|
PENICILLIN V POTASSIUM 500MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400616
|
|
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
|
|
|
PERCUTANEOUS DECOMPRESSION DEVICE KIT #M
|
Facility
OP
|
$8,139.00
|
|
| Hospital Charge Code |
4478231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,767.26 |
| Max. Negotiated Rate |
$6,551.90 |
| Rate for Payer: Aetna of NY Commercial |
$5,697.30
|
| Rate for Payer: Aetna of NY Medicare |
$3,743.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,011.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,069.50
|
| Rate for Payer: Cash Price |
$6,104.25
|
| Rate for Payer: CDPHP Commercial |
$6,551.90
|
| Rate for Payer: CDPHP Medicare |
$3,011.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6,511.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,511.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,511.20
|
| Rate for Payer: EmblemHealth Medicaid |
$6,511.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,767.26
|
| Rate for Payer: EmblemHealth Select Care |
$5,860.08
|
| Rate for Payer: Fidelis Medicare |
$3,101.77
|
| Rate for Payer: Galaxy Health Commercial |
$5,290.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,011.43
|
| Rate for Payer: Humana Medicare |
$3,011.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,697.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,743.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,104.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,582.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,162.00
|
| Rate for Payer: United Healthcare Medicare |
$3,011.43
|
| Rate for Payer: WellCare Medicare |
$4,476.45
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
OP
|
$314,327.00
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$314,327.00 |
| 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 |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,072.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,143.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,421.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,143.27
|
| Rate for Payer: CDPHP Essential Plan |
$7,072.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,771.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,143.27
|
| Rate for Payer: EmblemHealth Medicaid |
$3,143.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,072.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$314,327.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$314,327.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,758.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,758.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,143.27
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,300.43
|
|
|
PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONIC SALINE, ENZYME) OR MECHANICAL MEANS (EG, CATHETER) INCLUDING RADIOLOGIC LOCALIZATION (INCLUDES CONTRAST WHEN ADMINISTERED), MULTIPLE ADHESIOLYSIS SESSIONS; 1 DAY
|
Facility
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62264
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$636.00 |
| 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 |
$636.00
|
| 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 |
$868.45
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
PERFIX PLUG LARGE, 1.6"
|
Facility
OP
|
$1,427.00
|
|
| Hospital Charge Code |
4471028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.18 |
| Max. Negotiated Rate |
$1,148.74 |
| Rate for Payer: Aetna of NY Commercial |
$998.90
|
| Rate for Payer: Aetna of NY Medicare |
$656.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$527.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$713.50
|
| Rate for Payer: Cash Price |
$1,070.25
|
| Rate for Payer: CDPHP Commercial |
$1,148.74
|
| Rate for Payer: CDPHP Medicare |
$527.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$713.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,141.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,141.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,141.60
|
| Rate for Payer: EmblemHealth Medicare |
$485.18
|
| Rate for Payer: EmblemHealth Select Care |
$713.50
|
| Rate for Payer: Fidelis Medicare |
$543.83
|
| Rate for Payer: Galaxy Health Commercial |
$927.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$527.99
|
| Rate for Payer: Humana Medicare |
$527.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$998.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$656.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$927.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$927.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$554.39
|
| Rate for Payer: United Healthcare Medicare |
$527.99
|
| Rate for Payer: WellCare Medicare |
$784.85
|
|
|
PERFIX PLUG MEDIUM, 1.3" X 1.
|
Facility
OP
|
$1,851.00
|
|
| Hospital Charge Code |
4471027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.34 |
| Max. Negotiated Rate |
$1,490.06 |
| Rate for Payer: Aetna of NY Commercial |
$1,295.70
|
| Rate for Payer: Aetna of NY Medicare |
$851.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$832.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$832.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$684.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$925.50
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: CDPHP Commercial |
$1,490.06
|
| Rate for Payer: CDPHP Medicare |
$684.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$925.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,480.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,480.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,480.80
|
| Rate for Payer: EmblemHealth Medicare |
$629.34
|
| Rate for Payer: EmblemHealth Select Care |
$925.50
|
| Rate for Payer: Fidelis Medicare |
$705.42
|
| Rate for Payer: Galaxy Health Commercial |
$1,203.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$684.87
|
| Rate for Payer: Humana Medicare |
$684.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,295.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$851.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,203.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,203.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$719.11
|
| Rate for Payer: United Healthcare Medicare |
$684.87
|
| Rate for Payer: WellCare Medicare |
$1,018.05
|
|
|
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
4601206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| 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 |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| 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 |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| 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 |
$1,780.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
PERMETHRIN CREAM
|
Facility
OP
|
$573.45
|
|
| Hospital Charge Code |
4408968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.97 |
| Max. Negotiated Rate |
$461.63 |
| Rate for Payer: Aetna of NY Commercial |
$401.42
|
| Rate for Payer: Aetna of NY Medicare |
$263.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$430.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$430.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.72
|
| Rate for Payer: Cash Price |
$430.09
|
| Rate for Payer: CDPHP Commercial |
$461.63
|
| Rate for Payer: CDPHP Medicare |
$212.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.76
|
| Rate for Payer: EmblemHealth Medicaid |
$458.76
|
| Rate for Payer: EmblemHealth Medicare |
$194.97
|
| Rate for Payer: EmblemHealth Select Care |
$412.88
|
| Rate for Payer: Fidelis Medicare |
$218.54
|
| Rate for Payer: Galaxy Health Commercial |
$372.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.18
|
| Rate for Payer: Humana Medicare |
$212.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$430.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.79
|
| Rate for Payer: United Healthcare Medicare |
$212.18
|
| Rate for Payer: WellCare Medicare |
$315.40
|
|
|
PERPHENAZINE 4 MG TABLET 4 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| 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: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| 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 |
$4.32
|
| 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 |
$4.20
|
| 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: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4201070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$670.36
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, LEFT SIDE
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 LT
|
| Hospital Charge Code |
4201077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG, RIGHT SIDE
|
Facility
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19285 RT
|
| Hospital Charge Code |
4201078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,620.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,409.10
|
| Rate for Payer: Aetna of NY Medicare |
$925.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,509.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$744.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: CDPHP Commercial |
$1,620.46
|
| Rate for Payer: CDPHP Medicare |
$744.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,610.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.40
|
| Rate for Payer: EmblemHealth Medicare |
$684.42
|
| Rate for Payer: Fidelis Medicare |
$767.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$744.81
|
| Rate for Payer: Humana Medicare |
$744.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,409.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$925.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,133.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$782.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$744.81
|
| Rate for Payer: WellCare Medicare |
$1,107.15
|
|
|
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
4201083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$108.50
|
| Rate for Payer: Aetna of NY Medicare |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$116.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$77.50
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: CDPHP Commercial |
$124.78
|
| Rate for Payer: CDPHP Medicare |
$57.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$124.00
|
| Rate for Payer: EmblemHealth Medicare |
$52.70
|
| Rate for Payer: Fidelis Medicare |
$59.07
|
| Rate for Payer: Galaxy Health Commercial |
$100.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.35
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$108.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$71.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$87.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.28
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$57.35
|
| Rate for Payer: WellCare Medicare |
$85.25
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
4201081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$3,689.32 |
| Rate for Payer: Aetna of NY Commercial |
$3,208.10
|
| Rate for Payer: Aetna of NY Medicare |
$2,108.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,437.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,695.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,291.50
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: Cash Price |
$3,437.25
|
| Rate for Payer: CDPHP Commercial |
$3,689.32
|
| Rate for Payer: CDPHP Medicare |
$1,695.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,666.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,666.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,558.22
|
| Rate for Payer: Fidelis Medicare |
$1,746.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,978.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,695.71
|
| Rate for Payer: Humana Medicare |
$1,695.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,208.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,108.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,437.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,580.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,780.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,525.93
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$1,695.71
|
| Rate for Payer: WellCare Medicare |
$2,520.65
|
|
|
PERSONAL THERAPY MANAGER
|
Facility
OP
|
$2,762.00
|
|
| Hospital Charge Code |
4471656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.08 |
| Max. Negotiated Rate |
$2,223.41 |
| Rate for Payer: Aetna of NY Commercial |
$1,933.40
|
| Rate for Payer: Aetna of NY Medicare |
$1,270.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,021.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,381.00
|
| Rate for Payer: Cash Price |
$2,071.50
|
| Rate for Payer: CDPHP Commercial |
$2,223.41
|
| Rate for Payer: CDPHP Medicare |
$1,021.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,381.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,209.60
|
| Rate for Payer: EmblemHealth Medicare |
$939.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,381.00
|
| Rate for Payer: Fidelis Medicare |
$1,052.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,795.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,021.94
|
| Rate for Payer: Humana Medicare |
$1,021.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,933.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,270.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,795.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,795.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,073.04
|
| Rate for Payer: United Healthcare Medicare |
$1,021.94
|
| Rate for Payer: WellCare Medicare |
$1,519.10
|
|
|
PFIZER COVID VACCINE 10 MCG/0.2 ML 5 Y - 11Y
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
4403002
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$87.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$87.78
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 30 MCG/0.3 ML 12 Y OLDER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
4403003
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$131.10
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 3MCG/0.2ML 6 MO - 4Y
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
4403001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$65.55
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PHARMACY GI COCKTAIL
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
4409070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
PHENAZOPYRIDINE HCL 100MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400617
|
|
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
|
|
|
PHENYLEPHRINE HCL 0.01 SPIN 15 ML
|
Facility
OP
|
$13.13
|
|
| Hospital Charge Code |
4400553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Aetna of NY Commercial |
$9.19
|
| Rate for Payer: Aetna of NY Medicare |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.56
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: CDPHP Commercial |
$10.57
|
| Rate for Payer: CDPHP Medicare |
$4.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.50
|
| Rate for Payer: EmblemHealth Medicaid |
$10.50
|
| Rate for Payer: EmblemHealth Medicare |
$4.46
|
| Rate for Payer: EmblemHealth Select Care |
$9.45
|
| Rate for Payer: Fidelis Medicare |
$5.00
|
| Rate for Payer: Galaxy Health Commercial |
$8.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.86
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.10
|
| Rate for Payer: United Healthcare Medicare |
$4.86
|
| Rate for Payer: WellCare Medicare |
$7.22
|
|
|
PHENYLEPHRINE HCL 0.025 DROP 3 ML
|
Facility
OP
|
$72.10
|
|
| Hospital Charge Code |
4400618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of NY Commercial |
$50.47
|
| Rate for Payer: Aetna of NY Medicare |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.05
|
| Rate for Payer: Cash Price |
$54.07
|
| Rate for Payer: CDPHP Commercial |
$58.04
|
| Rate for Payer: CDPHP Medicare |
$26.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.68
|
| Rate for Payer: EmblemHealth Medicaid |
$57.68
|
| Rate for Payer: EmblemHealth Medicare |
$24.51
|
| Rate for Payer: EmblemHealth Select Care |
$51.91
|
| Rate for Payer: Fidelis Medicare |
$27.48
|
| Rate for Payer: Galaxy Health Commercial |
$46.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.68
|
| Rate for Payer: Humana Medicare |
$26.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.01
|
| Rate for Payer: United Healthcare Medicare |
$26.68
|
| Rate for Payer: WellCare Medicare |
$39.66
|
|
|
PHENYLEPHRINE HCL, UP TO 1 ML
|
Facility
OP
|
$44.55
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
4400619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.28
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: CDPHP Commercial |
$35.86
|
| Rate for Payer: CDPHP Medicare |
$16.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.64
|
| Rate for Payer: EmblemHealth Medicaid |
$35.64
|
| Rate for Payer: EmblemHealth Medicare |
$15.15
|
| Rate for Payer: EmblemHealth Select Care |
$32.08
|
| Rate for Payer: Fidelis Medicare |
$16.98
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.31
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
PHENYTOIN SOD EXTENDED 100MG CAPS 10X10E
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400230
|
|
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
|
|
|
PHENYTOIN SODIUM, PER 50 MG
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
4400620
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| 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: 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 |
$0.64
|
| 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 |
$0.64
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
