|
CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
4002028
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,623.90 |
| Max. Negotiated Rate |
$9,623.90 |
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
|
|
CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Facility
|
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
4002028
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$11,918.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,810.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,478.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: CDPHP Commercial |
$11,918.83
|
| Rate for Payer: CDPHP Medicare |
$5,478.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicare |
$5,034.04
|
| Rate for Payer: EmblemHealth Select Care |
$10,660.32
|
| Rate for Payer: Fidelis Medicare |
$5,642.57
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,478.22
|
| Rate for Payer: Humana Medicare |
$5,478.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,810.76
|
| Rate for Payer: Multiplan Commercial |
$11,844.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,104.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,335.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,752.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,930.08
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
4002027
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
4002027
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
4002026
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
4002026
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
CYTOLOGY EFFUSIONS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300256
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
CYTOLOGY EFFUSIONS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300256
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$74.75
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$69.00
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$86.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$86.25
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
CYTOLOGY RESPIRATORY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300258
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
CYTOLOGY RESPIRATORY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300258
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$74.75
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$69.00
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$86.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$86.25
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
CYTOMEGALOV AMPLIF NA PROBE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
4305527
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
|
|
CYTOMEGALOV AMPLIF NA PROBE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
4305527
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$152.14 |
| Rate for Payer: Aetna of NY Commercial |
$122.85
|
| Rate for Payer: Aetna of NY Medicare |
$86.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$94.50
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: CDPHP Commercial |
$152.14
|
| Rate for Payer: CDPHP Medicare |
$69.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$113.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$151.20
|
| Rate for Payer: EmblemHealth Medicaid |
$151.20
|
| Rate for Payer: EmblemHealth Medicare |
$64.26
|
| Rate for Payer: EmblemHealth Select Care |
$113.40
|
| Rate for Payer: Fidelis Medicare |
$72.03
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.93
|
| Rate for Payer: Humana Medicare |
$69.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$106.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$141.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.62
|
| Rate for Payer: United Healthcare Commercial |
$141.75
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
| Rate for Payer: WellCare Medicare |
$103.95
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
4008173
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
4305531
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
4008173
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
4305531
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
4305530
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$317.85
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$293.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: EmblemHealth Select Care |
$293.40
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$317.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$366.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$162.74
|
| Rate for Payer: United Healthcare Commercial |
$366.75
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
4305530
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
|
|
CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
4302014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna of NY Commercial |
$100.75
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: EmblemHealth Select Care |
$93.00
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$116.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.11
|
| Rate for Payer: United Healthcare Commercial |
$116.25
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
4302014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
|
|
DABIGATRAN ETEXILATE 75MG CAPS 10X6EA
|
Facility
|
IP
|
$21.63
|
|
|
Service Code
|
NDC 00597014960
|
| Hospital Charge Code |
4400638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Galaxy Health Commercial |
$14.06
|
| Rate for Payer: WellCare Medicare |
$11.90
|
|
|
DABIGATRAN ETEXILATE 75MG CAPS 10X6EA
|
Facility
|
OP
|
$21.63
|
|
|
Service Code
|
NDC 00597014960
|
| Hospital Charge Code |
4400638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna of NY Commercial |
$15.14
|
| Rate for Payer: Aetna of NY Medicare |
$9.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.82
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: CDPHP Commercial |
$17.41
|
| Rate for Payer: CDPHP Medicare |
$8.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.30
|
| Rate for Payer: EmblemHealth Medicaid |
$17.30
|
| Rate for Payer: EmblemHealth Medicare |
$7.35
|
| Rate for Payer: EmblemHealth Select Care |
$15.57
|
| Rate for Payer: Fidelis Medicare |
$8.24
|
| Rate for Payer: Galaxy Health Commercial |
$14.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.14
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.40
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.90
|
|
|
DAPTOmycin 350 MG VIAL 1 mg, 1 each
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of NY Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Galaxy Health Commercial |
$0.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.34
|
| Rate for Payer: WellCare Medicare |
$0.34
|
|
|
DAPTOmycin 350 MG VIAL 1 mg, 1 each
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of NY Commercial |
$0.34
|
| Rate for Payer: Aetna of NY Medicare |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.31
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: CDPHP Commercial |
$0.50
|
| Rate for Payer: CDPHP Medicare |
$0.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.50
|
| Rate for Payer: EmblemHealth Medicaid |
$0.50
|
| Rate for Payer: EmblemHealth Medicare |
$0.21
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Fidelis Medicare |
$0.24
|
| Rate for Payer: Galaxy Health Commercial |
$0.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.23
|
| Rate for Payer: Humana Medicare |
$0.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.47
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WellCare Medicare |
$0.34
|
|
|
DAPTOMYCIN INJ 1 MG
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna of NY Commercial |
$1.77
|
| Rate for Payer: Aetna of NY Medicare |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.60
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: CDPHP Commercial |
$2.58
|
| Rate for Payer: CDPHP Medicare |
$1.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.57
|
| Rate for Payer: EmblemHealth Medicaid |
$2.57
|
| Rate for Payer: EmblemHealth Medicare |
$1.09
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Fidelis Medicare |
$1.22
|
| Rate for Payer: Galaxy Health Commercial |
$2.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.19
|
| Rate for Payer: Humana Medicare |
$1.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WellCare Medicare |
$1.77
|
|
