|
DRUG SCREEN QUANTITATIVE PHENOBARBITAL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
4300082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$33.15
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$30.60
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
DRUG SCREEN QUANTITATIVE ZONISAMIDE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
4302017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna of NY Commercial |
$30.55
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.50
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Commercial |
$37.84
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: EmblemHealth Select Care |
$28.20
|
| Rate for Payer: Fidelis Medicare |
$17.91
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.39
|
| Rate for Payer: Humana Medicare |
$17.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$35.25
|
| Rate for Payer: United Healthcare Medicare |
$17.39
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
DRUG SCREEN QUANTITATIVE ZONISAMIDE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
4302017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
|
|
DRUG SCRN QUANT OXCARBAZEPIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
4302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
|
|
DRUG SCRN QUANT OXCARBAZEPIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
4302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$48.30 |
| Rate for Payer: Aetna of NY Commercial |
$39.00
|
| Rate for Payer: Aetna of NY Medicare |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: CDPHP Commercial |
$48.30
|
| Rate for Payer: CDPHP Medicare |
$22.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.00
|
| Rate for Payer: EmblemHealth Medicaid |
$48.00
|
| Rate for Payer: EmblemHealth Medicare |
$20.40
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$22.87
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.20
|
| Rate for Payer: Humana Medicare |
$22.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$45.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Medicare |
$22.20
|
| Rate for Payer: WellCare Medicare |
$33.00
|
|
|
DRUG TEST PRSMV CHEM ANLYZR
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4302000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
|
|
DRUG TEST PRSMV CHEM ANLYZR
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4302000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$4,772.00 |
| Rate for Payer: Aetna of NY Commercial |
$146.25
|
| Rate for Payer: Aetna of NY Medicare |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.72
|
| Rate for Payer: CDPHP Commercial |
$181.12
|
| Rate for Payer: CDPHP Essential Plan |
$107.37
|
| Rate for Payer: CDPHP Medicare |
$83.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$135.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.72
|
| Rate for Payer: EmblemHealth Medicaid |
$47.72
|
| Rate for Payer: EmblemHealth Medicare |
$76.50
|
| Rate for Payer: EmblemHealth Select Care |
$135.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$107.37
|
| Rate for Payer: Fidelis Medicare |
$85.75
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$70.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,772.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.25
|
| Rate for Payer: Humana Medicare |
$83.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,772.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$168.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.72
|
| Rate for Payer: United Healthcare Commercial |
$168.75
|
| Rate for Payer: United Healthcare Medicare |
$83.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
4301999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
4301999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$24.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$10.92
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Essential Plan |
$24.57
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
| Rate for Payer: EmblemHealth Medicaid |
$10.92
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$34.20
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$24.57
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$16.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,092.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,092.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$23.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$23.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.92
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.47
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
DSTRJ LESION PENIS EXTENSIVE
|
Facility
|
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
4002046
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| 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 |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: EmblemHealth Select Care |
$3,756.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: Multiplan Commercial |
$4,174.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
|
DSTRJ LESION PENIS EXTENSIVE
|
Facility
|
IP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
4002046
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,391.70 |
| Max. Negotiated Rate |
$3,391.70 |
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
|
|
DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
4002045
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,391.70 |
| Max. Negotiated Rate |
$3,391.70 |
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
|
|
DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
4002045
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,200.49 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,400.28
|
| 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 |
$1,930.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: Cash Price |
$3,913.50
|
| Rate for Payer: CDPHP Commercial |
$4,200.49
|
| Rate for Payer: CDPHP Medicare |
$1,930.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,774.12
|
| Rate for Payer: EmblemHealth Select Care |
$3,756.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,391.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.66
|
| Rate for Payer: Humana Medicare |
$1,930.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,400.28
|
| Rate for Payer: Multiplan Commercial |
$4,174.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,937.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,027.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,737.53
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$1,930.66
|
| Rate for Payer: WellCare Medicare |
$2,869.90
|
|
|
DUAL SPRAY FOR GPS III
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
4471610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$102.05 |
| Rate for Payer: Cash Price |
$117.75
|
| Rate for Payer: Galaxy Health Commercial |
$102.05
|
|
|
DUAL SPRAY FOR GPS III
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
4471610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$126.38 |
| Rate for Payer: Aetna of NY Commercial |
$109.90
|
| Rate for Payer: Aetna of NY Medicare |
$72.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$78.50
|
| Rate for Payer: Cash Price |
$117.75
|
| Rate for Payer: CDPHP Commercial |
$126.38
|
| Rate for Payer: CDPHP Medicare |
$58.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$125.60
|
| Rate for Payer: EmblemHealth Medicare |
$53.38
|
| Rate for Payer: EmblemHealth Select Care |
$113.04
|
| Rate for Payer: Fidelis Medicare |
$59.83
|
| Rate for Payer: Galaxy Health Commercial |
$102.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.09
|
| Rate for Payer: Humana Medicare |
$58.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.99
|
| Rate for Payer: United Healthcare Medicare |
$58.09
|
| Rate for Payer: WellCare Medicare |
$86.35
|
|
|
DUDERM 4X4 CGF DRESSING
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4479234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| 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 |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| 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 |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
DUDERM 4X4 CGF DRESSING
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4479234
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
DULOXETINE HCL 30MG CAPS 100 EA
|
Facility
|
IP
|
$27.04
|
|
|
Service Code
|
NDC 00904645361
|
| Hospital Charge Code |
4400204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
DULOXETINE HCL 30MG CAPS 100 EA
|
Facility
|
OP
|
$27.04
|
|
|
Service Code
|
NDC 00904645361
|
| Hospital Charge Code |
4400204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna of NY Commercial |
$18.93
|
| Rate for Payer: Aetna of NY Medicare |
$12.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.52
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: CDPHP Commercial |
$21.77
|
| Rate for Payer: CDPHP Medicare |
$10.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.63
|
| Rate for Payer: EmblemHealth Medicaid |
$21.63
|
| Rate for Payer: EmblemHealth Medicare |
$9.19
|
| Rate for Payer: EmblemHealth Select Care |
$19.47
|
| Rate for Payer: Fidelis Medicare |
$10.30
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$10.00
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
DUODERM CGF BORDER
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4479233
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
DUODERM CGF BORDER
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4479233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| 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 |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| 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 |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
DUPLEX A IVC IL/BPG; UNIL/LIM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
4200027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
DUPLEX A IVC IL/BPG; UNIL/LIM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
4200027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of NY Commercial |
$204.75
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$204.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.58
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4480082
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.18 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: EmblemHealth Select Care |
$455.65
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4480082
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
