|
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
|
|
|
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 |
$8.25 |
| Max. Negotiated Rate |
$44.00 |
| 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) Medicare |
$22.00
|
| Rate for Payer: Cash Price |
$41.25
|
| 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 |
$22.00
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.00
|
| Rate for Payer: Humana Medicare |
$22.00
|
| 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 |
$23.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
|
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
|
|
|
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 |
$7.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.46
|
| 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 |
$31.46
|
| Rate for Payer: Fidelis Medicare |
$20.00
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.00
|
| Rate for Payer: Humana Medicare |
$20.00
|
| 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 |
$21.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$33.28
|
| Rate for Payer: United Healthcare Medicare |
$20.00
|
| 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 |
$27.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.46
|
| Rate for Payer: EmblemHealth Select Care |
$31.46
|
| 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
|
$15.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
4300127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
4300127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
4300129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
4300129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
BIOCHEMICAL ID
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of NY Commercial |
$15.60
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$14.40
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$18.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
BIOCHEMICAL ID
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
4301135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
BIOCLUSIVE DRESS 2" X 3
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
4471913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Galaxy Health Commercial |
$26.78
|
|
|
BIOCLUSIVE DRESS 2" X 3
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
4471913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.96 |
| Rate for Payer: Aetna of NY Commercial |
$28.84
|
| Rate for Payer: Aetna of NY Medicare |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: CDPHP Medicare |
$15.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.96
|
| Rate for Payer: EmblemHealth Medicaid |
$32.96
|
| Rate for Payer: EmblemHealth Medicare |
$14.01
|
| Rate for Payer: EmblemHealth Select Care |
$29.66
|
| Rate for Payer: Fidelis Medicare |
$16.48
|
| Rate for Payer: Galaxy Health Commercial |
$26.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.18
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$22.66
|
|
|
BIOGLO FLUORESCEIN OPHTH DIAGNOSTIC STRI
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 17238090030
|
| Hospital Charge Code |
4409113
|
|
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
|
|
|
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
|
$2,415.35
|
|
| Hospital Charge Code |
4471234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.30 |
| Max. Negotiated Rate |
$1,932.28 |
| Rate for Payer: Aetna of NY Commercial |
$1,690.74
|
| Rate for Payer: Aetna of NY Medicare |
$1,111.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$966.14
|
| Rate for Payer: Cash Price |
$1,811.51
|
| Rate for Payer: CDPHP Medicare |
$893.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,932.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,932.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,932.28
|
| Rate for Payer: EmblemHealth Medicaid |
$1,932.28
|
| Rate for Payer: EmblemHealth Medicare |
$821.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,739.05
|
| Rate for Payer: Fidelis Medicare |
$966.14
|
| Rate for Payer: Galaxy Health Commercial |
$1,569.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$966.14
|
| Rate for Payer: Humana Medicare |
$966.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,690.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,111.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,811.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,359.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,014.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$362.30
|
| Rate for Payer: United Healthcare Medicare |
$966.14
|
| Rate for Payer: WellCare Medicare |
$1,328.44
|
|
|
BIOPSY FORCEPS
|
Facility
|
IP
|
$2,415.35
|
|
| Hospital Charge Code |
4471234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,569.98 |
| Max. Negotiated Rate |
$1,569.98 |
| Rate for Payer: Cash Price |
$1,811.51
|
| Rate for Payer: Galaxy Health Commercial |
$1,569.98
|
|
|
BIOPSY FORCEPS 3.7MM CHANNEL
|
Facility
|
OP
|
$1,293.68
|
|
| Hospital Charge Code |
4471870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$194.05 |
| Max. Negotiated Rate |
$1,034.94 |
| Rate for Payer: Aetna of NY Commercial |
$905.58
|
| Rate for Payer: Aetna of NY Medicare |
$595.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$517.47
|
| Rate for Payer: Cash Price |
$970.26
|
| Rate for Payer: CDPHP Medicare |
$478.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,034.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,034.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,034.94
|
| Rate for Payer: EmblemHealth Medicaid |
$1,034.94
|
| Rate for Payer: EmblemHealth Medicare |
$439.85
|
| Rate for Payer: EmblemHealth Select Care |
$931.45
|
| Rate for Payer: Fidelis Medicare |
$517.47
|
| Rate for Payer: Galaxy Health Commercial |
$840.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$517.47
|
| Rate for Payer: Humana Medicare |
$517.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$905.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$595.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$728.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$543.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$194.05
|
| Rate for Payer: United Healthcare Medicare |
$517.47
|
| Rate for Payer: WellCare Medicare |
$711.52
|
|
|
BIOPSY FORCEPS 3.7MM CHANNEL
|
Facility
|
IP
|
$1,293.68
|
|
| Hospital Charge Code |
4471870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$840.89 |
| Max. Negotiated Rate |
$840.89 |
| Rate for Payer: Cash Price |
$970.26
|
| Rate for Payer: Galaxy Health Commercial |
$840.89
|
|
|
BIOPSY MUSCLE PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
4853035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$4,049.60 |
| Rate for Payer: Aetna of NY Commercial |
$3,543.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,024.80
|
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: CDPHP Medicare |
$1,872.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,049.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,049.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,721.08
|
| Rate for Payer: EmblemHealth Select Care |
$3,644.64
|
| Rate for Payer: Fidelis Medicare |
$2,024.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,024.80
|
| Rate for Payer: Humana Medicare |
$2,024.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,543.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,796.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,849.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,126.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$759.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.80
|
| Rate for Payer: WellCare Medicare |
$2,784.10
|
|
|
BIOPSY MUSCLE PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$5,062.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
4853035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,290.30 |
| Max. Negotiated Rate |
$3,290.30 |
| Rate for Payer: Cash Price |
$3,796.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,290.30
|
|
|
BIOPSY PENIS DEEP STRUCTURES
|
Facility
|
OP
|
$8,903.00
|
|
|
Service Code
|
HCPCS 54105
|
| Hospital Charge Code |
4002044
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,335.45 |
| Max. Negotiated Rate |
$7,122.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,095.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,561.20
|
| Rate for Payer: Cash Price |
$6,677.25
|
| Rate for Payer: Cash Price |
$6,677.25
|
| Rate for Payer: CDPHP Medicare |
$3,294.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,122.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$7,122.40
|
| Rate for Payer: EmblemHealth Medicare |
$3,027.02
|
| Rate for Payer: EmblemHealth Select Care |
$6,410.16
|
| Rate for Payer: Fidelis Medicare |
$3,561.20
|
| Rate for Payer: Galaxy Health Commercial |
$5,786.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,561.20
|
| Rate for Payer: Humana Medicare |
$3,561.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,095.38
|
| Rate for Payer: Multiplan Commercial |
$7,122.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,677.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,012.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,739.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,335.45
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$3,561.20
|
| Rate for Payer: WellCare Medicare |
$4,896.65
|
|
|
BIOPSY PENIS DEEP STRUCTURES
|
Facility
|
IP
|
$8,903.00
|
|
|
Service Code
|
HCPCS 54105
|
| Hospital Charge Code |
4002044
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$5,786.95 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Cash Price |
$6,677.25
|
| Rate for Payer: Galaxy Health Commercial |
$5,786.95
|
|
|
BIOPSY PROSTATE ANY APPROACH NONIMAGING-GUIDED
|
Facility
|
OP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55705
|
| Hospital Charge Code |
4002075
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,080.45 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$3,313.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,881.20
|
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: CDPHP Medicare |
$2,665.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,762.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,762.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,762.40
|
| Rate for Payer: EmblemHealth Medicaid |
$5,762.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,449.02
|
| Rate for Payer: EmblemHealth Select Care |
$5,186.16
|
| Rate for Payer: Fidelis Medicare |
$2,881.20
|
| Rate for Payer: Galaxy Health Commercial |
$4,681.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,881.20
|
| Rate for Payer: Humana Medicare |
$2,881.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,313.38
|
| Rate for Payer: Multiplan Commercial |
$5,762.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,402.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,055.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,025.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,080.45
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$2,881.20
|
| Rate for Payer: WellCare Medicare |
$3,961.65
|
|
|
BIOPSY PROSTATE ANY APPROACH NONIMAGING-GUIDED
|
Facility
|
IP
|
$7,203.00
|
|
|
Service Code
|
HCPCS 55705
|
| Hospital Charge Code |
4002075
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,681.95 |
| Max. Negotiated Rate |
$4,681.95 |
| Rate for Payer: Cash Price |
$5,402.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,681.95
|
|
