|
BARRIER SKIN 2 3/4 FLEX COST BOX 10
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4479131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
BASIC DIAGNOSTIC TRAY (BREAST BIOPSY)
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4473020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
BASIC DIAGNOSTIC TRAY (BREAST BIOPSY)
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
4473020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
BASIC METABOLIC PANEL
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
4300117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
|
|
BASIC METABOLIC PANEL
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
4300117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$31.20
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$28.80
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
BASIC PACKS
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
4479173
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
BASIC PACKS
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
4479173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna of NY Commercial |
$28.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Commercial |
$32.20
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.00
|
| 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 |
$28.80
|
| Rate for Payer: Fidelis Medicare |
$15.24
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.00
|
| 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 |
$15.54
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 96127
|
| Hospital Charge Code |
4600003
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 96127
|
| Hospital Charge Code |
4600003
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$80.50
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$80.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.21
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
BEHAVRAL QUALIT ANALYS VOICE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN
|
| Hospital Charge Code |
4670254
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BEHAVRAL QUALIT ANALYS VOICE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN
|
| Hospital Charge Code |
4670254
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (MOD 59)
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59
|
| Hospital Charge Code |
4670294
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (MOD 59)
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59
|
| Hospital Charge Code |
4670294
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (MOD 59 W KX)
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59,KX
|
| Hospital Charge Code |
4670310
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (MOD 59 W KX)
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59,KX
|
| Hospital Charge Code |
4670310
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (W/ KX)
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,KX
|
| Hospital Charge Code |
4670272
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (W/ KX)
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,KX
|
| Hospital Charge Code |
4670272
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BENTSON PLUS WIRE GUIDE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
|
|
BENTSON PLUS WIRE GUIDE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna of NY Commercial |
$60.20
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: EmblemHealth Select Care |
$61.92
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$60.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
BENZOCAINE/MENTHOL 15-3.6MG LOZG 16 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63824071316
|
| Hospital Charge Code |
4400152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BENZOCAINE/MENTHOL 15-3.6MG LOZG 16 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63824071316
|
| Hospital Charge Code |
4400152
|
|
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
|
|
|
BENZONATATE 100MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739002910
|
| Hospital Charge Code |
4400100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BENZONATATE 100MG CAPS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739002910
|
| Hospital Charge Code |
4400100
|
|
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
|
|
|
BENZTROPINE 1 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 76385010401
|
| Hospital Charge Code |
4401253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BENZTROPINE 1 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 76385010401
|
| Hospital Charge Code |
4401253
|
|
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
|
|
