|
T3 FREE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
4300755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
T3 UPTAKE
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
4300754
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T3 UPTAKE
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
4300754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$15.20 |
| 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) Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$14.25
|
| 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 |
$7.60
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.60
|
| Rate for Payer: Humana Medicare |
$7.60
|
| 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 |
$7.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.85
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.60
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
T4 (THYROXINE)
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
4300756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
T4 (THYROXINE)
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
4300756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$13.65
|
| 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 |
$12.60
|
| 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 |
$12.60
|
| 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 |
$13.65
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$15.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Commercial |
$15.75
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
tacrolimus 0.5 MG CAPSULE 0.5 mg, 100 eaches
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.80
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Fidelis Medicare |
$2.80
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.80
|
| Rate for Payer: Humana Medicare |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$2.80
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
tacrolimus 0.5 MG CAPSULE 0.5 mg, 100 eaches
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna of NY Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.85
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
tacrolimus 1 MG CAPSULE (IR) 1 mg, 100 eaches
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Fidelis Medicare |
$19.20
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.20
|
| Rate for Payer: Humana Medicare |
$19.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.20
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$19.20
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
tacrolimus 1 MG CAPSULE (IR) 1 mg, 100 eaches
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.40
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
TACROLIMUS-BLOOD
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
4300760
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TACROLIMUS-BLOOD
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
4300760
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TAMIFLU 30 MG CAPSULE 30 mg, 10 eaches
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 4080285
|
| Hospital Charge Code |
4401311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
TAMIFLU 30 MG CAPSULE 30 mg, 10 eaches
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 4080285
|
| Hospital Charge Code |
4401311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
TAMOXIFEN 20 MG TABLET 20 mg, 30 eaches
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4401418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
TAMOXIFEN 20 MG TABLET 20 mg, 30 eaches
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4401418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.80
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.80
|
| Rate for Payer: Humana Medicare |
$4.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
TAMSULOSIN HCL 0.4MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
4400746
|
|
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
|
|
|
TAMSULOSIN HCL 0.4MG CAPS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
4400746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
4853026
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
4853026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| 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 |
$128.00
|
| 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 |
$115.20
|
| 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 |
$112.00
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
4853025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
4853025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$996.80 |
| Rate for Payer: Aetna of NY Commercial |
$872.20
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$897.12
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$872.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$934.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$701.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$523.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
TARGET CATH ACCESSORIES KI
|
Facility
|
OP
|
$95.79
|
|
| Hospital Charge Code |
4472107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Aetna of NY Commercial |
$67.05
|
| Rate for Payer: Aetna of NY Medicare |
$44.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.32
|
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: CDPHP Medicare |
$35.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$76.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$76.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$76.63
|
| Rate for Payer: EmblemHealth Medicaid |
$76.63
|
| Rate for Payer: EmblemHealth Medicare |
$32.57
|
| Rate for Payer: EmblemHealth Select Care |
$68.97
|
| Rate for Payer: Fidelis Medicare |
$38.32
|
| Rate for Payer: Galaxy Health Commercial |
$62.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.32
|
| Rate for Payer: Humana Medicare |
$38.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$67.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$38.32
|
| Rate for Payer: WellCare Medicare |
$52.68
|
|
|
TARGET CATH ACCESSORIES KI
|
Facility
|
IP
|
$95.79
|
|
| Hospital Charge Code |
4472107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.26 |
| Max. Negotiated Rate |
$62.26 |
| Rate for Payer: Cash Price |
$71.84
|
| Rate for Payer: Galaxy Health Commercial |
$62.26
|
|
|
TB TEST CELL IMMUN MEASURE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
4304879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
|
|
TB TEST CELL IMMUN MEASURE
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
4304879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Aetna of NY Commercial |
$120.90
|
| Rate for Payer: Aetna of NY Medicare |
$85.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.40
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: CDPHP Medicare |
$68.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$111.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.47
|
| Rate for Payer: EmblemHealth Medicaid |
$70.47
|
| Rate for Payer: EmblemHealth Medicare |
$63.24
|
| Rate for Payer: EmblemHealth Select Care |
$111.60
|
| Rate for Payer: Fidelis Medicare |
$74.40
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
| Rate for Payer: Galaxy Health Workers Comp |
$69.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$70.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.40
|
| Rate for Payer: Humana Medicare |
$74.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$73.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$139.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
| Rate for Payer: United Healthcare Medicare |
$74.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$73.99
|
| Rate for Payer: WellCare Medicare |
$102.30
|
|
