|
DRAIN POUCH (COLOSTOMY SUPPLY
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
4479197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.48
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
DRAW BLOOD OFF VENOUS DEVICE
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
4602218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4853016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
4609666
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
DRESSING ADHESIVE ISLAND NON-ADH PAD STE
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
4478188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
DR EXT EAR ABSCESS/HEMATOMA; SIMPLE
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
4602217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
DRILL BIT, JACOBS CHUCK
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
4472237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$503.12 |
| Rate for Payer: Aetna of NY Commercial |
$437.50
|
| Rate for Payer: Aetna of NY Medicare |
$287.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$468.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$468.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$231.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$312.50
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: CDPHP Commercial |
$503.12
|
| Rate for Payer: CDPHP Medicare |
$231.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$500.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$500.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.00
|
| Rate for Payer: EmblemHealth Medicaid |
$500.00
|
| Rate for Payer: EmblemHealth Medicare |
$212.50
|
| Rate for Payer: EmblemHealth Select Care |
$450.00
|
| Rate for Payer: Fidelis Medicare |
$238.19
|
| Rate for Payer: Galaxy Health Commercial |
$406.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$231.25
|
| Rate for Payer: Humana Medicare |
$231.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$437.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$287.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$351.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$242.81
|
| Rate for Payer: United Healthcare Medicare |
$231.25
|
| Rate for Payer: WellCare Medicare |
$343.75
|
|
|
DRILL FOR 4.3MM SCREW
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
4471369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Commercial |
$136.85
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: EmblemHealth Select Care |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$64.79
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.90
|
| Rate for Payer: Humana Medicare |
$62.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.04
|
| Rate for Payer: United Healthcare Medicare |
$62.90
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
DRONEDARONE 400MG TABS 10X10EA
|
Facility
OP
|
$35.02
|
|
| Hospital Charge Code |
4400530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna of NY Commercial |
$24.51
|
| Rate for Payer: Aetna of NY Medicare |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.51
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: CDPHP Commercial |
$28.19
|
| Rate for Payer: CDPHP Medicare |
$12.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.02
|
| Rate for Payer: EmblemHealth Medicaid |
$28.02
|
| Rate for Payer: EmblemHealth Medicare |
$11.91
|
| Rate for Payer: EmblemHealth Select Care |
$25.21
|
| Rate for Payer: Fidelis Medicare |
$13.35
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.96
|
| Rate for Payer: Humana Medicare |
$12.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.61
|
| Rate for Payer: United Healthcare Medicare |
$12.96
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
DRUG SCREEN
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4300278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$4,772.00 |
| Rate for Payer: Aetna of NY Commercial |
$146.25
|
| Rate for Payer: Aetna of NY Medicare |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.72
|
| Rate for Payer: CDPHP Commercial |
$181.12
|
| Rate for Payer: CDPHP Essential Plan |
$107.37
|
| Rate for Payer: CDPHP Medicare |
$83.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.72
|
| Rate for Payer: EmblemHealth Medicaid |
$47.72
|
| Rate for Payer: EmblemHealth Medicare |
$76.50
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$107.37
|
| Rate for Payer: Fidelis Medicare |
$85.75
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,772.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.25
|
| Rate for Payer: Humana Medicare |
$83.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,772.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$168.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.72
|
| Rate for Payer: United Healthcare Commercial |
$168.75
|
| Rate for Payer: United Healthcare Medicare |
$83.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
DRUG SCREEN QUANTITATIVE PHENOBARBITAL
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
4300082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$33.15
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| 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: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.15
|
| 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 |
$19.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
DRUG SCREEN QUANTITATIVE ZONISAMIDE
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
4302017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna of NY Commercial |
$30.55
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.50
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Commercial |
$37.84
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: Fidelis Medicare |
$17.91
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.39
|
| Rate for Payer: Humana Medicare |
$17.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$35.25
|
| Rate for Payer: United Healthcare Medicare |
$17.39
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
DRUG SCRN QUANT OXCARBAZEPIN
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
4302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$48.30 |
| Rate for Payer: Aetna of NY Commercial |
$39.00
|
| Rate for Payer: Aetna of NY Medicare |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: CDPHP Commercial |
$48.30
|
| Rate for Payer: CDPHP Medicare |
$22.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.00
|
| Rate for Payer: EmblemHealth Medicaid |
$48.00
|
| Rate for Payer: EmblemHealth Medicare |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$22.87
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.20
|
| Rate for Payer: Humana Medicare |
$22.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$45.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Medicare |
$22.20
|
| Rate for Payer: WellCare Medicare |
$33.00
|
|
|
DRUG TEST PRSMV CHEM ANLYZR
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4302000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$4,772.00 |
| Rate for Payer: Aetna of NY Commercial |
$146.25
|
| Rate for Payer: Aetna of NY Medicare |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.72
|
| Rate for Payer: CDPHP Commercial |
$181.12
|
| Rate for Payer: CDPHP Essential Plan |
$107.37
|
| Rate for Payer: CDPHP Medicare |
$83.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.72
|
| Rate for Payer: EmblemHealth Medicaid |
$47.72
|
| Rate for Payer: EmblemHealth Medicare |
$76.50
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$107.37
|
| Rate for Payer: Fidelis Medicare |
$85.75
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,772.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.25
|
| Rate for Payer: Humana Medicare |
$83.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,772.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$168.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.72
|
| Rate for Payer: United Healthcare Commercial |
$168.75
|
| Rate for Payer: United Healthcare Medicare |
$83.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
4301999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$1,092.00 |
| 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) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$10.92
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Essential Plan |
$24.57
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
| Rate for Payer: EmblemHealth Medicaid |
$10.92
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$24.57
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,092.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| 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 Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,092.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$23.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$23.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.92
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.47
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
DSTRJ LESION PENIS EXTENSIVE
|
Facility
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
4002046
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: Multiplan Commercial |
$4,174.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
|
DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Facility
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
4002045
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: Multiplan Commercial |
$4,174.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
|
DUAL SPRAY FOR GPS III
|
Facility
OP
|
$157.00
|
|
| Hospital Charge Code |
4471610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$126.38 |
| Rate for Payer: Aetna of NY Commercial |
$109.90
|
| Rate for Payer: Aetna of NY Medicare |
$72.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$78.50
|
| Rate for Payer: Cash Price |
$117.75
|
| Rate for Payer: CDPHP Commercial |
$126.38
|
| Rate for Payer: CDPHP Medicare |
$58.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$125.60
|
| Rate for Payer: EmblemHealth Medicare |
$53.38
|
| Rate for Payer: EmblemHealth Select Care |
$113.04
|
| Rate for Payer: Fidelis Medicare |
$59.83
|
| Rate for Payer: Galaxy Health Commercial |
$102.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.09
|
| Rate for Payer: Humana Medicare |
$58.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.99
|
| Rate for Payer: United Healthcare Medicare |
$58.09
|
| Rate for Payer: WellCare Medicare |
$86.35
|
|
|
DUDERM 4X4 CGF DRESSING
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
4479234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
DULOXETINE HCL 30MG CAPS 100 EA
|
Facility
OP
|
$27.04
|
|
| Hospital Charge Code |
4400204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna of NY Commercial |
$18.93
|
| Rate for Payer: Aetna of NY Medicare |
$12.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.52
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: CDPHP Commercial |
$21.77
|
| Rate for Payer: CDPHP Medicare |
$10.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.63
|
| Rate for Payer: EmblemHealth Medicaid |
$21.63
|
| Rate for Payer: EmblemHealth Medicare |
$9.19
|
| Rate for Payer: EmblemHealth Select Care |
$19.47
|
| Rate for Payer: Fidelis Medicare |
$10.30
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$10.00
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
DUODERM CGF BORDER
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
4479233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
DUPLEX A IVC IL/BPG; UNIL/LIM
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
4200027
|
|
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 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: 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
|
|
|
DUPLEX ARTERIAL FLOW; COMPL
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4480082
|
|
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 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: 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
|
|
|
DUPLEX ARTERIAL FLOW; LIMITED
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
4201025
|
|
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 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: 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
|
|
|
DUPLEX EXT VEINS; BILAT
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
4200022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.08 |
| 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 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: 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 |
$109.08
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
