|
FO PIP DIP JNT/SPRNG PRE OTS
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
4690267
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$247.94 |
| Rate for Payer: Aetna of NY Commercial |
$215.60
|
| Rate for Payer: Aetna of NY Medicare |
$141.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$154.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: CDPHP Commercial |
$247.94
|
| Rate for Payer: CDPHP Medicare |
$113.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$246.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$246.40
|
| Rate for Payer: EmblemHealth Medicaid |
$246.40
|
| Rate for Payer: EmblemHealth Medicare |
$104.72
|
| Rate for Payer: EmblemHealth Select Care |
$154.00
|
| Rate for Payer: Fidelis Medicare |
$117.38
|
| Rate for Payer: Galaxy Health Commercial |
$200.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$113.96
|
| Rate for Payer: Humana Medicare |
$113.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$215.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$141.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$173.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$119.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$113.96
|
| Rate for Payer: WellCare Medicare |
$169.40
|
|
|
FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
4002049
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
FREE THROXINE INDEX
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
4300359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$31.20
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
FRESH FROZEN PLASMA
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4304876
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$503.93 |
| Rate for Payer: Aetna of NY Commercial |
$438.20
|
| Rate for Payer: Aetna of NY Medicare |
$287.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$469.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$469.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$231.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$313.00
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: CDPHP Commercial |
$503.93
|
| Rate for Payer: CDPHP Medicare |
$231.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$500.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.80
|
| Rate for Payer: EmblemHealth Medicaid |
$500.80
|
| Rate for Payer: EmblemHealth Medicare |
$212.84
|
| Rate for Payer: EmblemHealth Select Care |
$313.00
|
| Rate for Payer: Fidelis Medicare |
$238.57
|
| Rate for Payer: Galaxy Health Commercial |
$406.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$231.62
|
| Rate for Payer: Humana Medicare |
$231.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$438.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$287.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$469.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$352.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$243.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$469.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$136.51
|
| Rate for Payer: United Healthcare Commercial |
$469.50
|
| Rate for Payer: United Healthcare Medicare |
$231.62
|
| Rate for Payer: WellCare Medicare |
$344.30
|
|
|
FUROSEMIDE 20MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FUROSEMIDE 40 MG/4 ML VIAL 10 mg, 4 mL
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
4401517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.61
|
| 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: 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 |
$0.61
|
| 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 |
$0.61
|
| 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 |
$3.30
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$0.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
FUROSEMIDE 40MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400313
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FUROSEMIDE INJ, UP TO 20 MG
|
Facility
OP
|
$18.80
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
4400311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of NY Commercial |
$10.34
|
| Rate for Payer: Aetna of NY Medicare |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.40
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: CDPHP Commercial |
$15.13
|
| Rate for Payer: CDPHP Medicare |
$6.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.04
|
| Rate for Payer: EmblemHealth Medicaid |
$15.04
|
| Rate for Payer: EmblemHealth Medicare |
$6.39
|
| Rate for Payer: EmblemHealth Select Care |
$0.61
|
| Rate for Payer: Fidelis Medicare |
$7.16
|
| Rate for Payer: Galaxy Health Commercial |
$12.22
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.96
|
| Rate for Payer: Humana Medicare |
$6.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$6.96
|
| Rate for Payer: WellCare Medicare |
$10.34
|
|
|
GABAPENTIN 100MG CAPS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
GABAPENTIN 300MG CAPS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
GABAPENTIN 400MG CAPS 10X10EA
|
Facility
OP
|
$7.25
|
|
| Hospital Charge Code |
4400316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna of NY Medicare |
$3.34
|
| Rate for Payer: Aetna of NY Commercial |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.62
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: CDPHP Commercial |
$5.84
|
| Rate for Payer: CDPHP Medicare |
$2.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.80
|
| Rate for Payer: EmblemHealth Medicaid |
$5.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.46
|
| Rate for Payer: EmblemHealth Select Care |
$5.22
|
| Rate for Payer: Fidelis Medicare |
$2.76
|
| Rate for Payer: Galaxy Health Commercial |
$4.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.82
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.99
|
|
|
GAD-BASE MR CONTRAST NOS PER 1 ML (OPTIMARK)
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
4231000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$234.26 |
| Rate for Payer: Aetna of NY Commercial |
$160.05
|
| Rate for Payer: Aetna of NY Medicare |
$133.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$107.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$145.50
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: CDPHP Commercial |
$234.26
|
| Rate for Payer: CDPHP Medicare |
$107.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$232.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$232.80
|
| Rate for Payer: EmblemHealth Medicaid |
$232.80
|
| Rate for Payer: EmblemHealth Medicare |
$98.94
|
| Rate for Payer: EmblemHealth Select Care |
$1.51
|
| Rate for Payer: Fidelis Medicare |
$110.90
|
| Rate for Payer: Galaxy Health Commercial |
$189.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$107.67
|
| Rate for Payer: Humana Medicare |
$107.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$133.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$218.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$163.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$113.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$2.56
|
| Rate for Payer: United Healthcare Medicare |
$107.67
|
| Rate for Payer: WellCare Medicare |
$160.05
|
|
|
GALLIUM 67 (PER MCI)
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
4211243
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$48.24
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.64
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
GAMMA GLUT TRANS (GGT)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
4300365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Commercial |
$31.40
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: Fidelis Medicare |
$14.86
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.43
|
| Rate for Payer: Humana Medicare |
$14.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
GANGLION CYST INJ OR ASPIR
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
4850032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
GARAMYCIN GENTAMICIN INJ, UP TO 80 MG
|
Facility
OP
|
$11.85
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
4400322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Aetna of NY Commercial |
$6.52
|
| Rate for Payer: Aetna of NY Medicare |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.92
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: CDPHP Commercial |
$9.54
|
| Rate for Payer: CDPHP Medicare |
$4.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.48
|
| Rate for Payer: EmblemHealth Medicaid |
$9.48
|
| Rate for Payer: EmblemHealth Medicare |
$4.03
|
| Rate for Payer: EmblemHealth Select Care |
$2.73
|
| Rate for Payer: Fidelis Medicare |
$4.52
|
| Rate for Payer: Galaxy Health Commercial |
$7.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.38
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.73
|
| Rate for Payer: United Healthcare Commercial |
$4.93
|
| Rate for Payer: United Healthcare Medicare |
$4.38
|
| Rate for Payer: WellCare Medicare |
$6.52
|
|
|
GASTRIC EMPTYING STUDY
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78264
|
| Hospital Charge Code |
4210013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GASTROESOPHAGEAL REFLUX STUDY
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78262
|
| Hospital Charge Code |
4210014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GASTROGRAFFIN 120ML
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4471048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna of NY Commercial |
$51.10
|
| Rate for Payer: Aetna of NY Medicare |
$33.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.50
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: CDPHP Commercial |
$58.76
|
| Rate for Payer: CDPHP Medicare |
$27.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.40
|
| Rate for Payer: EmblemHealth Medicaid |
$58.40
|
| Rate for Payer: EmblemHealth Medicare |
$24.82
|
| Rate for Payer: EmblemHealth Select Care |
$36.50
|
| Rate for Payer: Fidelis Medicare |
$27.82
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.01
|
| Rate for Payer: Humana Medicare |
$27.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$47.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.36
|
| Rate for Payer: United Healthcare Medicare |
$27.01
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
GB SCAN W DRUG
|
Facility
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
4211247
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$143.43 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$143.43
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
GB SCAN W/O DRUG
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
4210016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$104.78
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GELSYN-3 16.8 MG/2 ML SYRINGE 16.8 mg, 2 mL
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
4401552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$0.49
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
GEMFIBROZIL 600MG TABS 25 EA
|
Facility
OP
|
$13.65
|
|
| Hospital Charge Code |
4400318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Aetna of NY Commercial |
$9.56
|
| Rate for Payer: Aetna of NY Medicare |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.82
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: CDPHP Commercial |
$10.99
|
| Rate for Payer: CDPHP Medicare |
$5.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
| Rate for Payer: EmblemHealth Medicaid |
$10.92
|
| Rate for Payer: EmblemHealth Medicare |
$4.64
|
| Rate for Payer: EmblemHealth Select Care |
$9.83
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.05
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.30
|
| Rate for Payer: United Healthcare Medicare |
$5.05
|
| Rate for Payer: WellCare Medicare |
$7.51
|
|
|
GEN COOLED PROBE NO TIP CRI-17-100
|
Facility
OP
|
$407.00
|
|
| Hospital Charge Code |
4479259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$327.64 |
| Rate for Payer: Aetna of NY Commercial |
$284.90
|
| Rate for Payer: Aetna of NY Medicare |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.50
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: CDPHP Commercial |
$327.64
|
| Rate for Payer: CDPHP Medicare |
$150.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$325.60
|
| Rate for Payer: EmblemHealth Medicaid |
$325.60
|
| Rate for Payer: EmblemHealth Medicare |
$138.38
|
| Rate for Payer: EmblemHealth Select Care |
$293.04
|
| Rate for Payer: Fidelis Medicare |
$155.11
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.59
|
| Rate for Payer: Humana Medicare |
$150.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$158.12
|
| Rate for Payer: United Healthcare Medicare |
$150.59
|
| Rate for Payer: WellCare Medicare |
$223.85
|
|
|
GEN COOLED RF GUAGE CRP-17-75-4
|
Facility
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479261
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
