|
EMERGENCY DEPT VISIT LVL 1
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4600082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$657.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: CDPHP Commercial |
$185.15
|
| Rate for Payer: CDPHP Medicare |
$85.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$184.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.00
|
| Rate for Payer: EmblemHealth Medicaid |
$184.00
|
| Rate for Payer: EmblemHealth Medicare |
$78.20
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$87.65
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.10
|
| Rate for Payer: Humana Medicare |
$85.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$84.59
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$85.10
|
| Rate for Payer: WellCare Medicare |
$126.50
|
|
|
EMERGENCY DEPT VISIT LVL 1
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4600082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Galaxy Health Commercial |
$149.50
|
|
|
EMERGENCY DEPT VISIT LVL 2
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4600083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$197.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$159.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$657.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: CDPHP Commercial |
$346.15
|
| Rate for Payer: CDPHP Medicare |
$159.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$344.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$344.00
|
| Rate for Payer: EmblemHealth Medicaid |
$344.00
|
| Rate for Payer: EmblemHealth Medicare |
$146.20
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$163.87
|
| Rate for Payer: Galaxy Health Commercial |
$279.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$159.10
|
| Rate for Payer: Humana Medicare |
$159.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$167.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$155.83
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$159.10
|
| Rate for Payer: WellCare Medicare |
$236.50
|
|
|
EMERGENCY DEPT VISIT LVL 2
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4600083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Galaxy Health Commercial |
$279.50
|
|
|
EMERGENCY DEPT VISIT LVL 3
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4600084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$277.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$657.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: CDPHP Commercial |
$603.75
|
| Rate for Payer: CDPHP Medicare |
$277.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$600.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$600.00
|
| Rate for Payer: EmblemHealth Medicaid |
$600.00
|
| Rate for Payer: EmblemHealth Medicare |
$255.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$285.82
|
| Rate for Payer: Galaxy Health Commercial |
$487.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$277.50
|
| Rate for Payer: Humana Medicare |
$277.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$291.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$271.85
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$277.50
|
| Rate for Payer: WellCare Medicare |
$412.50
|
|
|
EMERGENCY DEPT VISIT LVL 3
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4600084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Galaxy Health Commercial |
$487.50
|
|
|
EMERGENCY DEPT VISIT LVL 4
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4600085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
EMERGENCY DEPT VISIT LVL 4
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4600085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$407.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$745.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Commercial |
$885.50
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$419.21
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$407.00
|
| Rate for Payer: Humana Medicare |
$407.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$427.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$422.00
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$407.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
EMERGENCY DEPT VISIT LVL 5
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4600086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Galaxy Health Commercial |
$910.00
|
|
|
EMERGENCY DEPT VISIT LVL 5
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4600086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$644.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$518.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$745.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: CDPHP Commercial |
$1,127.00
|
| Rate for Payer: CDPHP Medicare |
$518.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,120.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,120.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,120.00
|
| Rate for Payer: EmblemHealth Medicare |
$476.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$533.54
|
| Rate for Payer: Galaxy Health Commercial |
$910.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$518.00
|
| Rate for Payer: Humana Medicare |
$518.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$543.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$611.99
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$518.00
|
| Rate for Payer: WellCare Medicare |
$770.00
|
|
|
ENALAPRILAT DIHYDRATE 1.25MG/ML SDV 10X1
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
4400270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of NY Commercial |
$7.75
|
| Rate for Payer: Aetna of NY Medicare |
$5.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.54
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: CDPHP Commercial |
$8.91
|
| Rate for Payer: CDPHP Medicare |
$4.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.86
|
| Rate for Payer: EmblemHealth Medicaid |
$8.86
|
| Rate for Payer: EmblemHealth Medicare |
$3.76
|
| Rate for Payer: EmblemHealth Select Care |
$7.97
|
| Rate for Payer: Fidelis Medicare |
$4.22
|
| Rate for Payer: Galaxy Health Commercial |
$7.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.10
|
| Rate for Payer: Humana Medicare |
$4.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.30
|
| Rate for Payer: United Healthcare Medicare |
$4.10
|
| Rate for Payer: WellCare Medicare |
$6.09
|
|
|
ENALAPRILAT DIHYDRATE 1.25MG/ML SDV 10X1
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
4400270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Galaxy Health Commercial |
$7.20
|
| Rate for Payer: WellCare Medicare |
$6.09
|
|
|
ENDOSCOPIC CYTOLOGY BRUSH
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
4479159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna of NY Commercial |
$37.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.50
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: CDPHP Commercial |
$42.66
|
| Rate for Payer: CDPHP Medicare |
$19.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.40
|
| Rate for Payer: EmblemHealth Medicaid |
$42.40
|
| Rate for Payer: EmblemHealth Medicare |
$18.02
|
| Rate for Payer: EmblemHealth Select Care |
$38.16
|
| Rate for Payer: Fidelis Medicare |
$20.20
|
| Rate for Payer: Galaxy Health Commercial |
$34.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.61
|
| Rate for Payer: Humana Medicare |
$19.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.59
|
| Rate for Payer: United Healthcare Medicare |
$19.61
|
| Rate for Payer: WellCare Medicare |
$29.15
|
|
|
ENDOSCOPIC CYTOLOGY BRUSH
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
4479159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Galaxy Health Commercial |
$34.45
|
|
|
ENDOVIVE SAFETY PEG PUSH METH
|
Facility
|
IP
|
$662.00
|
|
| Hospital Charge Code |
4471978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$430.30 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
|
|
ENDOVIVE SAFETY PEG PUSH METH
|
Facility
|
OP
|
$662.00
|
|
| Hospital Charge Code |
4471978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.08 |
| Max. Negotiated Rate |
$532.91 |
| Rate for Payer: Aetna of NY Commercial |
$463.40
|
| Rate for Payer: Aetna of NY Medicare |
$304.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$244.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$331.00
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Commercial |
$532.91
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$529.60
|
| Rate for Payer: EmblemHealth Medicaid |
$529.60
|
| Rate for Payer: EmblemHealth Medicare |
$225.08
|
| Rate for Payer: EmblemHealth Select Care |
$476.64
|
| Rate for Payer: Fidelis Medicare |
$252.29
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$244.94
|
| Rate for Payer: Humana Medicare |
$244.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$463.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$304.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$372.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$257.19
|
| Rate for Payer: United Healthcare Medicare |
$244.94
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.40
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Commercial |
$2.25
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.03
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| 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: 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 |
$0.62
|
| 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 |
$0.62
|
| 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 |
$3.30
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.40
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Commercial |
$2.25
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.03
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
4304884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$146.51 |
| Rate for Payer: Aetna of NY Commercial |
$118.30
|
| Rate for Payer: Aetna of NY Medicare |
$83.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$91.00
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: CDPHP Commercial |
$146.51
|
| Rate for Payer: CDPHP Medicare |
$67.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$145.60
|
| Rate for Payer: EmblemHealth Medicaid |
$145.60
|
| Rate for Payer: EmblemHealth Medicare |
$61.88
|
| Rate for Payer: EmblemHealth Select Care |
$109.20
|
| Rate for Payer: Fidelis Medicare |
$69.36
|
| Rate for Payer: Galaxy Health Commercial |
$118.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.34
|
| Rate for Payer: Humana Medicare |
$67.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$118.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$102.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$136.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$136.50
|
| Rate for Payer: United Healthcare Medicare |
$67.34
|
| Rate for Payer: WellCare Medicare |
$100.10
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
4304884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Galaxy Health Commercial |
$118.30
|
|
|
ENTRESTO 24 MG-26 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
4401356
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
