| Rate for Payer: EmblemHealth Select Care |
$144.72
|
| Rate for Payer: Fidelis Medicare |
$76.60
|
| Rate for Payer: Galaxy Health Commercial |
$130.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.37
|
| Rate for Payer: Humana Medicare |
$74.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$140.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.09
|
| Rate for Payer: United Healthcare Medicare |
$74.37
|
| Rate for Payer: WellCare Medicare |
$110.55
|
|
|
TRUVADA 200/300 TABLET
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
4401290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$130.65 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Galaxy Health Commercial |
$130.65
|
| Rate for Payer: WellCare Medicare |
$110.55
|
|
|
TTE CONG ABN; LIMITED/F-UP
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4480110
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,026.35
|
| Rate for Payer: Aetna of NY Medicare |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,184.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$584.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$789.50
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: CDPHP Commercial |
$1,271.10
|
| Rate for Payer: CDPHP Medicare |
$584.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,105.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,263.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,263.20
|
| Rate for Payer: EmblemHealth Medicare |
$536.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,026.35
|
| Rate for Payer: Fidelis Medicare |
$601.76
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$584.23
|
| Rate for Payer: Humana Medicare |
$584.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,026.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$726.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,184.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$888.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$613.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,184.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,184.25
|
| Rate for Payer: United Healthcare Medicare |
$584.23
|
| Rate for Payer: WellCare Medicare |
$868.45
|
|
|
TTE CONG ABN; LIMITED/F-UP
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4480110
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Cash Price |
$1,184.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,026.35
|
|
|
TTE W OR WO FOL WCON DOPPLER
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8929 TC
|
| Hospital Charge Code |
4480106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$778.94 |
| Max. Negotiated Rate |
$1,844.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,603.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,603.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,489.15
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,603.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,289.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$890.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,718.25
|
| Rate for Payer: United Healthcare Commercial |
$1,718.25
|
| Rate for Payer: United Healthcare Medicare |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
|
TTE W OR WO FOL WCON DOPPLER
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8929 TC
|
| Hospital Charge Code |
4480106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,489.15 |
| Max. Negotiated Rate |
$1,489.15 |
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
|
|
TTE W OR W/O FOL W/CONT COM
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
4480103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,489.15 |
| Max. Negotiated Rate |
$1,489.15 |
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
|
|
TTE W OR W/O FOL W/CONT COM
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
4480103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$762.88 |
| Max. Negotiated Rate |
$1,844.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,603.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,603.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,489.15
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,603.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,289.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$890.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,718.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$762.88
|
| Rate for Payer: United Healthcare Commercial |
$1,718.25
|
| Rate for Payer: United Healthcare Medicare |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 42023010401
|
| Hospital Charge Code |
4400064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Galaxy Health Commercial |
$14.90
|
| Rate for Payer: WellCare Medicare |
$12.61
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
|
OP
|
$17.77
|
|
|
Service Code
|
NDC 42023010405
|
| Hospital Charge Code |
4400065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.44
|
| Rate for Payer: Aetna of NY Medicare |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.88
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: CDPHP Commercial |
$14.30
|
| Rate for Payer: CDPHP Medicare |
$6.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.22
|
| Rate for Payer: EmblemHealth Medicaid |
$14.22
|
| Rate for Payer: EmblemHealth Medicare |
$6.04
|
| Rate for Payer: EmblemHealth Select Care |
$12.79
|
| Rate for Payer: Fidelis Medicare |
$6.77
|
| Rate for Payer: Galaxy Health Commercial |
$11.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.57
|
| Rate for Payer: Humana Medicare |
$6.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.33
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.90
|
| Rate for Payer: United Healthcare Medicare |
$6.57
|
| Rate for Payer: WellCare Medicare |
$9.77
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 42023010401
|
| Hospital Charge Code |
4400064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna of NY Commercial |
$16.04
|
| Rate for Payer: Aetna of NY Medicare |
$10.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.46
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: CDPHP Commercial |
$18.45
|
| Rate for Payer: CDPHP Medicare |
$8.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.34
|
| Rate for Payer: EmblemHealth Medicaid |
$18.34
|
| Rate for Payer: EmblemHealth Medicare |
$7.79
|
| Rate for Payer: EmblemHealth Select Care |
$16.50
|
| Rate for Payer: Fidelis Medicare |
$8.73
|
| Rate for Payer: Galaxy Health Commercial |
$14.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.48
|
| Rate for Payer: Humana Medicare |
$8.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.19
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.90
|
| Rate for Payer: United Healthcare Medicare |
$8.48
|
| Rate for Payer: WellCare Medicare |
$12.61
|
|
|
TUBERCULIN PURIF PROT DERIV 5TU/0.1ML MD
|
Facility
|
IP
|
$17.77
|
|
|
Service Code
|
NDC 42023010405
|
| Hospital Charge Code |
4400065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Galaxy Health Commercial |
$11.55
|
| Rate for Payer: WellCare Medicare |
$9.77
|
|
|
TUBING FLOWTRON
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
4471654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$22.50
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
TUBING FLOWTRON
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
4471654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.50
|
| Rate for Payer: EmblemHealth Select Care |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.25
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
TUBING OXYGEN 7FT CRSH RESIS
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4472139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
TUBING OXYGEN 7FT CRSH RESIS
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4472139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
