|
CVC/PICC DRESSING CHANGE KIT
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
4479204
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Aetna of NY Commercial |
$47.60
|
| Rate for Payer: Aetna of NY Medicare |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: CDPHP Commercial |
$54.74
|
| Rate for Payer: CDPHP Medicare |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$54.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$54.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.40
|
| Rate for Payer: EmblemHealth Medicaid |
$54.40
|
| Rate for Payer: EmblemHealth Medicare |
$23.12
|
| Rate for Payer: EmblemHealth Select Care |
$48.96
|
| Rate for Payer: Fidelis Medicare |
$25.91
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.16
|
| Rate for Payer: Humana Medicare |
$25.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$47.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.42
|
| Rate for Payer: United Healthcare Medicare |
$25.16
|
| Rate for Payer: WellCare Medicare |
$37.40
|
|
|
CVC/PICC DRESSING CHANGE KIT
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
4479204
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
|
|
Cyanocobalamin 1000 MCG Tab
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
4400832
|
|
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
|
|
|
Cyanocobalamin 1000 MCG Tab
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
4400832
|
|
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
|
|
|
CYCLOBENZAPRINE 5 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268019011
|
| Hospital Charge Code |
4401264
|
|
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
|
|
|
CYCLOBENZAPRINE 5 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268019011
|
| Hospital Charge Code |
4401264
|
|
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
|
|
|
CYCLOBENZAPRINE HCL 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904780961
|
| Hospital Charge Code |
4400202
|
|
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
|
|
|
CYCLOBENZAPRINE HCL 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904780961
|
| Hospital Charge Code |
4400202
|
|
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
|
|
|
CYCLOPENTOLATE 1 % OS
|
Facility
|
IP
|
$57.17
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
4409051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$37.16 |
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: Galaxy Health Commercial |
$37.16
|
| Rate for Payer: WellCare Medicare |
$31.44
|
|
|
CYCLOPENTOLATE 1 % OS
|
Facility
|
OP
|
$57.17
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
4409051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$46.02 |
| Rate for Payer: Aetna of NY Commercial |
$40.02
|
| Rate for Payer: Aetna of NY Medicare |
$26.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.58
|
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: CDPHP Commercial |
$46.02
|
| Rate for Payer: CDPHP Medicare |
$21.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.74
|
| Rate for Payer: EmblemHealth Medicaid |
$45.74
|
| Rate for Payer: EmblemHealth Medicare |
$19.44
|
| Rate for Payer: EmblemHealth Select Care |
$41.16
|
| Rate for Payer: Fidelis Medicare |
$21.79
|
| Rate for Payer: Galaxy Health Commercial |
$37.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.15
|
| Rate for Payer: Humana Medicare |
$21.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.21
|
| Rate for Payer: United Healthcare Medicare |
$21.15
|
| Rate for Payer: WellCare Medicare |
$31.44
|
|
|
CYCLOSPORIN WHOLE BLOOD
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
4300252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna of NY Commercial |
$81.25
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$93.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$93.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$62.50
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Commercial |
$100.62
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: EmblemHealth Select Care |
$75.00
|
| Rate for Payer: Fidelis Medicare |
$47.64
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.25
|
| Rate for Payer: Humana Medicare |
$46.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$81.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$93.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$93.75
|
| Rate for Payer: United Healthcare Medicare |
$46.25
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
CYCLOSPORIN WHOLE BLOOD
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
4300252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
|
|
CYGNUS MATRIX, PER SQUARE CENTIMETER
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
4473041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.64 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna of NY Commercial |
$669.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$317.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$317.64
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$317.64
|
| Rate for Payer: EmblemHealth Select Care |
$317.64
|
| Rate for Payer: Galaxy Health Commercial |
$791.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$669.90
|
| Rate for Payer: WellCare Medicare |
$669.90
|
|
|
CYGNUS MATRIX, PER SQUARE CENTIMETER
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
4473041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.64 |
| Max. Negotiated Rate |
$980.49 |
| Rate for Payer: Aetna of NY Commercial |
$669.90
|
| Rate for Payer: Aetna of NY Medicare |
$560.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$317.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$317.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$450.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$609.00
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: CDPHP Commercial |
$980.49
|
| Rate for Payer: CDPHP Medicare |
$450.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$317.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$974.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$974.40
|
| Rate for Payer: EmblemHealth Medicaid |
$974.40
|
| Rate for Payer: EmblemHealth Medicare |
$414.12
|
| Rate for Payer: EmblemHealth Select Care |
$317.64
|
| Rate for Payer: Fidelis Medicare |
$464.18
|
| Rate for Payer: Galaxy Health Commercial |
$791.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$450.66
|
| Rate for Payer: Humana Medicare |
$450.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$669.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$560.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$913.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$685.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$473.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$469.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$317.64
|
| Rate for Payer: United Healthcare Commercial |
$469.67
|
| Rate for Payer: United Healthcare Medicare |
$450.66
|
| Rate for Payer: WellCare Medicare |
$669.90
|
|
|
CYMBALTA 20 MG
|
Facility
|
IP
|
$23.95
|
|
|
Service Code
|
NDC 00904645204
|
| Hospital Charge Code |
4401251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$15.57 |
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Galaxy Health Commercial |
$15.57
|
| Rate for Payer: WellCare Medicare |
$13.17
|
|
|
CYMBALTA 20 MG
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 00904645204
|
| Hospital Charge Code |
4401251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna of NY Commercial |
$16.76
|
| Rate for Payer: Aetna of NY Medicare |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.98
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: CDPHP Commercial |
$19.28
|
| Rate for Payer: CDPHP Medicare |
$8.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.16
|
| Rate for Payer: EmblemHealth Medicaid |
$19.16
|
| Rate for Payer: EmblemHealth Medicare |
$8.14
|
| Rate for Payer: EmblemHealth Select Care |
$17.24
|
| Rate for Payer: Fidelis Medicare |
$9.13
|
| Rate for Payer: Galaxy Health Commercial |
$15.57
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.86
|
| Rate for Payer: Humana Medicare |
$8.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.96
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.30
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WellCare Medicare |
$13.17
|
|
|
CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
4002015
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
4002015
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
4002019
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
4002019
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Facility
|
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
4002006
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$11,918.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,810.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,478.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: CDPHP Commercial |
$11,918.83
|
| Rate for Payer: CDPHP Medicare |
$5,478.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicare |
$5,034.04
|
| Rate for Payer: EmblemHealth Select Care |
$10,660.32
|
| Rate for Payer: Fidelis Medicare |
$5,642.57
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,478.22
|
| Rate for Payer: Humana Medicare |
$5,478.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,810.76
|
| Rate for Payer: Multiplan Commercial |
$11,844.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,104.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,335.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,752.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,930.08
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
4002006
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,623.90 |
| Max. Negotiated Rate |
$9,623.90 |
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
|
|
CYSTO MANJ W/O RMVL URETERAL STONE
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52330
|
| Hospital Charge Code |
4002024
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
CYSTO MANJ W/O RMVL URETERAL STONE
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 52330
|
| Hospital Charge Code |
4002024
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Facility
|
IP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
4002029
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,623.90 |
| Max. Negotiated Rate |
$9,623.90 |
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
|
