|
URINALYSIS (NO MICROSCOPE)
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
4300812
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
URINALYSIS (NO MICROSCOPE)
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
4300812
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$11.40
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
URINE COLLECTION FEE
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
4304865
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
|
|
URINE COLLECTION FEE
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
4304865
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
URINE CULTURE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
URINE CULTURE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$19.20
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
URINE CULTURE ID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
URINE CULTURE ID
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$19.20
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
URINE PHOSPHATE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
4300628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
URINE PHOSPHATE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
4300628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
URINE TOTAL PROTEIN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
4300665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
URINE TOTAL PROTEIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
4300665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Commercial |
$31.40
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$14.86
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.43
|
| Rate for Payer: Humana Medicare |
$14.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
URSODIOL 300 MG
|
Facility
|
IP
|
$23.69
|
|
|
Service Code
|
NDC 51079038320
|
| Hospital Charge Code |
4409057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
| Rate for Payer: WellCare Medicare |
$13.03
|
|
|
URSODIOL 300 MG
|
Facility
|
OP
|
$23.69
|
|
|
Service Code
|
NDC 51079038320
|
| Hospital Charge Code |
4409057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Aetna of NY Commercial |
$16.58
|
| Rate for Payer: Aetna of NY Medicare |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.84
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: CDPHP Commercial |
$19.07
|
| Rate for Payer: CDPHP Medicare |
$8.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.95
|
| Rate for Payer: EmblemHealth Medicaid |
$18.95
|
| Rate for Payer: EmblemHealth Medicare |
$8.05
|
| Rate for Payer: EmblemHealth Select Care |
$17.06
|
| Rate for Payer: Fidelis Medicare |
$9.03
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.77
|
| Rate for Payer: Humana Medicare |
$8.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.20
|
| Rate for Payer: United Healthcare Medicare |
$8.77
|
| Rate for Payer: WellCare Medicare |
$13.03
|
|
|
ursodioL 300 MG CAPSULE 300 unit, 100 eaches
|
Facility
|
IP
|
$62.84
|
|
|
Service Code
|
NDC 69238154001
|
| Hospital Charge Code |
4401460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Cash Price |
$47.13
|
| Rate for Payer: Galaxy Health Commercial |
$40.85
|
| Rate for Payer: WellCare Medicare |
$34.56
|
|
|
ursodioL 300 MG CAPSULE 300 unit, 100 eaches
|
Facility
|
OP
|
$62.84
|
|
|
Service Code
|
NDC 69238154001
|
| Hospital Charge Code |
4401460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna of NY Commercial |
$43.99
|
| Rate for Payer: Aetna of NY Medicare |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.42
|
| Rate for Payer: Cash Price |
$47.13
|
| Rate for Payer: CDPHP Commercial |
$50.59
|
| Rate for Payer: CDPHP Medicare |
$23.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.27
|
| Rate for Payer: EmblemHealth Medicaid |
$50.27
|
| Rate for Payer: EmblemHealth Medicare |
$21.37
|
| Rate for Payer: EmblemHealth Select Care |
$45.24
|
| Rate for Payer: Fidelis Medicare |
$23.95
|
| Rate for Payer: Galaxy Health Commercial |
$40.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.25
|
| Rate for Payer: Humana Medicare |
$23.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$43.99
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.41
|
| Rate for Payer: United Healthcare Medicare |
$23.25
|
| Rate for Payer: WellCare Medicare |
$34.56
|
|
|
US ABDOMEN DUPLEX
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
4201040
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.18 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: EmblemHealth Select Care |
$455.65
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
US ABDOMEN DUPLEX
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
4201040
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
US ABDOMEN DUPLEX LIMITED
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
4201041
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US ABDOMEN DUPLEX LIMITED
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
4201041
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of NY Commercial |
$204.75
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$204.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.58
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US ABDOMEN LIMITED
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna of NY Commercial |
$420.00
|
| Rate for Payer: Aetna of NY Medicare |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$222.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: CDPHP Commercial |
$483.00
|
| Rate for Payer: CDPHP Medicare |
$222.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$420.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$480.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$480.00
|
| Rate for Payer: EmblemHealth Medicaid |
$480.00
|
| Rate for Payer: EmblemHealth Medicare |
$204.00
|
| Rate for Payer: EmblemHealth Select Care |
$390.00
|
| Rate for Payer: Fidelis Medicare |
$228.66
|
| Rate for Payer: Galaxy Health Commercial |
$390.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$222.00
|
| Rate for Payer: Humana Medicare |
$222.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$420.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$276.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$337.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$233.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$222.00
|
| Rate for Payer: WellCare Medicare |
$330.00
|
|
|
US ABDOMEN LIMITED
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Galaxy Health Commercial |
$390.00
|
|
|
US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Hospital Charge Code |
4201050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| 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 |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Hospital Charge Code |
4201050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 76700 TC
|
| Hospital Charge Code |
4200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Galaxy Health Commercial |
$390.00
|
|
