|
TISSUE EXAM BY PATHOLOGIST LVL 6
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
HCPCS 88309 TC
|
| Hospital Charge Code |
4008309
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,604.85 |
| Max. Negotiated Rate |
$1,604.85 |
| Rate for Payer: Cash Price |
$1,851.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,604.85
|
|
|
TISSUE PATHOLOGY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4301113
|
|
Hospital Revenue Code
|
310
|
| 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
|
|
|
TISSUE PATHOLOGY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
4301113
|
|
Hospital Revenue Code
|
310
|
| 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
|
|
|
TITER EACH ANTIBODY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
4300083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
TITER EACH ANTIBODY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
4300083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
tiZANidine HCL 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 904641861
|
| Hospital Charge Code |
4401485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
tiZANidine HCL 4 MG TABLET 4 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 904641861
|
| Hospital Charge Code |
4401485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
TL201 THALLIUM PER 1 MCI
|
Facility
|
IP
|
$163.77
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
4210055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.45 |
| Max. Negotiated Rate |
$106.45 |
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: Galaxy Health Commercial |
$106.45
|
|
|
TL201 THALLIUM PER 1 MCI
|
Facility
|
OP
|
$163.77
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
4210055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$166.06 |
| Rate for Payer: Aetna of NY Medicare |
$75.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$65.51
|
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: CDPHP Medicare |
$60.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.02
|
| Rate for Payer: EmblemHealth Medicaid |
$131.02
|
| Rate for Payer: EmblemHealth Medicare |
$55.68
|
| Rate for Payer: EmblemHealth Select Care |
$117.91
|
| Rate for Payer: Fidelis Medicare |
$65.51
|
| Rate for Payer: Galaxy Health Commercial |
$106.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$65.51
|
| Rate for Payer: Humana Medicare |
$65.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$68.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$166.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.57
|
| Rate for Payer: United Healthcare Commercial |
$166.06
|
| Rate for Payer: United Healthcare Medicare |
$65.51
|
| Rate for Payer: WellCare Medicare |
$90.07
|
|
|
TOBRADEX OO
|
Facility
|
IP
|
$726.15
|
|
|
Service Code
|
NDC 65064835
|
| Hospital Charge Code |
4408998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Cash Price |
$544.61
|
| Rate for Payer: Galaxy Health Commercial |
$472.00
|
| Rate for Payer: WellCare Medicare |
$399.38
|
|
|
TOBRADEX OO
|
Facility
|
OP
|
$726.15
|
|
|
Service Code
|
NDC 65064835
|
| Hospital Charge Code |
4408998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$580.92 |
| Rate for Payer: Aetna of NY Commercial |
$508.31
|
| Rate for Payer: Aetna of NY Medicare |
$334.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.46
|
| Rate for Payer: Cash Price |
$544.61
|
| Rate for Payer: CDPHP Medicare |
$268.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.92
|
| Rate for Payer: EmblemHealth Medicaid |
$580.92
|
| Rate for Payer: EmblemHealth Medicare |
$246.89
|
| Rate for Payer: EmblemHealth Select Care |
$522.83
|
| Rate for Payer: Fidelis Medicare |
$290.46
|
| Rate for Payer: Galaxy Health Commercial |
$472.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.46
|
| Rate for Payer: Humana Medicare |
$290.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$508.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$334.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.92
|
| Rate for Payer: United Healthcare Medicare |
$290.46
|
| Rate for Payer: WellCare Medicare |
$399.38
|
|
|
TOBRAMYCIN/DEXAMETHASONE 0.3-0.1% DROP 5
|
Facility
|
IP
|
$80.86
|
|
|
Service Code
|
NDC 24208029505
|
| Hospital Charge Code |
4400763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.47 |
| Max. Negotiated Rate |
$52.56 |
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: Galaxy Health Commercial |
$52.56
|
| Rate for Payer: WellCare Medicare |
$44.47
|
|
|
TOBRAMYCIN/DEXAMETHASONE 0.3-0.1% DROP 5
|
Facility
|
OP
|
$80.86
|
|
|
Service Code
|
NDC 24208029505
|
| Hospital Charge Code |
4400763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna of NY Commercial |
$56.60
|
| Rate for Payer: Aetna of NY Medicare |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.34
|
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: CDPHP Medicare |
$29.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.69
|
| Rate for Payer: EmblemHealth Medicaid |
$64.69
|
| Rate for Payer: EmblemHealth Medicare |
$27.49
|
| Rate for Payer: EmblemHealth Select Care |
$58.22
|
| Rate for Payer: Fidelis Medicare |
$32.34
|
| Rate for Payer: Galaxy Health Commercial |
$52.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.34
|
| Rate for Payer: Humana Medicare |
$32.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.13
|
| Rate for Payer: United Healthcare Medicare |
$32.34
|
| Rate for Payer: WellCare Medicare |
$44.47
|
|
|
TOBRAMYCIN OS
|
Facility
|
IP
|
$45.06
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
4409000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Galaxy Health Commercial |
$29.29
|
| Rate for Payer: WellCare Medicare |
$24.78
|
|
|
TOBRAMYCIN OS
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
4409000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$36.05 |
| Rate for Payer: Aetna of NY Commercial |
$31.54
|
| Rate for Payer: Aetna of NY Medicare |
$20.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.02
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: CDPHP Medicare |
$16.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.05
|
| Rate for Payer: EmblemHealth Medicaid |
$36.05
|
| Rate for Payer: EmblemHealth Medicare |
$15.32
|
| Rate for Payer: EmblemHealth Select Care |
$32.44
|
| Rate for Payer: Fidelis Medicare |
$18.02
|
| Rate for Payer: Galaxy Health Commercial |
$29.29
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.02
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.76
|
| Rate for Payer: United Healthcare Medicare |
$18.02
|
| Rate for Payer: WellCare Medicare |
$24.78
|
|
|
TOBREX OO
|
Facility
|
OP
|
$714.05
|
|
|
Service Code
|
NDC 65064435
|
| Hospital Charge Code |
4408999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.11 |
| Max. Negotiated Rate |
$571.24 |
| Rate for Payer: Aetna of NY Commercial |
$499.83
|
| Rate for Payer: Aetna of NY Medicare |
$328.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$285.62
|
| Rate for Payer: Cash Price |
$535.54
|
| Rate for Payer: CDPHP Medicare |
$264.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$571.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$571.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$571.24
|
| Rate for Payer: EmblemHealth Medicaid |
$571.24
|
| Rate for Payer: EmblemHealth Medicare |
$242.78
|
| Rate for Payer: EmblemHealth Select Care |
$514.12
|
| Rate for Payer: Fidelis Medicare |
$285.62
|
| Rate for Payer: Galaxy Health Commercial |
$464.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$285.62
|
| Rate for Payer: Humana Medicare |
$285.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$499.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$328.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$535.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$402.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$299.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.11
|
| Rate for Payer: United Healthcare Medicare |
$285.62
|
| Rate for Payer: WellCare Medicare |
$392.73
|
|
|
TOBREX OO
|
Facility
|
IP
|
$714.05
|
|
|
Service Code
|
NDC 65064435
|
| Hospital Charge Code |
4408999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$392.73 |
| Max. Negotiated Rate |
$464.13 |
| Rate for Payer: Cash Price |
$535.54
|
| Rate for Payer: Galaxy Health Commercial |
$464.13
|
| Rate for Payer: WellCare Medicare |
$392.73
|
|
|
TOMOSYNTHESIS, MAMMO
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 TC
|
| Hospital Charge Code |
4150404
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
|
|
TOMOSYNTHESIS, MAMMO
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS G0279 26
|
| Hospital Charge Code |
5150404
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
|
|
TOMOSYNTHESIS, MAMMO
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 TC
|
| Hospital Charge Code |
4150404
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$135.80
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$77.60
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: EmblemHealth Select Care |
$126.10
|
| Rate for Payer: Fidelis Medicare |
$77.60
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$77.60
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.10
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
TOMOSYNTHESIS, MAMMO
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS G0279 26
|
| Hospital Charge Code |
5150404
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Aetna of NY Commercial |
$62.30
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: Fidelis Medicare |
$35.60
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.60
|
| Rate for Payer: Humana Medicare |
$35.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$35.60
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
TOMOSYNTHESIS, MAMMO, LEFT
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 LT,TC
|
| Hospital Charge Code |
4150410
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
|
|
TOMOSYNTHESIS, MAMMO, LEFT
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0279 LT,TC
|
| Hospital Charge Code |
4150410
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$135.80
|
| Rate for Payer: Aetna of NY Medicare |
$89.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$77.60
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: CDPHP Medicare |
$71.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.20
|
| Rate for Payer: EmblemHealth Medicaid |
$155.20
|
| Rate for Payer: EmblemHealth Medicare |
$65.96
|
| Rate for Payer: EmblemHealth Select Care |
$126.10
|
| Rate for Payer: Fidelis Medicare |
$77.60
|
| Rate for Payer: Galaxy Health Commercial |
$126.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$77.60
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$135.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.10
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: WellCare Medicare |
$106.70
|
|
|
TOMOSYNTHESIS, MAMMO, LEFT
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS G0279 26,LT
|
| Hospital Charge Code |
5150410
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
|
|
TOMOSYNTHESIS, MAMMO, LEFT
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS G0279 26,LT
|
| Hospital Charge Code |
5150410
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Aetna of NY Commercial |
$62.30
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: Fidelis Medicare |
$35.60
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.60
|
| Rate for Payer: Humana Medicare |
$35.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$35.60
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
