|
CT UPPER EXTREMITY W/O DYE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 73200 26
|
| Hospital Charge Code |
5220048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.40
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: CDPHP Medicare |
$54.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.80
|
| Rate for Payer: EmblemHealth Medicaid |
$116.80
|
| Rate for Payer: EmblemHealth Medicare |
$49.64
|
| Rate for Payer: Fidelis Medicare |
$58.40
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.40
|
| Rate for Payer: Humana Medicare |
$58.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.90
|
| Rate for Payer: United Healthcare Medicare |
$58.40
|
| Rate for Payer: WellCare Medicare |
$80.30
|
|
|
CT UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 73200 26
|
| Hospital Charge Code |
5220048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$94.90 |
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
|
|
CT UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
4220048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$865.80 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Galaxy Health Commercial |
$865.80
|
|
|
CT UPPER EXTREMITY W/O & W/ DYE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 73202 26
|
| Hospital Charge Code |
5220049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.05 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Galaxy Health Commercial |
$115.05
|
|
|
CT UPPER EXTREMITY W/O & W/ DYE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 73202 26
|
| Hospital Charge Code |
5220049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.80
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: CDPHP Medicare |
$65.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$141.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$141.60
|
| Rate for Payer: EmblemHealth Medicaid |
$141.60
|
| Rate for Payer: EmblemHealth Medicare |
$60.18
|
| Rate for Payer: Fidelis Medicare |
$70.80
|
| Rate for Payer: Galaxy Health Commercial |
$115.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.80
|
| Rate for Payer: Humana Medicare |
$70.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$99.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.55
|
| Rate for Payer: United Healthcare Medicare |
$70.80
|
| Rate for Payer: WellCare Medicare |
$97.35
|
|
|
CT UPPR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
4220049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$868.40 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Galaxy Health Commercial |
$868.40
|
|
|
CT UPPR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
4220049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$614.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$534.40
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: CDPHP Medicare |
$494.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$935.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,068.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,068.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,068.80
|
| Rate for Payer: EmblemHealth Medicare |
$454.24
|
| Rate for Payer: EmblemHealth Select Care |
$868.40
|
| Rate for Payer: Fidelis Medicare |
$534.40
|
| Rate for Payer: Galaxy Health Commercial |
$868.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$534.40
|
| Rate for Payer: Humana Medicare |
$534.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$614.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$752.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$561.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$200.40
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$534.40
|
| Rate for Payer: WellCare Medicare |
$734.80
|
|
|
CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
4300015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Commercial |
$14.95
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$13.80
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$17.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
4300015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
CULTURE AFB URINE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
4301086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| 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 |
$19.20
|
| Rate for Payer: Fidelis Medicare |
$12.80
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.80
|
| Rate for Payer: Humana Medicare |
$12.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| 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 |
$13.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
CULTURE AFB URINE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
4301086
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
CULTURE ANAEROBIC
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4300233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna of NY Commercial |
$18.20
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| 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 |
$16.80
|
| Rate for Payer: Fidelis Medicare |
$11.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.20
|
| 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 |
$11.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
CULTURE ANAEROBIC
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
4300233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
CULTURE BLOOD
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4300235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
CULTURE BLOOD
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4300235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$61.60 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$30.80
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$30.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$30.80
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
CULTURE CSF
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300237
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.40
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
CULTURE CSF
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300237
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
CULTURE FLUID
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300238
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
CULTURE FLUID
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300238
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
CULTURE G C
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300240
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
CULTURE G C
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300240
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$17.55
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$16.20
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$20.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
CULTURELLE HEALTH-WELLNESS CAP 1 ea, 30 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 49100036404
|
| Hospital Charge Code |
4401300
|
|
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
|
|
|
CULTURELLE HEALTH-WELLNESS CAP 1 ea, 30 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 49100036404
|
| Hospital Charge Code |
4401300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CULTURE SPUTUM
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300243
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
CULTURE SPUTUM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300243
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.40
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
