|
BUPRENORPHINE-NALOX 4-1MG FILM 4 mg, 1 each
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
4401480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
BUPRENORPHINE-NALOX 8-2MG FILM 8 ea, 30 eaches
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
4401490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$7.08
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Essential Plan |
$15.93
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.08
|
| Rate for Payer: EmblemHealth Medicaid |
$7.08
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$15.93
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$6.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$708.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$708.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$15.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$15.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.08
|
| Rate for Payer: United Healthcare Commercial |
$19.32
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.43
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
BUPRENORPHINE ORAL 1MG
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
4473006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$0.24
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Essential Plan |
$0.54
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.24
|
| Rate for Payer: EmblemHealth Medicaid |
$0.24
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$2.16
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Galaxy Health Workers Comp |
$0.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$24.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$0.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$0.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$0.25
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
BUPROPION HCL 150MG TABS 30 EA
|
Facility
OP
|
$14.42
|
|
| Hospital Charge Code |
4400118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.21
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: CDPHP Commercial |
$11.61
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.34
|
| Rate for Payer: Humana Medicare |
$5.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.60
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
BUPROPION HCL 75MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400116
|
|
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
|
|
|
BUPROPION SR 100 MG TAB
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409094
|
|
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
|
|
|
BUPROPION SR 150MG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409060
|
|
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
|
|
|
BURR OVAL 10 FLUTE 3.5MM (AR-9350OBT)
|
Facility
OP
|
$204.00
|
|
| Hospital Charge Code |
4473030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.36 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna of NY Commercial |
$142.80
|
| Rate for Payer: Aetna of NY Medicare |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: CDPHP Commercial |
$164.22
|
| Rate for Payer: CDPHP Medicare |
$75.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.20
|
| Rate for Payer: EmblemHealth Medicaid |
$163.20
|
| Rate for Payer: EmblemHealth Medicare |
$69.36
|
| Rate for Payer: EmblemHealth Select Care |
$146.88
|
| Rate for Payer: Fidelis Medicare |
$77.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.48
|
| Rate for Payer: Humana Medicare |
$75.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.25
|
| Rate for Payer: United Healthcare Medicare |
$75.48
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
|
BURR ROUND 10 FLUTE 3.0MM (AR-9300RBT)
|
Facility
OP
|
$204.00
|
|
| Hospital Charge Code |
4473031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.36 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna of NY Commercial |
$142.80
|
| Rate for Payer: Aetna of NY Medicare |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: CDPHP Commercial |
$164.22
|
| Rate for Payer: CDPHP Medicare |
$75.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.20
|
| Rate for Payer: EmblemHealth Medicaid |
$163.20
|
| Rate for Payer: EmblemHealth Medicare |
$69.36
|
| Rate for Payer: EmblemHealth Select Care |
$146.88
|
| Rate for Payer: Fidelis Medicare |
$77.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.48
|
| Rate for Payer: Humana Medicare |
$75.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.25
|
| Rate for Payer: United Healthcare Medicare |
$75.48
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
|
BUSPIRONE 15 MG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409077
|
|
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
|
|
|
busPIRone HCL 5 MG TABLET 5 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401520
|
|
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
|
|
|
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
4201073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, BILTERAL
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 19083 50
|
| Hospital Charge Code |
4201072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, LEFT SIDE
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 19083 LT
|
| Hospital Charge Code |
4201071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, RIGHT SIDE
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 19083 RT
|
| Hospital Charge Code |
4201068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Facility
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4201069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.23 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$193.90
|
| Rate for Payer: Aetna of NY Medicare |
$127.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$207.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$207.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$138.50
|
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: CDPHP Commercial |
$222.98
|
| Rate for Payer: CDPHP Medicare |
$102.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$221.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.60
|
| Rate for Payer: EmblemHealth Medicaid |
$221.60
|
| Rate for Payer: EmblemHealth Medicare |
$94.18
|
| Rate for Payer: Fidelis Medicare |
$105.56
|
| Rate for Payer: Galaxy Health Commercial |
$180.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.49
|
| Rate for Payer: Humana Medicare |
$102.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$193.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$107.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.23
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$102.49
|
| Rate for Payer: WellCare Medicare |
$152.35
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
OP
|
$4,639.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
4201080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,247.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,133.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,479.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,716.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,319.50
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: Cash Price |
$3,479.25
|
| Rate for Payer: CDPHP Commercial |
$3,734.40
|
| Rate for Payer: CDPHP Medicare |
$1,716.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,711.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,711.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,577.26
|
| Rate for Payer: Fidelis Medicare |
$1,767.92
|
| Rate for Payer: Galaxy Health Commercial |
$3,015.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,716.43
|
| Rate for Payer: Humana Medicare |
$1,716.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,247.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,133.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,479.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,611.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,802.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,544.75
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.43
|
| Rate for Payer: WellCare Medicare |
$2,551.45
|
|
|
BX NAIL UNIT
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
4856703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Facility
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 55706
|
| Hospital Charge Code |
4002066
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
BYSTOLIC 2.5 MG TABLET
|
Facility
OP
|
$13.91
|
|
| Hospital Charge Code |
4409156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: Aetna of NY Commercial |
$9.74
|
| Rate for Payer: Aetna of NY Medicare |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.96
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: CDPHP Commercial |
$11.20
|
| Rate for Payer: CDPHP Medicare |
$5.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.13
|
| Rate for Payer: EmblemHealth Medicaid |
$11.13
|
| Rate for Payer: EmblemHealth Medicare |
$4.73
|
| Rate for Payer: EmblemHealth Select Care |
$10.02
|
| Rate for Payer: Fidelis Medicare |
$5.30
|
| Rate for Payer: Galaxy Health Commercial |
$9.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.15
|
| Rate for Payer: Humana Medicare |
$5.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.40
|
| Rate for Payer: United Healthcare Medicare |
$5.15
|
| Rate for Payer: WellCare Medicare |
$7.65
|
|
|
BYSTOLIC 5 MG TAB
|
Facility
OP
|
$13.91
|
|
| Hospital Charge Code |
4409096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: Aetna of NY Commercial |
$9.74
|
| Rate for Payer: Aetna of NY Medicare |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.96
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: CDPHP Commercial |
$11.20
|
| Rate for Payer: CDPHP Medicare |
$5.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.13
|
| Rate for Payer: EmblemHealth Medicaid |
$11.13
|
| Rate for Payer: EmblemHealth Medicare |
$4.73
|
| Rate for Payer: EmblemHealth Select Care |
$10.02
|
| Rate for Payer: Fidelis Medicare |
$5.30
|
| Rate for Payer: Galaxy Health Commercial |
$9.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.15
|
| Rate for Payer: Humana Medicare |
$5.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.40
|
| Rate for Payer: United Healthcare Medicare |
$5.15
|
| Rate for Payer: WellCare Medicare |
$7.65
|
|
|
CA 19-9
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
4301023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$86.14 |
| Rate for Payer: Aetna of NY Commercial |
$69.55
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.50
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$69.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$80.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$80.25
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
CAD BREAST MRI
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
4230213
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
CALCITONIN
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
4301152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$214.13 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$122.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$133.00
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: CDPHP Commercial |
$214.13
|
| Rate for Payer: CDPHP Medicare |
$98.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.80
|
| Rate for Payer: EmblemHealth Medicaid |
$212.80
|
| Rate for Payer: EmblemHealth Medicare |
$90.44
|
| Rate for Payer: Fidelis Medicare |
$101.37
|
| Rate for Payer: Galaxy Health Commercial |
$172.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.42
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$199.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.79
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: United Healthcare Medicare |
$98.42
|
| Rate for Payer: WellCare Medicare |
$146.30
|
|
|
CALCITRATE ORAL
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409233
|
|
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
|
|
