|
AB; HSV 1
|
Facility
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
4301304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$137.66 |
| Rate for Payer: Aetna of NY Commercial |
$111.15
|
| Rate for Payer: Aetna of NY Medicare |
$78.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.50
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: CDPHP Commercial |
$137.66
|
| Rate for Payer: CDPHP Medicare |
$63.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.80
|
| Rate for Payer: EmblemHealth Medicaid |
$136.80
|
| Rate for Payer: EmblemHealth Medicare |
$58.14
|
| Rate for Payer: Fidelis Medicare |
$65.17
|
| Rate for Payer: Galaxy Health Commercial |
$111.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.27
|
| Rate for Payer: Humana Medicare |
$63.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$111.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$96.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$128.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WellCare Medicare |
$94.05
|
|
|
ABO AND RH TYPE
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300011
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
ABO GROUP
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
AB; PARVOVIRUS
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
4304881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna of NY Commercial |
$49.40
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Commercial |
$61.18
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: Fidelis Medicare |
$28.96
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.12
|
| Rate for Payer: Humana Medicare |
$28.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$57.00
|
| Rate for Payer: United Healthcare Medicare |
$28.12
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
ABP MONITORING 24+ HRS; RECORDING
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 93786
|
| Hospital Charge Code |
4480039
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.18
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
ABP MONITORING 24+ HRS; SCANNING ANALYSIS
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 93788
|
| Hospital Charge Code |
4480089
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
ABSCESS DRAINAGE UNDER X-RAY
|
Facility
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
4220005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$197.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$158.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: CDPHP Commercial |
$345.34
|
| Rate for Payer: CDPHP Medicare |
$158.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$343.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$343.20
|
| Rate for Payer: EmblemHealth Medicaid |
$343.20
|
| Rate for Payer: EmblemHealth Medicare |
$145.86
|
| Rate for Payer: Fidelis Medicare |
$163.49
|
| Rate for Payer: Galaxy Health Commercial |
$278.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$158.73
|
| Rate for Payer: Humana Medicare |
$158.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$197.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$241.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$166.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$158.73
|
| Rate for Payer: WellCare Medicare |
$235.95
|
|
|
ACCESS SYS KII OPTCL THRD 5MMX
|
Facility
OP
|
$66.00
|
|
| Hospital Charge Code |
4471821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of NY Commercial |
$46.20
|
| Rate for Payer: Aetna of NY Medicare |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: CDPHP Commercial |
$53.13
|
| Rate for Payer: CDPHP Medicare |
$24.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.80
|
| Rate for Payer: EmblemHealth Medicaid |
$52.80
|
| Rate for Payer: EmblemHealth Medicare |
$22.44
|
| Rate for Payer: EmblemHealth Select Care |
$47.52
|
| Rate for Payer: Fidelis Medicare |
$25.15
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.42
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.64
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WellCare Medicare |
$36.30
|
|
|
ACEPHEN SUPPOS 650 MG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4408948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ACETAMIN/BUTALB/CAFF 325-50-40MG TABS 10
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ACETAMINOPHEN
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
4300014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna of NY Commercial |
$234.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$180.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: CDPHP Commercial |
$289.80
|
| Rate for Payer: CDPHP Medicare |
$133.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
| Rate for Payer: EmblemHealth Medicaid |
$288.00
|
| Rate for Payer: EmblemHealth Medicare |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$137.20
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$234.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$270.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$270.00
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$198.00
|
|
|
ACETAMINOPHEN 1000MG/100ML BAG 10 mg, 100 mL
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
4401541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna of NY Commercial |
$18.20
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Commercial |
$20.93
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.80
|
| 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 |
$18.72
|
| Rate for Payer: Fidelis Medicare |
$9.91
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.62
|
| Rate for Payer: Humana Medicare |
$9.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.20
|
| 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 |
$10.10
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
ACETAMINOPHEN 120MG SUPP 12 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ACETAMINOPHEN 325MG TABS 20X150EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400783
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ACETAZOLAMIDE 250MG TABS 100 EA
|
Facility
OP
|
$9.01
|
|
| Hospital Charge Code |
4400008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of NY Commercial |
$6.31
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Commercial |
$7.25
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
ACETYLCYSTEINE 200MG/ML AMPS 3X30ML
|
Facility
OP
|
$77.25
|
|
| Hospital Charge Code |
4400011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Aetna of NY Commercial |
$54.08
|
| Rate for Payer: Aetna of NY Medicare |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.62
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: CDPHP Commercial |
$62.19
|
| Rate for Payer: CDPHP Medicare |
$28.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.80
|
| Rate for Payer: EmblemHealth Medicaid |
$61.80
|
| Rate for Payer: EmblemHealth Medicare |
$26.26
|
| Rate for Payer: EmblemHealth Select Care |
$55.62
|
| Rate for Payer: Fidelis Medicare |
$29.44
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.58
|
| Rate for Payer: Humana Medicare |
$28.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.01
|
| Rate for Payer: United Healthcare Medicare |
$28.58
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
ACETYLCYSTEINE 20% 4 ML
|
Facility
OP
|
$47.38
|
|
| Hospital Charge Code |
4401259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$38.14 |
| Rate for Payer: Aetna of NY Commercial |
$33.17
|
| Rate for Payer: Aetna of NY Medicare |
$21.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.69
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: CDPHP Commercial |
$38.14
|
| Rate for Payer: CDPHP Medicare |
$17.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.90
|
| Rate for Payer: EmblemHealth Medicaid |
$37.90
|
| Rate for Payer: EmblemHealth Medicare |
$16.11
|
| Rate for Payer: EmblemHealth Select Care |
$34.11
|
| Rate for Payer: Fidelis Medicare |
$18.06
|
| Rate for Payer: Galaxy Health Commercial |
$30.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.53
|
| Rate for Payer: Humana Medicare |
$17.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.41
|
| Rate for Payer: United Healthcare Medicare |
$17.53
|
| Rate for Payer: WellCare Medicare |
$26.06
|
|
|
ACETYLCYSTEINE INJECTION 100 MG
|
Facility
OP
|
$10.50
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
4400004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of NY Commercial |
$5.78
|
| Rate for Payer: Aetna of NY Medicare |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.25
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: CDPHP Commercial |
$8.45
|
| Rate for Payer: CDPHP Medicare |
$3.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.40
|
| Rate for Payer: EmblemHealth Medicaid |
$8.40
|
| Rate for Payer: EmblemHealth Medicare |
$3.57
|
| Rate for Payer: EmblemHealth Select Care |
$0.77
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.82
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.88
|
| Rate for Payer: Humana Medicare |
$3.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$3.88
|
| Rate for Payer: WellCare Medicare |
$5.78
|
|
|
ACID FAST SMEAR
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
4300019
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$13.65
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.50
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Commercial |
$16.90
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$15.75
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
ACTH
|
Facility
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
4300021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$216.54 |
| Rate for Payer: Aetna of NY Commercial |
$174.85
|
| Rate for Payer: Aetna of NY Medicare |
$123.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$201.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$201.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$99.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$134.50
|
| Rate for Payer: Cash Price |
$201.75
|
| Rate for Payer: Cash Price |
$201.75
|
| Rate for Payer: CDPHP Commercial |
$216.54
|
| Rate for Payer: CDPHP Medicare |
$99.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$215.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$215.20
|
| Rate for Payer: EmblemHealth Medicaid |
$215.20
|
| Rate for Payer: EmblemHealth Medicare |
$91.46
|
| Rate for Payer: Fidelis Medicare |
$102.52
|
| Rate for Payer: Galaxy Health Commercial |
$174.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.53
|
| Rate for Payer: Humana Medicare |
$99.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$174.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$123.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$151.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$104.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$201.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.62
|
| Rate for Payer: United Healthcare Commercial |
$201.75
|
| Rate for Payer: United Healthcare Medicare |
$99.53
|
| Rate for Payer: WellCare Medicare |
$147.95
|
|
|
ACTIVATED CHARCOAL 50GM LIQD 240 ML
|
Facility
OP
|
$73.13
|
|
| Hospital Charge Code |
4400015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Aetna of NY Commercial |
$51.19
|
| Rate for Payer: Aetna of NY Medicare |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.56
|
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: CDPHP Commercial |
$58.87
|
| Rate for Payer: CDPHP Medicare |
$27.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.50
|
| Rate for Payer: EmblemHealth Medicaid |
$58.50
|
| Rate for Payer: EmblemHealth Medicare |
$24.86
|
| Rate for Payer: EmblemHealth Select Care |
$52.65
|
| Rate for Payer: Fidelis Medicare |
$27.87
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.06
|
| Rate for Payer: Humana Medicare |
$27.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.41
|
| Rate for Payer: United Healthcare Medicare |
$27.06
|
| Rate for Payer: WellCare Medicare |
$40.22
|
|
|
ACTOS 15 MG
|
Facility
OP
|
$21.05
|
|
| Hospital Charge Code |
4409012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Aetna of NY Commercial |
$14.74
|
| Rate for Payer: Aetna of NY Medicare |
$9.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.52
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: CDPHP Commercial |
$16.95
|
| Rate for Payer: CDPHP Medicare |
$7.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.84
|
| Rate for Payer: EmblemHealth Medicaid |
$16.84
|
| Rate for Payer: EmblemHealth Medicare |
$7.16
|
| Rate for Payer: EmblemHealth Select Care |
$15.16
|
| Rate for Payer: Fidelis Medicare |
$8.02
|
| Rate for Payer: Galaxy Health Commercial |
$13.68
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.79
|
| Rate for Payer: Humana Medicare |
$7.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.79
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.18
|
| Rate for Payer: United Healthcare Medicare |
$7.79
|
| Rate for Payer: WellCare Medicare |
$11.58
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
4300022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$194.81 |
| Rate for Payer: Aetna of NY Commercial |
$157.30
|
| Rate for Payer: Aetna of NY Medicare |
$111.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$89.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$121.00
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: CDPHP Commercial |
$194.81
|
| Rate for Payer: CDPHP Medicare |
$89.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$193.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$193.60
|
| Rate for Payer: EmblemHealth Medicaid |
$193.60
|
| Rate for Payer: EmblemHealth Medicare |
$82.28
|
| Rate for Payer: Fidelis Medicare |
$92.23
|
| Rate for Payer: Galaxy Health Commercial |
$157.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$89.54
|
| Rate for Payer: Humana Medicare |
$89.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$157.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$111.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$136.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$94.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$181.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.63
|
| Rate for Payer: United Healthcare Commercial |
$181.50
|
| Rate for Payer: United Healthcare Medicare |
$89.54
|
| Rate for Payer: WellCare Medicare |
$133.10
|
|
|
ACUTE VENOUS THROMBOSIS IMAGE
|
Facility
OP
|
$4,063.00
|
|
|
Service Code
|
HCPCS 78456
|
| Hospital Charge Code |
4210002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna of NY Commercial |
$2,844.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,868.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,503.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,031.50
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: Cash Price |
$3,047.25
|
| Rate for Payer: CDPHP Commercial |
$3,270.72
|
| Rate for Payer: CDPHP Medicare |
$1,503.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,381.42
|
| Rate for Payer: Fidelis Medicare |
$1,548.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,640.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,503.31
|
| Rate for Payer: Humana Medicare |
$1,503.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,844.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,868.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,047.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,287.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,578.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,503.31
|
| Rate for Payer: WellCare Medicare |
$2,234.65
|
|
|
ACYCLOVIR 200 MG CAPSULE 200 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
44001376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| 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) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| 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 |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$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 |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
