|
FLUID CRYSTAL EXAM (SYNOVIAL)
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
4301119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of NY Commercial |
$107.90
|
| Rate for Payer: Aetna of NY Medicare |
$76.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$83.00
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: CDPHP Commercial |
$133.63
|
| Rate for Payer: CDPHP Medicare |
$61.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$99.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.80
|
| Rate for Payer: EmblemHealth Medicaid |
$132.80
|
| Rate for Payer: EmblemHealth Medicare |
$56.44
|
| Rate for Payer: EmblemHealth Select Care |
$99.60
|
| Rate for Payer: Fidelis Medicare |
$63.26
|
| Rate for Payer: Galaxy Health Commercial |
$107.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.42
|
| Rate for Payer: Humana Medicare |
$61.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$107.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$76.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$93.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$124.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.06
|
| Rate for Payer: United Healthcare Commercial |
$124.50
|
| Rate for Payer: United Healthcare Medicare |
$61.42
|
| Rate for Payer: WellCare Medicare |
$91.30
|
|
|
FLUMAZENIL 0.1MG/ML MDV 10X10ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| 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: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FLUMAZENIL 0.1MG/ML MDV 10X10ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400303
|
|
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
|
|
|
FLUORESCEIN STRIP ER
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4609644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
FLUORESCEIN STRIP ER
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4609644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
FLUOR-GUIDE STEERABLE CATH KIT
|
Facility
|
OP
|
$456.00
|
|
| Hospital Charge Code |
4472106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.04 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna of NY Commercial |
$319.20
|
| Rate for Payer: Aetna of NY Medicare |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$168.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$228.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: CDPHP Commercial |
$367.08
|
| Rate for Payer: CDPHP Medicare |
$168.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$364.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$364.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$364.80
|
| Rate for Payer: EmblemHealth Medicaid |
$364.80
|
| Rate for Payer: EmblemHealth Medicare |
$155.04
|
| Rate for Payer: EmblemHealth Select Care |
$328.32
|
| Rate for Payer: Fidelis Medicare |
$173.78
|
| Rate for Payer: Galaxy Health Commercial |
$296.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$168.72
|
| Rate for Payer: Humana Medicare |
$168.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$319.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$209.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$256.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$177.16
|
| Rate for Payer: United Healthcare Medicare |
$168.72
|
| Rate for Payer: WellCare Medicare |
$250.80
|
|
|
FLUOR-GUIDE STEERABLE CATH KIT
|
Facility
|
IP
|
$456.00
|
|
| Hospital Charge Code |
4472106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Galaxy Health Commercial |
$296.40
|
|
|
FLUORO-GUIDED STEERABLE CATH
|
Facility
|
IP
|
$123.00
|
|
| Hospital Charge Code |
4471025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
|
|
FLUORO-GUIDED STEERABLE CATH
|
Facility
|
OP
|
$123.00
|
|
| Hospital Charge Code |
4471025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$99.02 |
| Rate for Payer: Aetna of NY Commercial |
$86.10
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$61.50
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$69.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.79
|
| Rate for Payer: United Healthcare Medicare |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
|
FLUOROMETHALONE OS
|
Facility
|
OP
|
$323.85
|
|
|
Service Code
|
NDC 00065009605
|
| Hospital Charge Code |
4409009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$260.70 |
| Rate for Payer: Aetna of NY Commercial |
$226.70
|
| Rate for Payer: Aetna of NY Medicare |
$148.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$242.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$242.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$119.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$161.92
|
| Rate for Payer: Cash Price |
$242.89
|
| Rate for Payer: CDPHP Commercial |
$260.70
|
| Rate for Payer: CDPHP Medicare |
$119.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$259.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$259.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$259.08
|
| Rate for Payer: EmblemHealth Medicaid |
$259.08
|
| Rate for Payer: EmblemHealth Medicare |
$110.11
|
| Rate for Payer: EmblemHealth Select Care |
$233.17
|
| Rate for Payer: Fidelis Medicare |
$123.42
|
| Rate for Payer: Galaxy Health Commercial |
$210.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$119.82
|
| Rate for Payer: Humana Medicare |
$119.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$226.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$148.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$182.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$125.82
|
| Rate for Payer: United Healthcare Medicare |
$119.82
|
| Rate for Payer: WellCare Medicare |
$178.12
|
|
|
FLUOROMETHALONE OS
|
Facility
|
IP
|
$323.85
|
|
|
Service Code
|
NDC 00065009605
|
| Hospital Charge Code |
4409009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.12 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Cash Price |
$242.89
|
| Rate for Payer: Galaxy Health Commercial |
$210.50
|
| Rate for Payer: WellCare Medicare |
$178.12
|
|
|
FLUOROSCOPE EXAMINATION =< 1 HR
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
4150064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$420.60
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: EmblemHealth Select Care |
$455.65
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$420.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
FLUOROSCOPE EXAMINATION =< 1 HR
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
4150064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL OR SUBARACHNOID) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 77003
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
|
|
FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 77002
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
|
|
FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL TIME
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 76000
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
|
|
FLUOXETINE 10 MG
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
4409041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of NY Commercial |
$5.23
|
| Rate for Payer: Aetna of NY Medicare |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.74
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: CDPHP Commercial |
$6.01
|
| Rate for Payer: CDPHP Medicare |
$2.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.98
|
| Rate for Payer: EmblemHealth Medicaid |
$5.98
|
| Rate for Payer: EmblemHealth Medicare |
$2.54
|
| Rate for Payer: EmblemHealth Select Care |
$5.38
|
| Rate for Payer: Fidelis Medicare |
$2.85
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.76
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
FLUOXETINE 10 MG
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
4409041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
FLUoxetine HCL 20 MG CAPSULE 20 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
4401502
|
|
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
|
|
|
FLUoxetine HCL 20 MG CAPSULE 20 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
4401502
|
|
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
|
|
|
FLUPHENAZINE HCL 2.5MG TABS 100 EA
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
NDC 00527178901
|
| Hospital Charge Code |
4400304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: WellCare Medicare |
$9.62
|
|
|
FLUPHENAZINE HCL 2.5MG TABS 100 EA
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
NDC 00527178901
|
| Hospital Charge Code |
4400304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna of NY Commercial |
$12.25
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.75
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Commercial |
$14.09
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.00
|
| Rate for Payer: EmblemHealth Medicaid |
$14.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.60
|
| Rate for Payer: Fidelis Medicare |
$6.67
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.80
|
| Rate for Payer: United Healthcare Medicare |
$6.48
|
| Rate for Payer: WellCare Medicare |
$9.62
|
|
|
FLURBIPROFEN SODIUM 0.0003 DROP 2.5 ML
|
Facility
|
IP
|
$129.60
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
4400305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Galaxy Health Commercial |
$84.24
|
| Rate for Payer: WellCare Medicare |
$71.28
|
|
|
FLURBIPROFEN SODIUM 0.0003 DROP 2.5 ML
|
Facility
|
OP
|
$129.60
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
4400305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$104.33 |
| Rate for Payer: Aetna of NY Commercial |
$90.72
|
| Rate for Payer: Aetna of NY Medicare |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.80
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: CDPHP Commercial |
$104.33
|
| Rate for Payer: CDPHP Medicare |
$47.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$103.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.68
|
| Rate for Payer: EmblemHealth Medicaid |
$103.68
|
| Rate for Payer: EmblemHealth Medicare |
$44.06
|
| Rate for Payer: EmblemHealth Select Care |
$93.31
|
| Rate for Payer: Fidelis Medicare |
$49.39
|
| Rate for Payer: Galaxy Health Commercial |
$84.24
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.95
|
| Rate for Payer: Humana Medicare |
$47.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$90.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$72.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.35
|
| Rate for Payer: United Healthcare Medicare |
$47.95
|
| Rate for Payer: WellCare Medicare |
$71.28
|
|
|
FLUTICASONE PROPIONATE 110MCG ARIN 12 GM
|
Facility
|
OP
|
$787.95
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
4400300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$267.90 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna of NY Commercial |
$551.56
|
| Rate for Payer: Aetna of NY Medicare |
$362.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$590.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$590.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$291.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$393.98
|
| Rate for Payer: Cash Price |
$590.96
|
| Rate for Payer: CDPHP Commercial |
$634.30
|
| Rate for Payer: CDPHP Medicare |
$291.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$630.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$630.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$630.36
|
| Rate for Payer: EmblemHealth Medicaid |
$630.36
|
| Rate for Payer: EmblemHealth Medicare |
$267.90
|
| Rate for Payer: EmblemHealth Select Care |
$567.32
|
| Rate for Payer: Fidelis Medicare |
$300.29
|
| Rate for Payer: Galaxy Health Commercial |
$512.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$291.54
|
| Rate for Payer: Humana Medicare |
$291.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$551.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$362.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.96
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$443.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$306.12
|
| Rate for Payer: United Healthcare Medicare |
$291.54
|
| Rate for Payer: WellCare Medicare |
$433.37
|
|
