|
TUMOR LOCALIZED SPECT
|
Facility
|
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
4211235
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.15 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$2,844.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,868.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,503.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,031.50
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: CDPHP Commercial |
$3,270.72
|
| Rate for Payer: CDPHP Medicare |
$1,503.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,844.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,381.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,640.95
|
| Rate for Payer: Fidelis Medicare |
$1,548.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,503.31
|
| Rate for Payer: Humana Medicare |
$1,503.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,844.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,868.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,047.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,287.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,578.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.15
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
TUMOR LOCALIZED SPECT
|
Facility
|
IP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
4211235
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,640.95 |
| Max. Negotiated Rate |
$2,640.95 |
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
|
|
TUNNELING TOOL
|
Facility
|
IP
|
$978.00
|
|
| Hospital Charge Code |
4479096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.70 |
| Max. Negotiated Rate |
$635.70 |
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Galaxy Health Commercial |
$635.70
|
|
|
TUNNELING TOOL
|
Facility
|
OP
|
$978.00
|
|
| Hospital Charge Code |
4479096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.52 |
| Max. Negotiated Rate |
$787.29 |
| Rate for Payer: Aetna of NY Commercial |
$684.60
|
| Rate for Payer: Aetna of NY Medicare |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$733.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$733.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$361.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$489.00
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: CDPHP Commercial |
$787.29
|
| Rate for Payer: CDPHP Medicare |
$361.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$782.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$782.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$782.40
|
| Rate for Payer: EmblemHealth Medicaid |
$782.40
|
| Rate for Payer: EmblemHealth Medicare |
$332.52
|
| Rate for Payer: EmblemHealth Select Care |
$704.16
|
| Rate for Payer: Fidelis Medicare |
$372.72
|
| Rate for Payer: Galaxy Health Commercial |
$635.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$361.86
|
| Rate for Payer: Humana Medicare |
$361.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$684.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$449.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$733.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$550.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$379.95
|
| Rate for Payer: United Healthcare Medicare |
$361.86
|
| Rate for Payer: WellCare Medicare |
$537.90
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
4450108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$45.26 |
| Max. Negotiated Rate |
$400.55 |
| Rate for Payer: Aetna of NY Commercial |
$105.00
|
| Rate for Payer: Aetna of NY Medicare |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$55.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$75.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: CDPHP Commercial |
$120.75
|
| Rate for Payer: CDPHP Medicare |
$55.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$120.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.00
|
| Rate for Payer: EmblemHealth Medicaid |
$120.00
|
| Rate for Payer: EmblemHealth Medicare |
$51.00
|
| Rate for Payer: EmblemHealth Select Care |
$108.00
|
| Rate for Payer: Fidelis Medicare |
$57.16
|
| Rate for Payer: Galaxy Health Commercial |
$97.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$55.50
|
| Rate for Payer: Humana Medicare |
$55.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$69.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$84.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$112.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.26
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Medicare |
$55.50
|
| Rate for Payer: WellCare Medicare |
$82.50
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
4450108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Galaxy Health Commercial |
$97.50
|
|
|
TX/PROPH/DG ADDL
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4451250
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$400.55 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$161.60
|
| Rate for Payer: EmblemHealth Medicaid |
$161.60
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$151.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
TX/PROPH/DG ADDL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4451250
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
4670260
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
4670260
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59
|
| Hospital Charge Code |
4670298
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59
|
| Hospital Charge Code |
4670298
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59 W KX)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59,KX
|
| Hospital Charge Code |
4670314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (MOD 59 W KX)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,59,KX
|
| Hospital Charge Code |
4670314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (W/ KX)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,KX
|
| Hospital Charge Code |
4670276
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: CDPHP Commercial |
$68.42
|
| Rate for Payer: CDPHP Medicare |
$31.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.00
|
| Rate for Payer: EmblemHealth Medicaid |
$68.00
|
| Rate for Payer: EmblemHealth Medicare |
$28.90
|
| Rate for Payer: EmblemHealth Select Care |
$61.20
|
| Rate for Payer: Fidelis Medicare |
$32.39
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.45
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.10
|
| 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 |
$33.02
|
| 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 |
$31.45
|
| Rate for Payer: WellCare Medicare |
$46.75
|
|
|
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV (W/ KX)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 92508 GN,KX
|
| Hospital Charge Code |
4670276
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Galaxy Health Commercial |
$55.25
|
|
|
TX TARSAL BONE FX; W MANIP
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
4850163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: EmblemHealth Select Care |
$3,311.28
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
TX TARSAL BONE FX; W MANIP
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
4850163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,989.35 |
| Max. Negotiated Rate |
$2,989.35 |
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
|
|
TYLENOL (APAP) EXTRA STRENGTH 500MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
4401278
|
|
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
|
|
|
TYLENOL (APAP) EXTRA STRENGTH 500MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
4401278
|
|
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
|
|
|
UGI W BX. SGL/MULTIPLE
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
4851925
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,686.10 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
|
|
UGI W BX. SGL/MULTIPLE
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
4851925
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$863.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,193.24
|
| 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 |
$959.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: CDPHP Commercial |
$2,088.17
|
| Rate for Payer: CDPHP Medicare |
$959.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$881.96
|
| Rate for Payer: EmblemHealth Select Care |
$1,867.68
|
| Rate for Payer: Fidelis Medicare |
$988.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$959.78
|
| Rate for Payer: Humana Medicare |
$959.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,193.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,945.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,460.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,007.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$959.78
|
| Rate for Payer: WellCare Medicare |
$1,426.70
|
|
|
ULTRASONIC GUIDANCE, INTRAOPERATIVE
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 76998
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.95
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Hospital Charge Code |
4201086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
|
|
ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Hospital Charge Code |
4201086
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$161.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$115.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: CDPHP Commercial |
$185.15
|
| Rate for Payer: CDPHP Medicare |
$85.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.00
|
| Rate for Payer: EmblemHealth Medicaid |
$184.00
|
| Rate for Payer: EmblemHealth Medicare |
$78.20
|
| Rate for Payer: EmblemHealth Select Care |
$149.50
|
| Rate for Payer: Fidelis Medicare |
$87.65
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.10
|
| Rate for Payer: Humana Medicare |
$85.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$129.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$85.10
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
