|
DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 93926 LT,TC
|
| Hospital Charge Code |
4200044
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.30 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Galaxy Health Commercial |
$287.30
|
|
|
DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 93926 RT,TC
|
| Hospital Charge Code |
4201036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.30 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Galaxy Health Commercial |
$287.30
|
|
|
DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 93926 RT,TC
|
| Hospital Charge Code |
4201036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$355.81 |
| Rate for Payer: Aetna of NY Commercial |
$287.30
|
| Rate for Payer: Aetna of NY Medicare |
$203.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$221.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: CDPHP Commercial |
$355.81
|
| Rate for Payer: CDPHP Medicare |
$163.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$309.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$353.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$353.60
|
| Rate for Payer: EmblemHealth Medicaid |
$353.60
|
| Rate for Payer: EmblemHealth Medicare |
$150.28
|
| Rate for Payer: EmblemHealth Select Care |
$287.30
|
| Rate for Payer: Fidelis Medicare |
$168.45
|
| Rate for Payer: Galaxy Health Commercial |
$287.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.54
|
| Rate for Payer: Humana Medicare |
$163.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$287.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$203.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$248.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$163.54
|
| Rate for Payer: WellCare Medicare |
$243.10
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
4200045
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
4200045
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$238.34 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
4201026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
4201026
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 LT,TC
|
| Hospital Charge Code |
4200029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, LEFT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 LT,TC
|
| Hospital Charge Code |
4200029
|
|
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
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 RT,TC
|
| Hospital Charge Code |
4201039
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY, RIGHT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93931 RT,TC
|
| Hospital Charge Code |
4201039
|
|
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
|
|
|
DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
4200048
|
|
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
|
|
|
DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
4200048
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$238.34 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
4200049
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
4200049
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 LT,TC
|
| Hospital Charge Code |
4201066
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, LEFT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 LT,TC
|
| Hospital Charge Code |
4201066
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 RT,TC
|
| Hospital Charge Code |
4201067
|
|
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
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY, RIGHT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 93971 RT,TC
|
| Hospital Charge Code |
4201067
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.10 |
| 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 Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DURAGESIC 100 MCG/HR PATCH 100 mcg, 5 eaches
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
NDC 50458010605
|
| Hospital Charge Code |
4401436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Galaxy Health Commercial |
$397.80
|
| Rate for Payer: WellCare Medicare |
$336.60
|
|
|
DURAGESIC 100 MCG/HR PATCH 100 mcg, 5 eaches
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
NDC 50458010605
|
| Hospital Charge Code |
4401436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$208.08 |
| Max. Negotiated Rate |
$492.66 |
| Rate for Payer: Aetna of NY Commercial |
$428.40
|
| Rate for Payer: Aetna of NY Medicare |
$281.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$226.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$306.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: CDPHP Commercial |
$492.66
|
| Rate for Payer: CDPHP Medicare |
$226.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$489.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$489.60
|
| Rate for Payer: EmblemHealth Medicare |
$208.08
|
| Rate for Payer: EmblemHealth Select Care |
$440.64
|
| Rate for Payer: Fidelis Medicare |
$233.23
|
| Rate for Payer: Galaxy Health Commercial |
$397.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$226.44
|
| Rate for Payer: Humana Medicare |
$226.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$428.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$281.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$344.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$237.76
|
| Rate for Payer: United Healthcare Medicare |
$226.44
|
| Rate for Payer: WellCare Medicare |
$336.60
|
|
|
DUTASTERIDE 0.5 MG CAPSULE 0.5 mg, 30 eaches
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
4401320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Galaxy Health Commercial |
$11.70
|
| Rate for Payer: WellCare Medicare |
$9.90
|
|
|
DUTASTERIDE 0.5 MG CAPSULE 0.5 mg, 30 eaches
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
4401320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$14.49 |
| Rate for Payer: Aetna of NY Commercial |
$12.60
|
| Rate for Payer: Aetna of NY Medicare |
$8.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: CDPHP Commercial |
$14.49
|
| Rate for Payer: CDPHP Medicare |
$6.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.40
|
| Rate for Payer: EmblemHealth Medicaid |
$14.40
|
| Rate for Payer: EmblemHealth Medicare |
$6.12
|
| Rate for Payer: EmblemHealth Select Care |
$12.96
|
| Rate for Payer: Fidelis Medicare |
$6.86
|
| Rate for Payer: Galaxy Health Commercial |
$11.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.66
|
| Rate for Payer: Humana Medicare |
$6.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.99
|
| Rate for Payer: United Healthcare Medicare |
$6.66
|
| Rate for Payer: WellCare Medicare |
$9.90
|
|
|
DUTASTERIDE 0.5MG GCAP 30 EA
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
4400086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$16.79 |
| Rate for Payer: Aetna of NY Commercial |
$14.60
|
| Rate for Payer: Aetna of NY Medicare |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.43
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: CDPHP Commercial |
$16.79
|
| Rate for Payer: CDPHP Medicare |
$7.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.69
|
| Rate for Payer: EmblemHealth Medicaid |
$16.69
|
| Rate for Payer: EmblemHealth Medicare |
$7.09
|
| Rate for Payer: EmblemHealth Select Care |
$15.02
|
| Rate for Payer: Fidelis Medicare |
$7.95
|
| Rate for Payer: Galaxy Health Commercial |
$13.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.72
|
| Rate for Payer: Humana Medicare |
$7.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.10
|
| Rate for Payer: United Healthcare Medicare |
$7.72
|
| Rate for Payer: WellCare Medicare |
$11.47
|
|
|
DUTASTERIDE 0.5MG GCAP 30 EA
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
4400086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Galaxy Health Commercial |
$13.56
|
| Rate for Payer: WellCare Medicare |
$11.47
|
|
