|
DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
4602216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.25 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,000.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$870.00
|
| Rate for Payer: Cash Price |
$1,631.25
|
| Rate for Payer: Cash Price |
$1,631.25
|
| Rate for Payer: Cash Price |
$1,631.25
|
| Rate for Payer: CDPHP Medicare |
$804.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,740.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,740.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,740.00
|
| Rate for Payer: EmblemHealth Medicare |
$739.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$870.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$870.00
|
| Rate for Payer: Humana Medicare |
$870.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,000.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$913.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WellCare Medicare |
$1,196.25
|
|
|
DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
4602216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,413.75 |
| Max. Negotiated Rate |
$1,413.75 |
| Rate for Payer: Cash Price |
$1,631.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.75
|
|
|
DRILL BIT, JACOBS CHUCK
|
Facility
|
IP
|
$643.75
|
|
| Hospital Charge Code |
4472237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.44 |
| Max. Negotiated Rate |
$418.44 |
| Rate for Payer: Cash Price |
$482.81
|
| Rate for Payer: Galaxy Health Commercial |
$418.44
|
|
|
DRILL BIT, JACOBS CHUCK
|
Facility
|
OP
|
$643.75
|
|
| Hospital Charge Code |
4472237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of NY Commercial |
$450.62
|
| Rate for Payer: Aetna of NY Medicare |
$296.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$482.81
|
| Rate for Payer: CDPHP Medicare |
$238.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$515.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$515.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$515.00
|
| Rate for Payer: EmblemHealth Medicaid |
$515.00
|
| Rate for Payer: EmblemHealth Medicare |
$218.88
|
| Rate for Payer: EmblemHealth Select Care |
$463.50
|
| Rate for Payer: Fidelis Medicare |
$257.50
|
| Rate for Payer: Galaxy Health Commercial |
$418.44
|
| Rate for Payer: Hamaspik Choice Medicare |
$257.50
|
| Rate for Payer: Humana Medicare |
$257.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$450.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$296.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$482.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$362.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$270.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$96.56
|
| Rate for Payer: United Healthcare Medicare |
$257.50
|
| Rate for Payer: WellCare Medicare |
$354.06
|
|
|
DRILL FOR 4.3MM SCREW
|
Facility
|
IP
|
$175.10
|
|
| Hospital Charge Code |
4471369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$113.81 |
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
|
|
DRILL FOR 4.3MM SCREW
|
Facility
|
OP
|
$175.10
|
|
| Hospital Charge Code |
4471369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna of NY Commercial |
$122.57
|
| Rate for Payer: Aetna of NY Medicare |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.04
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: CDPHP Medicare |
$64.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.08
|
| Rate for Payer: EmblemHealth Medicaid |
$140.08
|
| Rate for Payer: EmblemHealth Medicare |
$59.53
|
| Rate for Payer: EmblemHealth Select Care |
$126.07
|
| Rate for Payer: Fidelis Medicare |
$70.04
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.04
|
| Rate for Payer: Humana Medicare |
$70.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$70.04
|
| Rate for Payer: WellCare Medicare |
$96.31
|
|
|
DRONEDARONE 400MG TABS 10X10EA
|
Facility
|
IP
|
$35.02
|
|
|
Service Code
|
NDC 24414210
|
| Hospital Charge Code |
4400530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
DRONEDARONE 400MG TABS 10X10EA
|
Facility
|
OP
|
$35.02
|
|
|
Service Code
|
NDC 24414210
|
| Hospital Charge Code |
4400530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Aetna of NY Commercial |
$24.51
|
| Rate for Payer: Aetna of NY Medicare |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.01
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: CDPHP Medicare |
$12.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.02
|
| Rate for Payer: EmblemHealth Medicaid |
$28.02
|
| Rate for Payer: EmblemHealth Medicare |
$11.91
|
| Rate for Payer: EmblemHealth Select Care |
$25.21
|
| Rate for Payer: Fidelis Medicare |
$14.01
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.01
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.01
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
DRUG SCREEN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4300278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$168.75 |
| 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) Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare |
$90.00
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$46.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$47.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$90.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| 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 |
$50.11
|
| 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 |
$126.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$94.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$168.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$168.75
|
| Rate for Payer: United Healthcare Medicare |
$90.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
DRUG SCREEN
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4300278
|
|
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 SCREEN QUANTITATIVE PHENOBARBITAL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
4300082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
|
|
DRUG SCREEN QUANTITATIVE PHENOBARBITAL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
4300082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna of NY Commercial |
$29.90
|
| Rate for Payer: Aetna of NY Medicare |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: CDPHP Medicare |
$17.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.80
|
| Rate for Payer: EmblemHealth Medicaid |
$36.80
|
| Rate for Payer: EmblemHealth Medicare |
$15.64
|
| Rate for Payer: EmblemHealth Select Care |
$27.60
|
| Rate for Payer: Fidelis Medicare |
$18.40
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$34.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Commercial |
$34.50
|
| Rate for Payer: United Healthcare Medicare |
$18.40
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
DRUG SCREEN QUANTITATIVE ZONISAMIDE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
4302017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
DRUG SCREEN QUANTITATIVE ZONISAMIDE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
4302017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
DRUG SCRN QUANT OXCARBAZEPIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
4302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
DRUG SCRN QUANT OXCARBAZEPIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
4302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
DRUG TEST PRSMV CHEM ANLYZR
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
4302000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$168.75 |
| 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) Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare |
$90.00
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$46.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$47.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$90.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| 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 |
$50.11
|
| 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 |
$126.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$94.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$168.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$168.75
|
| Rate for Payer: United Healthcare Medicare |
$90.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
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 TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
4301999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
4301999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$38.25 |
| 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) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| 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 |
$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 |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$30.60
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$10.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$10.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| 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 Child Health Plus/Family Health Plus/HARP/Medicaid |
$11.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| 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 |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$38.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.47
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
DSTRJ LESION PENIS EXTENSIVE
|
Facility
|
OP
|
$6,324.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
4002046
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$948.60 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,909.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,529.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: CDPHP Medicare |
$2,339.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,059.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,059.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,059.20
|
| Rate for Payer: EmblemHealth Medicaid |
$5,059.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,150.16
|
| Rate for Payer: EmblemHealth Select Care |
$4,553.28
|
| Rate for Payer: Fidelis Medicare |
$2,529.60
|
| Rate for Payer: Galaxy Health Commercial |
$4,110.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,529.60
|
| Rate for Payer: Humana Medicare |
$2,529.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,909.04
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,743.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,560.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,656.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$948.60
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$2,529.60
|
| Rate for Payer: WellCare Medicare |
$3,478.20
|
|
|
DSTRJ LESION PENIS EXTENSIVE
|
Facility
|
IP
|
$6,324.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
4002046
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,110.60 |
| Max. Negotiated Rate |
$4,110.60 |
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,110.60
|
|
|
DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$6,324.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
4002045
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$948.60 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,909.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,529.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: CDPHP Medicare |
$2,339.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,059.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,059.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,059.20
|
| Rate for Payer: EmblemHealth Medicaid |
$5,059.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,150.16
|
| Rate for Payer: EmblemHealth Select Care |
$4,553.28
|
| Rate for Payer: Fidelis Medicare |
$2,529.60
|
| Rate for Payer: Galaxy Health Commercial |
$4,110.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,529.60
|
| Rate for Payer: Humana Medicare |
$2,529.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,909.04
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,743.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,560.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,656.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$948.60
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$2,529.60
|
| Rate for Payer: WellCare Medicare |
$3,478.20
|
|
|
DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$6,324.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
4002045
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,110.60 |
| Max. Negotiated Rate |
$4,110.60 |
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,110.60
|
|
|
DUAL SPRAY FOR GPS III
|
Facility
|
OP
|
$161.71
|
|
| Hospital Charge Code |
4471610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$129.37 |
| Rate for Payer: Aetna of NY Commercial |
$113.20
|
| Rate for Payer: Aetna of NY Medicare |
$74.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.68
|
| Rate for Payer: Cash Price |
$121.28
|
| Rate for Payer: CDPHP Medicare |
$59.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$129.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.37
|
| Rate for Payer: EmblemHealth Medicaid |
$129.37
|
| Rate for Payer: EmblemHealth Medicare |
$54.98
|
| Rate for Payer: EmblemHealth Select Care |
$116.43
|
| Rate for Payer: Fidelis Medicare |
$64.68
|
| Rate for Payer: Galaxy Health Commercial |
$105.11
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.68
|
| Rate for Payer: Humana Medicare |
$64.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.26
|
| Rate for Payer: United Healthcare Medicare |
$64.68
|
| Rate for Payer: WellCare Medicare |
$88.94
|
|
