|
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 96127
|
| Hospital Charge Code |
4600003
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$94.40 |
| Rate for Payer: Aetna of NY Commercial |
$82.60
|
| Rate for Payer: Aetna of NY Medicare |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: CDPHP Medicare |
$43.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.40
|
| Rate for Payer: EmblemHealth Medicaid |
$94.40
|
| Rate for Payer: EmblemHealth Medicare |
$40.12
|
| Rate for Payer: Fidelis Medicare |
$47.20
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.20
|
| Rate for Payer: Humana Medicare |
$47.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$82.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
| Rate for Payer: WellCare Medicare |
$64.90
|
|
|
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 96127
|
| Hospital Charge Code |
4600003
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
|
|
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
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN
|
| Hospital Charge Code |
4670254
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$315.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$157.60
|
| 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 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 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$157.60
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$157.60
|
| Rate for Payer: Humana Medicare |
$157.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$157.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| 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)
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59
|
| Hospital Charge Code |
4670294
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$315.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$157.60
|
| 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 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 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$157.60
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$157.60
|
| Rate for Payer: Humana Medicare |
$157.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$157.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
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 |
$59.10 |
| Max. Negotiated Rate |
$315.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$157.60
|
| 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 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 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$157.60
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$157.60
|
| Rate for Payer: Humana Medicare |
$157.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$157.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
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 (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 |
$59.10 |
| Max. Negotiated Rate |
$315.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$157.60
|
| 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 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 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$157.60
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$157.60
|
| Rate for Payer: Humana Medicare |
$157.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$157.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BENTSON PLUS WIRE GUIDE
|
Facility
|
OP
|
$88.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$70.86 |
| Rate for Payer: Aetna of NY Commercial |
$62.01
|
| Rate for Payer: Aetna of NY Medicare |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.43
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: CDPHP Medicare |
$32.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$70.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.86
|
| Rate for Payer: EmblemHealth Medicaid |
$70.86
|
| Rate for Payer: EmblemHealth Medicare |
$30.12
|
| Rate for Payer: EmblemHealth Select Care |
$63.78
|
| Rate for Payer: Fidelis Medicare |
$35.43
|
| Rate for Payer: Galaxy Health Commercial |
$57.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.43
|
| Rate for Payer: Humana Medicare |
$35.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.29
|
| Rate for Payer: United Healthcare Medicare |
$35.43
|
| Rate for Payer: WellCare Medicare |
$48.72
|
|
|
BENTSON PLUS WIRE GUIDE
|
Facility
|
IP
|
$88.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$57.58 |
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: Galaxy Health Commercial |
$57.58
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
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
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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
|
|
|
BETA 2 GLYCOPROTEIN I AB EA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
4301429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
|
|
BETA 2 GLYCOPROTEIN I AB EA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
4301429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of NY Commercial |
$49.40
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: EmblemHealth Select Care |
$45.60
|
| Rate for Payer: Fidelis Medicare |
$30.40
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.40
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.40
|
| Rate for Payer: United Healthcare Commercial |
$57.00
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
BETAMETHASONE ACET&SOD PHOSP 3MG
|
Facility
|
IP
|
$130.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
4400104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$85.03 |
| Rate for Payer: Aetna of NY Commercial |
$71.95
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.97
|
| Rate for Payer: EmblemHealth Select Care |
$6.97
|
| 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
|
|
|
BETAMETHASONE ACET&SOD PHOSP 3MG
|
Facility
|
OP
|
$130.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
4400104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna of NY Medicare |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.32
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: CDPHP Medicare |
$48.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.97
|
| 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 |
$6.97
|
| Rate for Payer: Fidelis Medicare |
$52.32
|
| Rate for Payer: Galaxy Health Commercial |
$85.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.32
|
| Rate for Payer: Humana Medicare |
$52.32
|
| 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 |
$54.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.62
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$52.32
|
| Rate for Payer: WellCare Medicare |
$71.95
|
|
|
BETA STREP CULTURE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
BETA STREP CULTURE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
4300124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of NY Commercial |
$13.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$12.00
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
BETHANECHOL 10 MG TABLET 10 mg, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 832051189
|
| 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
|
|
