|
CREATININE CLEARANCE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
4300221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.89
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CREATININE SERUM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
4300222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
CREATININE SERUM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
4300222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
CREATININE URINE RANDOM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
4300223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
|
|
CREATININE URINE RANDOM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
4300223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna of NY Commercial |
$19.50
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Commercial |
$24.15
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$11.43
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.10
|
| Rate for Payer: Humana Medicare |
$11.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$22.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
CREON DR 24,000 UNIT CAPSULE 24000 unit, 100 eaches
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
4401547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Commercial |
$22.54
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$20.16
|
| Rate for Payer: Fidelis Medicare |
$10.67
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
| Rate for Payer: Humana Medicare |
$10.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
CREON DR 24,000 UNIT CAPSULE 24000 unit, 100 eaches
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
4401547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
CRESTOR 10 MG
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4401257
|
|
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
|
|
|
CRESTOR 10 MG
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4401257
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| 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) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| 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 |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| 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 |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CROSSFLOW INTEGRATED CASSETTE TUBING
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
4479238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$343.20 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Galaxy Health Commercial |
$343.20
|
|
|
CROSSFLOW INTEGRATED CASSETTE TUBING
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
4479238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$425.04 |
| Rate for Payer: Aetna of NY Commercial |
$369.60
|
| Rate for Payer: Aetna of NY Medicare |
$242.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$195.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$264.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: CDPHP Commercial |
$425.04
|
| Rate for Payer: CDPHP Medicare |
$195.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$422.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$422.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$422.40
|
| Rate for Payer: EmblemHealth Medicaid |
$422.40
|
| Rate for Payer: EmblemHealth Medicare |
$179.52
|
| Rate for Payer: EmblemHealth Select Care |
$380.16
|
| Rate for Payer: Fidelis Medicare |
$201.22
|
| Rate for Payer: Galaxy Health Commercial |
$343.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$195.36
|
| Rate for Payer: Humana Medicare |
$195.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$369.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$242.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$297.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$205.13
|
| Rate for Payer: United Healthcare Medicare |
$195.36
|
| Rate for Payer: WellCare Medicare |
$290.40
|
|
|
CRUTCH ALUM PUSH BTN ADULT
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4471294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
CRUTCH ALUM PUSH BTN ADULT
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4471294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
CRUTCHES ANY SIZE
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
4472197
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
CRUTCHES ANY SIZE
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
4472197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| 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) 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: CDPHP Commercial |
$41.06
|
| 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 |
$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 |
$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 |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
CRUTCHES-S
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
4601186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
CRUTCHES-S
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
4601186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
CSF CELL COUNT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
4304872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna of NY Commercial |
$63.70
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Commercial |
$78.89
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: EmblemHealth Select Care |
$58.80
|
| Rate for Payer: Fidelis Medicare |
$37.35
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.26
|
| Rate for Payer: Humana Medicare |
$36.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$73.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.83
|
| Rate for Payer: United Healthcare Commercial |
$73.50
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
CSF CELL COUNT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
4304872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
|
|
CT ABDOMEN W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
4220004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$556.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Commercial |
$1,211.52
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,053.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: EmblemHealth Select Care |
$978.25
|
| Rate for Payer: Fidelis Medicare |
$573.56
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$556.85
|
| Rate for Payer: Humana Medicare |
$556.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$584.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$556.85
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT ABDOMEN W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Hospital Charge Code |
4220004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$978.25 |
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
|
|
CT ABDOMEN W/O DYE
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
4220080
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$475.32 |
| Max. Negotiated Rate |
$1,125.39 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$643.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$517.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: CDPHP Commercial |
$1,125.39
|
| Rate for Payer: CDPHP Medicare |
$517.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$978.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,118.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,118.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,118.40
|
| Rate for Payer: EmblemHealth Medicare |
$475.32
|
| Rate for Payer: EmblemHealth Select Care |
$908.70
|
| Rate for Payer: Fidelis Medicare |
$532.78
|
| Rate for Payer: Galaxy Health Commercial |
$908.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$517.26
|
| Rate for Payer: Humana Medicare |
$517.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$643.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,048.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$787.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$543.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$517.26
|
| Rate for Payer: WellCare Medicare |
$768.90
|
|
|
CT ABDOMEN W/O DYE
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Hospital Charge Code |
4220080
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$908.70 |
| Max. Negotiated Rate |
$908.70 |
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Galaxy Health Commercial |
$908.70
|
|
|
CT ABDOMEN W/O & W/DYE
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
4220003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$1,970.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$905.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: CDPHP Commercial |
$1,970.64
|
| Rate for Payer: CDPHP Medicare |
$905.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,713.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,958.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,958.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,958.40
|
| Rate for Payer: EmblemHealth Medicare |
$832.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,591.20
|
| Rate for Payer: Fidelis Medicare |
$932.93
|
| Rate for Payer: Galaxy Health Commercial |
$1,591.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$905.76
|
| Rate for Payer: Humana Medicare |
$905.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,126.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,836.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,378.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$951.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$905.76
|
| Rate for Payer: WellCare Medicare |
$1,346.40
|
|
|
CT ABDOMEN W/O & W/DYE
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Hospital Charge Code |
4220003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,591.20
|
|
