ERTAPENEM SODIUM 500 MG INJ
|
Facility
|
IP
|
$235.00
|
|
Service Code
|
HCPCS J1335
|
Hospital Charge Code |
4400392
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.90 |
Max. Negotiated Rate |
$152.75 |
Rate for Payer: Aetna of NY Commercial |
$129.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.90
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.90
|
Rate for Payer: Cash Price |
$176.25
|
Rate for Payer: Cash Price |
$176.25
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.90
|
Rate for Payer: EmblemHealth Select Care |
$11.90
|
Rate for Payer: Galaxy Health Commercial |
$152.75
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$129.25
|
Rate for Payer: WellCare Medicare |
$129.25
|
|
ERTAPENEM SODIUM 500 MG INJ
|
Facility
|
OP
|
$235.00
|
|
Service Code
|
HCPCS J1335
|
Hospital Charge Code |
4400392
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.90 |
Max. Negotiated Rate |
$189.18 |
Rate for Payer: Aetna of NY Commercial |
$129.25
|
Rate for Payer: Aetna of NY Medicare |
$108.10
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.90
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.90
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$86.95
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$117.50
|
Rate for Payer: Cash Price |
$176.25
|
Rate for Payer: Cash Price |
$176.25
|
Rate for Payer: CDPHP Commercial |
$189.18
|
Rate for Payer: CDPHP Medicare |
$86.95
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.90
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$188.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$188.00
|
Rate for Payer: EmblemHealth Medicaid |
$188.00
|
Rate for Payer: EmblemHealth Medicare |
$79.90
|
Rate for Payer: EmblemHealth Select Care |
$11.90
|
Rate for Payer: Fidelis Medicare |
$89.56
|
Rate for Payer: Galaxy Health Commercial |
$152.75
|
Rate for Payer: Hamaspik Choice Medicare |
$86.95
|
Rate for Payer: Humana Medicare |
$86.95
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$129.25
|
Rate for Payer: Local 1199SEIU Medicare |
$108.10
|
Rate for Payer: MVP Health Care of NY Commercial |
$176.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$132.30
|
Rate for Payer: MVP Health Care of NY Medicare |
$91.30
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.98
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.90
|
Rate for Payer: United Healthcare Commercial |
$21.98
|
Rate for Payer: United Healthcare Medicare |
$86.95
|
Rate for Payer: WellCare Medicare |
$129.25
|
|
ER VENIPUNCTURE FEE
|
Facility
|
OP
|
$9.00
|
|
Service Code
|
HCPCS 36415
|
Hospital Charge Code |
4604032
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$3.06 |
Max. Negotiated Rate |
$715.00 |
Rate for Payer: Aetna of NY Commercial |
$6.30
|
Rate for Payer: Aetna of NY Medicare |
$4.14
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$16.09
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$7.15
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$7.15
|
Rate for Payer: CDPHP Commercial |
$7.24
|
Rate for Payer: CDPHP Essential Plan |
$16.09
|
Rate for Payer: CDPHP Medicare |
$3.33
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.58
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.15
|
Rate for Payer: EmblemHealth Medicaid |
$7.15
|
Rate for Payer: EmblemHealth Medicare |
$3.06
|
Rate for Payer: EmblemHealth Select Care |
$5.40
|
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$16.09
|
Rate for Payer: Fidelis Medicare |
$3.43
|
Rate for Payer: Galaxy Health Commercial |
$5.85
|
Rate for Payer: Galaxy Health Workers Comp |
$10.51
|
Rate for Payer: Hamaspik Choice Medicaid |
$715.00
|
Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
Rate for Payer: Humana Medicare |
$3.33
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$715.00
|
Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$15.37
|
Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$15.37
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.75
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.15
|
Rate for Payer: United Healthcare Commercial |
$6.75
|
Rate for Payer: United Healthcare Medicare |
$3.33
|
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.51
|
Rate for Payer: WellCare Medicare |
$4.95
|
|
ER VENIPUNCTURE FEE
|
Facility
|
IP
|
$9.00
|
|
Service Code
|
HCPCS 36415
|
Hospital Charge Code |
4604032
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$5.85 |
Max. Negotiated Rate |
$5.85 |
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Galaxy Health Commercial |
$5.85
|
|
ER WRIST IMMOB/SPLINT
|
Facility
|
IP
|
$36.00
|
|
Hospital Charge Code |
4472176
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$23.40 |
Max. Negotiated Rate |
$23.40 |
Rate for Payer: Cash Price |
$27.00
|
Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
ER WRIST IMMOB/SPLINT
|
Facility
|
OP
|
$36.00
|
|
Hospital Charge Code |
4472176
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$12.24 |
Max. Negotiated Rate |
$28.98 |
Rate for Payer: Aetna of NY Commercial |
$25.20
|
Rate for Payer: Aetna of NY Medicare |
$16.56
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
Rate for Payer: Cash Price |
$27.00
|
Rate for Payer: CDPHP Commercial |
$28.98
|
Rate for Payer: CDPHP Medicare |
$13.32
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
Rate for Payer: EmblemHealth Medicaid |
$28.80
|
Rate for Payer: EmblemHealth Medicare |
$12.24
|
Rate for Payer: EmblemHealth Select Care |
$25.92
|
Rate for Payer: Fidelis Medicare |
$13.72
|
Rate for Payer: Galaxy Health Commercial |
$23.40
|
Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
Rate for Payer: Humana Medicare |
$13.32
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
Rate for Payer: United Healthcare Medicare |
$13.32
|
Rate for Payer: WellCare Medicare |
$19.80
|
|
ERYTHROMYCIN 0.5% EYE OINTMENT 5 mg, 1 g
|
Facility
|
IP
|
$37.00
|
|
Service Code
|
NDC 24208091019
|
Hospital Charge Code |
4401551
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$20.35 |
Max. Negotiated Rate |
$24.05 |
Rate for Payer: Cash Price |
$27.75
|
Rate for Payer: Galaxy Health Commercial |
$24.05
|
Rate for Payer: WellCare Medicare |
$20.35
|
|
ERYTHROMYCIN 0.5% EYE OINTMENT 5 mg, 1 g
|
Facility
|
OP
|
$37.00
|
|
Service Code
|
NDC 24208091019
|
Hospital Charge Code |
4401551
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$12.58 |
Max. Negotiated Rate |
$29.78 |
Rate for Payer: Aetna of NY Commercial |
$25.90
|
Rate for Payer: Aetna of NY Medicare |
$17.02
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
Rate for Payer: Cash Price |
$27.75
|
Rate for Payer: CDPHP Commercial |
$29.78
|
Rate for Payer: CDPHP Medicare |
$13.69
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
Rate for Payer: EmblemHealth Medicaid |
$29.60
|
Rate for Payer: EmblemHealth Medicare |
$12.58
|
Rate for Payer: EmblemHealth Select Care |
$26.64
|
Rate for Payer: Fidelis Medicare |
$14.10
|
Rate for Payer: Galaxy Health Commercial |
$24.05
|
Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
Rate for Payer: Humana Medicare |
$13.69
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
Rate for Payer: United Healthcare Medicare |
$13.69
|
Rate for Payer: WellCare Medicare |
$20.35
|
|
ERYTHROMYCIN BASE 250MG TABS 100 EA
|
Facility
|
OP
|
$22.66
|
|
Service Code
|
NDC 24338012213
|
Hospital Charge Code |
4400275
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$7.70 |
Max. Negotiated Rate |
$18.24 |
Rate for Payer: Aetna of NY Commercial |
$15.86
|
Rate for Payer: Aetna of NY Medicare |
$10.42
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.38
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.33
|
Rate for Payer: Cash Price |
$17.00
|
Rate for Payer: CDPHP Commercial |
$18.24
|
Rate for Payer: CDPHP Medicare |
$8.38
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
Rate for Payer: EmblemHealth Medicaid |
$18.13
|
Rate for Payer: EmblemHealth Medicare |
$7.70
|
Rate for Payer: EmblemHealth Select Care |
$16.32
|
Rate for Payer: Fidelis Medicare |
$8.64
|
Rate for Payer: Galaxy Health Commercial |
$14.73
|
Rate for Payer: Hamaspik Choice Medicare |
$8.38
|
Rate for Payer: Humana Medicare |
$8.38
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
Rate for Payer: MVP Health Care of NY Medicare |
$8.80
|
Rate for Payer: United Healthcare Medicare |
$8.38
|
Rate for Payer: WellCare Medicare |
$12.46
|
|
ERYTHROMYCIN BASE 250MG TABS 100 EA
|
Facility
|
IP
|
$22.66
|
|
Service Code
|
NDC 24338012213
|
Hospital Charge Code |
4400275
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$12.46 |
Max. Negotiated Rate |
$14.73 |
Rate for Payer: Cash Price |
$17.00
|
Rate for Payer: Galaxy Health Commercial |
$14.73
|
Rate for Payer: WellCare Medicare |
$12.46
|
|
ERYTHROMYCIN BASE 5MG/GM OINT 3.5 GM
|
Facility
|
OP
|
$58.71
|
|
Service Code
|
NDC 24208091055
|
Hospital Charge Code |
4400277
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$19.96 |
Max. Negotiated Rate |
$47.26 |
Rate for Payer: Aetna of NY Commercial |
$41.10
|
Rate for Payer: Aetna of NY Medicare |
$27.01
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.03
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.03
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.72
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.36
|
Rate for Payer: Cash Price |
$44.03
|
Rate for Payer: CDPHP Commercial |
$47.26
|
Rate for Payer: CDPHP Medicare |
$21.72
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
Rate for Payer: EmblemHealth Medicaid |
$46.97
|
Rate for Payer: EmblemHealth Medicare |
$19.96
|
Rate for Payer: EmblemHealth Select Care |
$42.27
|
Rate for Payer: Fidelis Medicare |
$22.37
|
Rate for Payer: Galaxy Health Commercial |
$38.16
|
Rate for Payer: Hamaspik Choice Medicare |
$21.72
|
Rate for Payer: Humana Medicare |
$21.72
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
Rate for Payer: MVP Health Care of NY Medicare |
$22.81
|
Rate for Payer: United Healthcare Medicare |
$21.72
|
Rate for Payer: WellCare Medicare |
$32.29
|
|
ERYTHROMYCIN BASE 5MG/GM OINT 3.5 GM
|
Facility
|
IP
|
$58.71
|
|
Service Code
|
NDC 24208091055
|
Hospital Charge Code |
4400277
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$32.29 |
Max. Negotiated Rate |
$38.16 |
Rate for Payer: Cash Price |
$44.03
|
Rate for Payer: Galaxy Health Commercial |
$38.16
|
Rate for Payer: WellCare Medicare |
$32.29
|
|
ERYTHROMYCIN LACTOBIONATE, PER 500 MG
|
Facility
|
IP
|
$225.00
|
|
Service Code
|
HCPCS J1364
|
Hospital Charge Code |
4400276
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$77.85 |
Max. Negotiated Rate |
$146.25 |
Rate for Payer: Aetna of NY Commercial |
$123.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.85
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.85
|
Rate for Payer: Cash Price |
$168.75
|
Rate for Payer: Cash Price |
$168.75
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.85
|
Rate for Payer: EmblemHealth Select Care |
$77.85
|
Rate for Payer: Galaxy Health Commercial |
$146.25
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$123.75
|
Rate for Payer: WellCare Medicare |
$123.75
|
|
ERYTHROMYCIN LACTOBIONATE, PER 500 MG
|
Facility
|
OP
|
$225.00
|
|
Service Code
|
HCPCS J1364
|
Hospital Charge Code |
4400276
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$76.50 |
Max. Negotiated Rate |
$181.12 |
Rate for Payer: Aetna of NY Commercial |
$123.75
|
Rate for Payer: Aetna of NY Medicare |
$103.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.85
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.85
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.25
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.50
|
Rate for Payer: Cash Price |
$168.75
|
Rate for Payer: Cash Price |
$168.75
|
Rate for Payer: CDPHP Commercial |
$181.12
|
Rate for Payer: CDPHP Medicare |
$83.25
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.85
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$180.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$180.00
|
Rate for Payer: EmblemHealth Medicaid |
$180.00
|
Rate for Payer: EmblemHealth Medicare |
$76.50
|
Rate for Payer: EmblemHealth Select Care |
$77.85
|
Rate for Payer: Fidelis Medicare |
$85.75
|
Rate for Payer: Galaxy Health Commercial |
$146.25
|
Rate for Payer: Hamaspik Choice Medicare |
$83.25
|
Rate for Payer: Humana Medicare |
$83.25
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$123.75
|
Rate for Payer: Local 1199SEIU Medicare |
$103.50
|
Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.68
|
Rate for Payer: MVP Health Care of NY Medicare |
$87.41
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$144.09
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$77.85
|
Rate for Payer: United Healthcare Commercial |
$144.09
|
Rate for Payer: United Healthcare Medicare |
$83.25
|
Rate for Payer: WellCare Medicare |
$123.75
|
|
ESCITALOPRAM OXALATE 10MG TABS 10X10EA
|
Facility
|
OP
|
$13.65
|
|
Service Code
|
NDC 00904642661
|
Hospital Charge Code |
4400435
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$4.64 |
Max. Negotiated Rate |
$10.99 |
Rate for Payer: Aetna of NY Commercial |
$9.56
|
Rate for Payer: Aetna of NY Medicare |
$6.28
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.24
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.24
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.05
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.82
|
Rate for Payer: Cash Price |
$10.24
|
Rate for Payer: CDPHP Commercial |
$10.99
|
Rate for Payer: CDPHP Medicare |
$5.05
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.92
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.92
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
Rate for Payer: EmblemHealth Medicaid |
$10.92
|
Rate for Payer: EmblemHealth Medicare |
$4.64
|
Rate for Payer: EmblemHealth Select Care |
$9.83
|
Rate for Payer: Fidelis Medicare |
$5.20
|
Rate for Payer: Galaxy Health Commercial |
$8.87
|
Rate for Payer: Hamaspik Choice Medicare |
$5.05
|
Rate for Payer: Humana Medicare |
$5.05
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.56
|
Rate for Payer: Local 1199SEIU Medicare |
$6.28
|
Rate for Payer: MVP Health Care of NY Commercial |
$10.24
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.68
|
Rate for Payer: MVP Health Care of NY Medicare |
$5.30
|
Rate for Payer: United Healthcare Medicare |
$5.05
|
Rate for Payer: WellCare Medicare |
$7.51
|
|
ESCITALOPRAM OXALATE 10MG TABS 10X10EA
|
Facility
|
IP
|
$13.65
|
|
Service Code
|
NDC 00904642661
|
Hospital Charge Code |
4400435
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$7.51 |
Max. Negotiated Rate |
$8.87 |
Rate for Payer: Cash Price |
$10.24
|
Rate for Payer: Galaxy Health Commercial |
$8.87
|
Rate for Payer: WellCare Medicare |
$7.51
|
|
ESMOLOL HCL 10MG/ML SDV 25X10ML
|
Facility
|
IP
|
$27.04
|
|
Service Code
|
NDC 67457018200
|
Hospital Charge Code |
4400112
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.87 |
Max. Negotiated Rate |
$17.58 |
Rate for Payer: Cash Price |
$20.28
|
Rate for Payer: Galaxy Health Commercial |
$17.58
|
Rate for Payer: WellCare Medicare |
$14.87
|
|
ESMOLOL HCL 10MG/ML SDV 25X10ML
|
Facility
|
OP
|
$27.04
|
|
Service Code
|
NDC 67457018200
|
Hospital Charge Code |
4400112
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$9.19 |
Max. Negotiated Rate |
$21.77 |
Rate for Payer: Aetna of NY Commercial |
$18.93
|
Rate for Payer: Aetna of NY Medicare |
$12.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.28
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.28
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.52
|
Rate for Payer: Cash Price |
$20.28
|
Rate for Payer: CDPHP Commercial |
$21.77
|
Rate for Payer: CDPHP Medicare |
$10.00
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.63
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.63
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.63
|
Rate for Payer: EmblemHealth Medicaid |
$21.63
|
Rate for Payer: EmblemHealth Medicare |
$9.19
|
Rate for Payer: EmblemHealth Select Care |
$19.47
|
Rate for Payer: Fidelis Medicare |
$10.30
|
Rate for Payer: Galaxy Health Commercial |
$17.58
|
Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
Rate for Payer: Humana Medicare |
$10.00
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.93
|
Rate for Payer: Local 1199SEIU Medicare |
$12.44
|
Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.22
|
Rate for Payer: MVP Health Care of NY Medicare |
$10.51
|
Rate for Payer: United Healthcare Medicare |
$10.00
|
Rate for Payer: WellCare Medicare |
$14.87
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,521.93
|
|
Service Code
|
CPT 43235
|
Hospital Revenue Code
|
490
|
Min. Negotiated Rate |
$863.69 |
Max. Negotiated Rate |
$2,521.93 |
Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,521.93
|
|
Service Code
|
CPT 43239
|
Hospital Revenue Code
|
490
|
Min. Negotiated Rate |
$863.69 |
Max. Negotiated Rate |
$2,521.93 |
Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$897.00
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
ESR-SEDIMENTATION RATE
|
Facility
|
OP
|
$20.00
|
|
Service Code
|
HCPCS 85651
|
Hospital Charge Code |
4300310
|
Hospital Revenue Code
|
305
|
Min. Negotiated Rate |
$2.02 |
Max. Negotiated Rate |
$16.10 |
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) Blue Access/Small Group |
$15.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
Rate for Payer: Cash Price |
$15.00
|
Rate for Payer: Cash Price |
$15.00
|
Rate for Payer: CDPHP Commercial |
$16.10
|
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 |
$7.62
|
Rate for Payer: Galaxy Health Commercial |
$13.00
|
Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
Rate for Payer: Humana Medicare |
$7.40
|
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 |
$7.77
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.02
|
Rate for Payer: United Healthcare Commercial |
$15.00
|
Rate for Payer: United Healthcare Medicare |
$7.40
|
Rate for Payer: WellCare Medicare |
$11.00
|
|
ESR-SEDIMENTATION RATE
|
Facility
|
IP
|
$20.00
|
|
Service Code
|
HCPCS 85651
|
Hospital Charge Code |
4300310
|
Hospital Revenue Code
|
305
|
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
|
|
ETHANOL QUANT BLOOD
|
Facility
|
OP
|
$360.00
|
|
Service Code
|
HCPCS G0480
|
Hospital Charge Code |
4300314
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$15.15 |
Max. Negotiated Rate |
$289.80 |
Rate for Payer: Aetna of NY Commercial |
$234.00
|
Rate for Payer: Aetna of NY Medicare |
$165.60
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$270.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$270.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$180.00
|
Rate for Payer: Cash Price |
$270.00
|
Rate for Payer: Cash Price |
$270.00
|
Rate for Payer: CDPHP Commercial |
$289.80
|
Rate for Payer: CDPHP Medicare |
$133.20
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$216.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
Rate for Payer: EmblemHealth Medicaid |
$288.00
|
Rate for Payer: EmblemHealth Medicare |
$122.40
|
Rate for Payer: EmblemHealth Select Care |
$216.00
|
Rate for Payer: Fidelis Medicare |
$137.20
|
Rate for Payer: Galaxy Health Commercial |
$234.00
|
Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
Rate for Payer: Humana Medicare |
$133.20
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$234.00
|
Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$270.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
Rate for Payer: United Healthcare Commercial |
$270.00
|
Rate for Payer: United Healthcare Medicare |
$133.20
|
Rate for Payer: WellCare Medicare |
$198.00
|
|
ETHANOL QUANT BLOOD
|
Facility
|
IP
|
$360.00
|
|
Service Code
|
HCPCS G0480
|
Hospital Charge Code |
4300314
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$234.00 |
Max. Negotiated Rate |
$234.00 |
Rate for Payer: Cash Price |
$270.00
|
Rate for Payer: Galaxy Health Commercial |
$234.00
|
|
ETHIBOND GREEN 30" CT-1 TAPER
|
Facility
|
IP
|
$13.00
|
|
Hospital Charge Code |
4472213
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$8.45 |
Max. Negotiated Rate |
$8.45 |
Rate for Payer: Cash Price |
$9.75
|
Rate for Payer: Galaxy Health Commercial |
$8.45
|
|