|
BETA 2 GLYCOPROTEIN I AB EA
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
4301429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: Galaxy Health Commercial |
$124.15
|
|
|
BETA 2 GLYCOPROTEIN I AB EA
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
4301429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna of NY Commercial |
$124.15
|
| Rate for Payer: Aetna of NY Medicare |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$143.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$143.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$95.50
|
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: CDPHP Commercial |
$153.76
|
| Rate for Payer: CDPHP Medicare |
$70.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$114.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$152.80
|
| Rate for Payer: EmblemHealth Medicaid |
$152.80
|
| Rate for Payer: EmblemHealth Medicare |
$64.94
|
| Rate for Payer: EmblemHealth Select Care |
$114.60
|
| Rate for Payer: Fidelis Medicare |
$72.79
|
| Rate for Payer: Galaxy Health Commercial |
$124.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.67
|
| Rate for Payer: Humana Medicare |
$70.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$124.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$87.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$107.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$143.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$143.25
|
| Rate for Payer: United Healthcare Medicare |
$70.67
|
| Rate for Payer: WellCare Medicare |
$105.05
|
|
|
BETAMETHASONE ACET&SOD PHOSP 3MG
|
Facility
|
OP
|
$130.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
4400104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of NY Commercial |
$71.95
|
| Rate for Payer: Aetna of NY Medicare |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$65.40
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: CDPHP Commercial |
$105.30
|
| Rate for Payer: CDPHP Medicare |
$48.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.65
|
| Rate for Payer: EmblemHealth Medicaid |
$104.65
|
| Rate for Payer: EmblemHealth Medicare |
$44.48
|
| Rate for Payer: EmblemHealth Select Care |
$6.88
|
| Rate for Payer: Fidelis Medicare |
$49.85
|
| Rate for Payer: Galaxy Health Commercial |
$85.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.40
|
| Rate for Payer: Humana Medicare |
$48.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$71.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$60.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$73.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.89
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$48.40
|
| Rate for Payer: WellCare Medicare |
$71.95
|
|
|
BETAMETHASONE ACET&SOD PHOSP 3MG
|
Facility
|
IP
|
$130.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
4400104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.03 |
| Rate for Payer: Aetna of NY Commercial |
$71.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.88
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.88
|
| Rate for Payer: EmblemHealth Select Care |
$6.88
|
| Rate for Payer: Galaxy Health Commercial |
$85.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$71.95
|
| Rate for Payer: WellCare Medicare |
$71.95
|
|
|
BETA STREP CULTURE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
BETA STREP CULTURE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$17.55
|
| 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: 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 |
$16.20
|
| 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 |
$16.20
|
| 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 |
$17.55
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$20.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
BETHANECHOL 10 MG TABLET 10 mg, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
4401387
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
BETHANECHOL 10 MG TABLET 10 mg, 1 each
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
4401387
|
|
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
|
|
|
BICALUTAMIDE 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
4401548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
BICALUTAMIDE 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
4401548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$44.28 |
| Rate for Payer: Aetna of NY Commercial |
$38.50
|
| Rate for Payer: Aetna of NY Medicare |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.50
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: CDPHP Commercial |
$44.28
|
| Rate for Payer: CDPHP Medicare |
$20.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.00
|
| Rate for Payer: EmblemHealth Medicaid |
$44.00
|
| Rate for Payer: EmblemHealth Medicare |
$18.70
|
| Rate for Payer: EmblemHealth Select Care |
$39.60
|
| Rate for Payer: Fidelis Medicare |
$20.96
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.35
|
| Rate for Payer: Humana Medicare |
$20.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.37
|
| Rate for Payer: United Healthcare Medicare |
$20.35
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
Bicillin L-A 2,400,000 UNITS 100000 unit, 4 mL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
4401347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$22.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$33.28
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
Bicillin L-A 2,400,000 UNITS 100000 unit, 4 mL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
4401347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.00
|
| Rate for Payer: EmblemHealth Select Care |
$22.00
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
4300127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$16.25
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$18.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$18.75
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
4300127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
4300129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$19.80
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
4300129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
BIOCHEMICAL ID
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$19.20
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
BIOCHEMICAL ID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
BIOCLUSIVE DRESS 2" X 3
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
4471913
|
|
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
|
|
|
BIOCLUSIVE DRESS 2" X 3
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
4471913
|
|
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
|
|
|
BIOGLO FLUORESCEIN OPHTH DIAGNOSTIC STRI
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 17238090030
|
| Hospital Charge Code |
4409113
|
|
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
|
|
|
BIOGLO FLUORESCEIN OPHTH DIAGNOSTIC STRI
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 17238090030
|
| Hospital Charge Code |
4409113
|
|
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
|
|
|
BIOPSY FORCEPS
|
Facility
|
OP
|
$2,345.00
|
|
| Hospital Charge Code |
4471234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$797.30 |
| Max. Negotiated Rate |
$1,887.72 |
| Rate for Payer: Aetna of NY Commercial |
$1,641.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,078.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,758.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,758.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$867.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,172.50
|
| Rate for Payer: Cash Price |
$1,758.75
|
| Rate for Payer: CDPHP Commercial |
$1,887.72
|
| Rate for Payer: CDPHP Medicare |
$867.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,876.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,876.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,876.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,876.00
|
| Rate for Payer: EmblemHealth Medicare |
$797.30
|
| Rate for Payer: EmblemHealth Select Care |
$1,688.40
|
| Rate for Payer: Fidelis Medicare |
$893.68
|
| Rate for Payer: Galaxy Health Commercial |
$1,524.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$867.65
|
| Rate for Payer: Humana Medicare |
$867.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,641.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,078.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,758.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,320.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.03
|
| Rate for Payer: United Healthcare Medicare |
$867.65
|
| Rate for Payer: WellCare Medicare |
$1,289.75
|
|
|
BIOPSY FORCEPS
|
Facility
|
IP
|
$2,345.00
|
|
| Hospital Charge Code |
4471234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,524.25 |
| Max. Negotiated Rate |
$1,524.25 |
| Rate for Payer: Cash Price |
$1,758.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,524.25
|
|
|
BIOPSY FORCEPS 3.7MM CHANNEL
|
Facility
|
OP
|
$1,256.00
|
|
| Hospital Charge Code |
4471870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.04 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna of NY Commercial |
$879.20
|
| Rate for Payer: Aetna of NY Medicare |
$577.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$942.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$942.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$464.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$628.00
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: CDPHP Commercial |
$1,011.08
|
| Rate for Payer: CDPHP Medicare |
$464.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,004.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,004.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,004.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,004.80
|
| Rate for Payer: EmblemHealth Medicare |
$427.04
|
| Rate for Payer: EmblemHealth Select Care |
$904.32
|
| Rate for Payer: Fidelis Medicare |
$478.66
|
| Rate for Payer: Galaxy Health Commercial |
$816.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$464.72
|
| Rate for Payer: Humana Medicare |
$464.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$879.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$577.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$942.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$707.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$487.96
|
| Rate for Payer: United Healthcare Medicare |
$464.72
|
| Rate for Payer: WellCare Medicare |
$690.80
|
|
