|
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 |
$8.55 |
| Max. Negotiated Rate |
$45.60 |
| 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) Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$42.75
|
| 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 |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| 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 |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
4302018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$22.20
|
| Rate for Payer: Fidelis Medicare |
$14.80
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.55
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
4302018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
ANTIBODY; RICKETTSIA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
4302009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$54.40 |
| 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) Medicare |
$27.20
|
| Rate for Payer: Cash Price |
$51.00
|
| 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 |
$27.20
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.20
|
| Rate for Payer: Humana Medicare |
$27.20
|
| 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 |
$28.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$51.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Medicare |
$27.20
|
| 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
|
$160.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
4300064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$104.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$96.00
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
ANTIBODY SCREEN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
4300064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
ANTIBODY TREPONEMA PALLIDUM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
4302035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
ANTIBODY TREPONEMA PALLIDUM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
4302035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
4302030
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
4302030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| 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) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| 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 |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| 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 |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
ANTICARDIOLIPIN AB IGM QN
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
4300067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of NY Commercial |
$49.40
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: EmblemHealth Select Care |
$45.60
|
| Rate for Payer: Fidelis Medicare |
$30.40
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.40
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.40
|
| Rate for Payer: United Healthcare Commercial |
$57.00
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
ANTICARDIOLIPIN AB IGM QN
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
4300067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
|
|
ANTI-DNA ANTIBODY DBLE S
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
4300072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$16.40
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.40
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.15
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
ANTI-DNA ANTIBODY DBLE S
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
4300072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
IP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of NY Commercial |
$30.02
|
| 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
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
OP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$43.67 |
| Rate for Payer: Aetna of NY Medicare |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.84
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: CDPHP Medicare |
$20.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.67
|
| Rate for Payer: EmblemHealth Medicaid |
$43.67
|
| Rate for Payer: EmblemHealth Medicare |
$18.56
|
| Rate for Payer: EmblemHealth Select Care |
$39.30
|
| Rate for Payer: Fidelis Medicare |
$21.84
|
| Rate for Payer: Galaxy Health Commercial |
$35.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.84
|
| Rate for Payer: Humana Medicare |
$21.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.19
|
| Rate for Payer: United Healthcare Medicare |
$21.84
|
| Rate for Payer: WellCare Medicare |
$30.02
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
OP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$43.67 |
| Rate for Payer: Aetna of NY Medicare |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.84
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: CDPHP Medicare |
$20.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.67
|
| Rate for Payer: EmblemHealth Medicaid |
$43.67
|
| Rate for Payer: EmblemHealth Medicare |
$18.56
|
| Rate for Payer: EmblemHealth Select Care |
$39.30
|
| Rate for Payer: Fidelis Medicare |
$21.84
|
| Rate for Payer: Galaxy Health Commercial |
$35.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.84
|
| Rate for Payer: Humana Medicare |
$21.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.19
|
| Rate for Payer: United Healthcare Medicare |
$21.84
|
| Rate for Payer: WellCare Medicare |
$30.02
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
IP
|
$41.46
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4401273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of NY Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Galaxy Health Commercial |
$26.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.80
|
| Rate for Payer: WellCare Medicare |
$22.80
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
IP
|
$54.59
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4400659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of NY Commercial |
$30.02
|
| 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
|
|
|
ANTIEMETIC RECTAL/SUPP NOS
|
Facility
|
OP
|
$41.46
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
4401273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$33.17 |
| Rate for Payer: Aetna of NY Medicare |
$19.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.58
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: CDPHP Medicare |
$15.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.17
|
| Rate for Payer: EmblemHealth Medicaid |
$33.17
|
| Rate for Payer: EmblemHealth Medicare |
$14.10
|
| Rate for Payer: EmblemHealth Select Care |
$29.85
|
| Rate for Payer: Fidelis Medicare |
$16.58
|
| Rate for Payer: Galaxy Health Commercial |
$26.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.58
|
| Rate for Payer: Humana Medicare |
$16.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$16.58
|
| Rate for Payer: WellCare Medicare |
$22.80
|
|
|
ANTIFUNGAL 2% POWDER 1 ea, 71 g
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 70000032301
|
| Hospital Charge Code |
4401411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
ANTIFUNGAL 2% POWDER 1 ea, 71 g
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 70000032301
|
| Hospital Charge Code |
4401411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: EmblemHealth Select Care |
$15.12
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
ANTIHEMOPHILIC FACTOR
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
4300081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
ANTIHEMOPHILIC FACTOR
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
4300081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
