|
FERRLECIT INJ 12.5 MG
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
4409235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna of NY Commercial |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.18
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.18
|
| Rate for Payer: EmblemHealth Select Care |
$2.18
|
| Rate for Payer: Galaxy Health Commercial |
$15.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.97
|
| Rate for Payer: WellCare Medicare |
$12.97
|
|
|
FERROUS SULFATE 325MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
4400290
|
|
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
|
|
|
FERROUS SULFATE 325MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
4400290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Hospital Charge Code |
4200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Hospital Charge Code |
4200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| 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 |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4200199
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4200199
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$220.50
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$220.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
FEVERALL 80 MG SUPPOSITORY 80 mg, 6 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 51672211402
|
| Hospital Charge Code |
4401544
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
FEVERALL 80 MG SUPPOSITORY 80 mg, 6 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51672211402
|
| Hospital Charge Code |
4401544
|
|
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
|
|
|
FINASTERIDE 5MG TABS 10X10EA
|
Facility
|
OP
|
$10.30
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
4400295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.15
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: CDPHP Commercial |
$8.29
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$3.93
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.81
|
| Rate for Payer: Humana Medicare |
$3.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.00
|
| Rate for Payer: United Healthcare Medicare |
$3.81
|
| Rate for Payer: WellCare Medicare |
$5.66
|
|
|
FINASTERIDE 5MG TABS 10X10EA
|
Facility
|
IP
|
$10.30
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
4400295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: WellCare Medicare |
$5.66
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4201074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$1,308.45 |
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,308.45
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4201074
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,409.10
|
| 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: EmblemHealth Select Care |
$1,308.45
|
| 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
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL,
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
4201092
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$132.30
|
| Rate for Payer: Aetna of NY Medicare |
$86.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$94.50
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: CDPHP Commercial |
$152.14
|
| Rate for Payer: CDPHP Medicare |
$69.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$132.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$151.20
|
| Rate for Payer: EmblemHealth Medicaid |
$151.20
|
| Rate for Payer: EmblemHealth Medicare |
$64.26
|
| Rate for Payer: EmblemHealth Select Care |
$122.85
|
| Rate for Payer: Fidelis Medicare |
$72.03
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.93
|
| Rate for Payer: Humana Medicare |
$69.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$132.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$106.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.27
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
| Rate for Payer: WellCare Medicare |
$103.95
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL,
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
4201092
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Galaxy Health Commercial |
$122.85
|
|
|
FINGER ORTHOTIC, WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
4473011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$201.62 |
| Max. Negotiated Rate |
$477.36 |
| Rate for Payer: Aetna of NY Commercial |
$415.10
|
| Rate for Payer: Aetna of NY Medicare |
$272.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$266.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$266.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$219.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$296.50
|
| Rate for Payer: Cash Price |
$444.75
|
| Rate for Payer: Cash Price |
$444.75
|
| Rate for Payer: CDPHP Commercial |
$477.36
|
| Rate for Payer: CDPHP Medicare |
$219.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$296.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$474.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$474.40
|
| Rate for Payer: EmblemHealth Medicaid |
$474.40
|
| Rate for Payer: EmblemHealth Medicare |
$201.62
|
| Rate for Payer: EmblemHealth Select Care |
$296.50
|
| Rate for Payer: Fidelis Medicare |
$225.99
|
| Rate for Payer: Galaxy Health Commercial |
$385.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$219.41
|
| Rate for Payer: Humana Medicare |
$219.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$415.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$272.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$333.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$230.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$207.44
|
| Rate for Payer: United Healthcare Medicare |
$219.41
|
| Rate for Payer: WellCare Medicare |
$326.15
|
|
|
FINGER ORTHOTIC, WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
4473011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.85 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$266.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$266.85
|
| Rate for Payer: Cash Price |
$444.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$296.50
|
| Rate for Payer: EmblemHealth Select Care |
$296.50
|
| Rate for Payer: Galaxy Health Commercial |
$385.45
|
| Rate for Payer: Multiplan Commercial |
$266.85
|
| Rate for Payer: WellCare Medicare |
$326.15
|
|
|
FINGER SPLINT APPLICATION
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4850022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| 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 |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| 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 |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| 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 |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
FINGER SPLINT APPLICATION
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4850022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
FIRST FRACTURE KIT 10/2
|
Facility
|
OP
|
$14,855.00
|
|
| Hospital Charge Code |
4478250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,050.70 |
| Max. Negotiated Rate |
$11,958.28 |
| Rate for Payer: Aetna of NY Commercial |
$10,398.50
|
| Rate for Payer: Aetna of NY Medicare |
$6,833.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,684.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,684.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,496.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,427.50
|
| Rate for Payer: Cash Price |
$11,141.25
|
| Rate for Payer: CDPHP Commercial |
$11,958.28
|
| Rate for Payer: CDPHP Medicare |
$5,496.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,427.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,884.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,884.00
|
| Rate for Payer: EmblemHealth Medicaid |
$11,884.00
|
| Rate for Payer: EmblemHealth Medicare |
$5,050.70
|
| Rate for Payer: EmblemHealth Select Care |
$7,427.50
|
| Rate for Payer: Fidelis Medicare |
$5,661.24
|
| Rate for Payer: Galaxy Health Commercial |
$9,655.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,496.35
|
| Rate for Payer: Humana Medicare |
$5,496.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,398.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,833.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,655.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,655.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,771.17
|
| Rate for Payer: United Healthcare Medicare |
$5,496.35
|
| Rate for Payer: WellCare Medicare |
$8,170.25
|
|
|
FIRST FRACTURE KIT 10/2
|
Facility
|
IP
|
$14,855.00
|
|
| Hospital Charge Code |
4478250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,684.75 |
| Max. Negotiated Rate |
$10,398.50 |
| Rate for Payer: Aetna of NY Commercial |
$10,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,684.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,684.75
|
| Rate for Payer: Cash Price |
$11,141.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,427.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,427.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,655.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,398.50
|
| Rate for Payer: Multiplan Commercial |
$6,684.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,655.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,655.75
|
| Rate for Payer: WellCare Medicare |
$8,170.25
|
|
|
First Mouth Wash BLM Kit
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
NDC 00000000002
|
| Hospital Charge Code |
4401939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$99.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$135.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: CDPHP Commercial |
$217.35
|
| Rate for Payer: CDPHP Medicare |
$99.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$216.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$216.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$216.00
|
| Rate for Payer: EmblemHealth Medicaid |
$216.00
|
| Rate for Payer: EmblemHealth Medicare |
$91.80
|
| Rate for Payer: EmblemHealth Select Care |
$194.40
|
| Rate for Payer: Fidelis Medicare |
$102.90
|
| Rate for Payer: Galaxy Health Commercial |
$175.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.90
|
| Rate for Payer: Humana Medicare |
$99.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$124.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$152.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$104.90
|
| Rate for Payer: United Healthcare Medicare |
$99.90
|
| Rate for Payer: WellCare Medicare |
$148.50
|
|
|
First Mouth Wash BLM Kit
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
NDC 00000000002
|
| Hospital Charge Code |
4401939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Galaxy Health Commercial |
$175.50
|
| Rate for Payer: WellCare Medicare |
$148.50
|
|
|
FISH OIL 1000MG GCAP 160+20EA
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4400585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
FISH OIL 1000MG GCAP 160+20EA
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4400585
|
|
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
|
|
