|
EYE TRAY
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
4479120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
EYE TRAY
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
4479120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
EZETIMIBE 10 MG TABLET 10 mg, 1 each
|
Facility
|
OP
|
$37.50
|
|
|
Service Code
|
NDC 00904666404
|
| Hospital Charge Code |
4401319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$30.19 |
| Rate for Payer: Aetna of NY Commercial |
$26.25
|
| Rate for Payer: Aetna of NY Medicare |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.75
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: CDPHP Commercial |
$30.19
|
| Rate for Payer: CDPHP Medicare |
$13.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.00
|
| Rate for Payer: EmblemHealth Medicaid |
$30.00
|
| Rate for Payer: EmblemHealth Medicare |
$12.75
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Fidelis Medicare |
$14.29
|
| Rate for Payer: Galaxy Health Commercial |
$24.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.88
|
| Rate for Payer: Humana Medicare |
$13.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$13.88
|
| Rate for Payer: WellCare Medicare |
$20.62
|
|
|
EZETIMIBE 10 MG TABLET 10 mg, 1 each
|
Facility
|
IP
|
$37.50
|
|
|
Service Code
|
NDC 00904666404
|
| Hospital Charge Code |
4401319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Galaxy Health Commercial |
$24.38
|
| Rate for Payer: WellCare Medicare |
$20.62
|
|
|
EZETIMIBE 10MG TABS 10X10EA
|
Facility
|
IP
|
$35.28
|
|
|
Service Code
|
NDC 66582041429
|
| Hospital Charge Code |
4400820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$22.93 |
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Galaxy Health Commercial |
$22.93
|
| Rate for Payer: WellCare Medicare |
$19.40
|
|
|
EZETIMIBE 10MG TABS 10X10EA
|
Facility
|
OP
|
$35.28
|
|
|
Service Code
|
NDC 66582041429
|
| Hospital Charge Code |
4400820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.40 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.64
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: CDPHP Commercial |
$28.40
|
| Rate for Payer: CDPHP Medicare |
$13.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.22
|
| Rate for Payer: EmblemHealth Medicaid |
$28.22
|
| Rate for Payer: EmblemHealth Medicare |
$12.00
|
| Rate for Payer: EmblemHealth Select Care |
$25.40
|
| Rate for Payer: Fidelis Medicare |
$13.45
|
| Rate for Payer: Galaxy Health Commercial |
$22.93
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.71
|
| Rate for Payer: United Healthcare Medicare |
$13.05
|
| Rate for Payer: WellCare Medicare |
$19.40
|
|
|
EZ-IO AD 15G INTRAOSSEOUS NEE
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
4471981
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.58 |
| Max. Negotiated Rate |
$351.78 |
| Rate for Payer: Aetna of NY Commercial |
$305.90
|
| Rate for Payer: Aetna of NY Medicare |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$161.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$218.50
|
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: CDPHP Commercial |
$351.78
|
| Rate for Payer: CDPHP Medicare |
$161.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$349.60
|
| Rate for Payer: EmblemHealth Medicaid |
$349.60
|
| Rate for Payer: EmblemHealth Medicare |
$148.58
|
| Rate for Payer: EmblemHealth Select Care |
$314.64
|
| Rate for Payer: Fidelis Medicare |
$166.54
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$161.69
|
| Rate for Payer: Humana Medicare |
$161.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$305.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$201.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$327.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$246.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$169.77
|
| Rate for Payer: United Healthcare Medicare |
$161.69
|
| Rate for Payer: WellCare Medicare |
$240.35
|
|
|
EZ-IO AD 15G INTRAOSSEOUS NEE
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
4471982
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
|
|
EZ-IO AD 15G INTRAOSSEOUS NEE
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
4471981
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
|
|
EZ-IO AD 15G INTRAOSSEOUS NEE
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
4471982
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.58 |
| Max. Negotiated Rate |
$351.78 |
| Rate for Payer: Aetna of NY Commercial |
$305.90
|
| Rate for Payer: Aetna of NY Medicare |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$161.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$218.50
|
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: CDPHP Commercial |
$351.78
|
| Rate for Payer: CDPHP Medicare |
$161.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$349.60
|
| Rate for Payer: EmblemHealth Medicaid |
$349.60
|
| Rate for Payer: EmblemHealth Medicare |
$148.58
|
| Rate for Payer: EmblemHealth Select Care |
$314.64
|
| Rate for Payer: Fidelis Medicare |
$166.54
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$161.69
|
| Rate for Payer: Humana Medicare |
$161.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$305.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$201.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$327.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$246.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$169.77
|
| Rate for Payer: United Healthcare Medicare |
$161.69
|
| Rate for Payer: WellCare Medicare |
$240.35
|
|
|
EZ-IO LD 15G 45MM IO NEE
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
4471983
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.58 |
| Max. Negotiated Rate |
$351.78 |
| Rate for Payer: Aetna of NY Commercial |
$305.90
|
| Rate for Payer: Aetna of NY Medicare |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$161.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$218.50
|
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: CDPHP Commercial |
$351.78
|
| Rate for Payer: CDPHP Medicare |
$161.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$349.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$349.60
|
| Rate for Payer: EmblemHealth Medicaid |
$349.60
|
| Rate for Payer: EmblemHealth Medicare |
$148.58
|
| Rate for Payer: EmblemHealth Select Care |
$314.64
|
| Rate for Payer: Fidelis Medicare |
$166.54
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$161.69
|
| Rate for Payer: Humana Medicare |
$161.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$305.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$201.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$327.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$246.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$169.77
|
| Rate for Payer: United Healthcare Medicare |
$161.69
|
| Rate for Payer: WellCare Medicare |
$240.35
|
|
|
EZ-IO LD 15G 45MM IO NEE
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
4471983
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Cash Price |
$327.75
|
| Rate for Payer: Galaxy Health Commercial |
$284.05
|
|
|
EZY SPLINT ROLL 2"
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
4472010
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
EZY SPLINT ROLL 2"
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
4472010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.00
|
| 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: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
| 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 |
$14.40
|
| 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 |
$14.00
|
| 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: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
EZY SPLINT ROLL 3"
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
4472011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
EZY SPLINT ROLL 3"
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
4472011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
|
|
EZY SPLINT ROLL 4"
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
4472012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
EZY SPLINT ROLL 4"
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
4472012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
EZY SPLINT ROLL 5"
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
4472008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
EZY SPLINT ROLL 5"
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
4472008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
FACTOR V LEIDEN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
4300335
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Aetna of NY Commercial |
$44.20
|
| Rate for Payer: Aetna of NY Medicare |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: CDPHP Commercial |
$54.74
|
| Rate for Payer: CDPHP Medicare |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$54.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.40
|
| Rate for Payer: EmblemHealth Medicaid |
$54.40
|
| Rate for Payer: EmblemHealth Medicare |
$23.12
|
| Rate for Payer: EmblemHealth Select Care |
$40.80
|
| Rate for Payer: Fidelis Medicare |
$25.91
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.16
|
| Rate for Payer: Humana Medicare |
$25.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$51.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.65
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Medicare |
$25.16
|
| Rate for Payer: WellCare Medicare |
$37.40
|
|
|
FACTOR V LEIDEN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
4300335
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
|
|
FALOPE RING BANDS,30 PROCEDURE
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
4479086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
FALOPE RING BANDS,30 PROCEDURE
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
4479086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
FAMOTIDINE 10MG/ML SDPF 25X2ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| 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 |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| 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 |
$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: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
