|
CYTOLOGY RESPIRATORY
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
4300258
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
|
|
CYTOMEGALOV AMPLIF NA PROBE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
4305527
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
CYTOMEGALOV AMPLIF NA PROBE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
4305527
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Medicare |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.00
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$42.00
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
4305531
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$104.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$96.00
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
4008173
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
4008173
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$104.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$96.00
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
4305531
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
4305530
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
|
|
CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
4305530
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of NY Commercial |
$339.30
|
| Rate for Payer: Aetna of NY Medicare |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: CDPHP Medicare |
$193.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$417.60
|
| Rate for Payer: EmblemHealth Medicare |
$177.48
|
| Rate for Payer: EmblemHealth Select Care |
$313.20
|
| Rate for Payer: Fidelis Medicare |
$208.80
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$208.80
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$339.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$240.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$391.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$293.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$391.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WellCare Medicare |
$287.10
|
|
|
CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
4302014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
4302014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$104.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$96.00
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
DABIGATRAN ETEXILATE 75MG CAPS 10X6EA
|
Facility
|
IP
|
$21.63
|
|
|
Service Code
|
NDC 597014960
|
| 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 597014960
|
| Hospital Charge Code |
4400638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$17.30 |
| 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) Medicare |
$8.65
|
| Rate for Payer: Cash Price |
$16.22
|
| 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 |
$8.65
|
| Rate for Payer: Galaxy Health Commercial |
$14.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.65
|
| Rate for Payer: Humana Medicare |
$8.65
|
| 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 |
$9.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.24
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: WellCare Medicare |
$11.90
|
|
|
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 |
$0.03 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of NY Medicare |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.25
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: CDPHP Medicare |
$0.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Fidelis Medicare |
$0.25
|
| Rate for Payer: Galaxy Health Commercial |
$0.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.25
|
| Rate for Payer: Humana Medicare |
$0.25
|
| 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 |
$0.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.25
|
| Rate for Payer: WellCare Medicare |
$0.34
|
|
|
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 |
$0.03 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of NY Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| Rate for Payer: EmblemHealth Select Care |
$0.03
|
| 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 INJ 1 MG
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of NY Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| Rate for Payer: EmblemHealth Select Care |
$0.03
|
| Rate for Payer: Galaxy Health Commercial |
$2.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.77
|
| Rate for Payer: WellCare Medicare |
$1.77
|
|
|
DAPTOMYCIN INJ 1 MG
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
4401267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of NY Medicare |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.28
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: CDPHP Medicare |
$1.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Fidelis Medicare |
$1.28
|
| Rate for Payer: Galaxy Health Commercial |
$2.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.28
|
| Rate for Payer: Humana Medicare |
$1.28
|
| 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 |
$1.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
| Rate for Payer: WellCare Medicare |
$1.77
|
|
|
DARIFENACIN 7.5MG TABS 30 EA
|
Facility
|
IP
|
$41.72
|
|
|
Service Code
|
NDC 430017015
|
| Hospital Charge Code |
4400267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$27.12 |
| Rate for Payer: Cash Price |
$31.29
|
| Rate for Payer: Galaxy Health Commercial |
$27.12
|
| Rate for Payer: WellCare Medicare |
$22.95
|
|
|
DARIFENACIN 7.5MG TABS 30 EA
|
Facility
|
OP
|
$41.72
|
|
|
Service Code
|
NDC 430017015
|
| Hospital Charge Code |
4400267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$33.38 |
| Rate for Payer: Aetna of NY Commercial |
$29.20
|
| Rate for Payer: Aetna of NY Medicare |
$19.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.69
|
| Rate for Payer: Cash Price |
$31.29
|
| Rate for Payer: CDPHP Medicare |
$15.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.38
|
| Rate for Payer: EmblemHealth Medicaid |
$33.38
|
| Rate for Payer: EmblemHealth Medicare |
$14.18
|
| Rate for Payer: EmblemHealth Select Care |
$30.04
|
| Rate for Payer: Fidelis Medicare |
$16.69
|
| Rate for Payer: Galaxy Health Commercial |
$27.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.69
|
| Rate for Payer: Humana Medicare |
$16.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$16.69
|
| Rate for Payer: WellCare Medicare |
$22.95
|
|
|
DBM BONE GRAFT
|
Facility
|
IP
|
$5,211.80
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4471391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.31 |
| Max. Negotiated Rate |
$3,648.26 |
| Rate for Payer: Aetna of NY Commercial |
$3,648.26
|
| Rate for Payer: Cash Price |
$3,908.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,605.90
|
| Rate for Payer: EmblemHealth Select Care |
$2,605.90
|
| Rate for Payer: Galaxy Health Commercial |
$3,387.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,648.26
|
| Rate for Payer: Multiplan Commercial |
$2,345.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,387.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,387.67
|
| Rate for Payer: WellCare Medicare |
$2,866.49
|
|
|
DBM BONE GRAFT
|
Facility
|
OP
|
$5,211.80
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4471391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.77 |
| Max. Negotiated Rate |
$4,169.44 |
| Rate for Payer: Aetna of NY Commercial |
$3,648.26
|
| Rate for Payer: Aetna of NY Medicare |
$2,397.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,084.72
|
| Rate for Payer: Cash Price |
$3,908.85
|
| Rate for Payer: CDPHP Medicare |
$1,928.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,605.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,169.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,169.44
|
| Rate for Payer: EmblemHealth Medicaid |
$4,169.44
|
| Rate for Payer: EmblemHealth Medicare |
$1,772.01
|
| Rate for Payer: EmblemHealth Select Care |
$2,605.90
|
| Rate for Payer: Fidelis Medicare |
$2,084.72
|
| Rate for Payer: Galaxy Health Commercial |
$3,387.67
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,084.72
|
| Rate for Payer: Humana Medicare |
$2,084.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,648.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,397.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,387.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,387.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,188.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$781.77
|
| Rate for Payer: United Healthcare Medicare |
$2,084.72
|
| Rate for Payer: WellCare Medicare |
$2,866.49
|
|
|
DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
4002064
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$2,097.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$753.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$655.20
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: CDPHP Medicare |
$606.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,310.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,310.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,310.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,310.40
|
| Rate for Payer: EmblemHealth Medicare |
$556.92
|
| Rate for Payer: EmblemHealth Select Care |
$1,179.36
|
| Rate for Payer: Fidelis Medicare |
$655.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,064.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$655.20
|
| Rate for Payer: Humana Medicare |
$655.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$753.48
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,228.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$922.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$687.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$245.70
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$655.20
|
| Rate for Payer: WellCare Medicare |
$900.90
|
|
|
DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
4002064
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,064.70 |
| Max. Negotiated Rate |
$1,064.70 |
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,064.70
|
|
|
D-DIMER
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 85378
|
| Hospital Charge Code |
4300260
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
D-DIMER
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 85378
|
| Hospital Charge Code |
4300260
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
