|
ER SIMPLE 2.6 TO 7.5 CM
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4609619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
ER SIMPLE REPAIR-12.6-20.0CM
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
4609596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
ER SIMPLE REPAIR-12.6-20.0CM
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
4609596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$523.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
ER SMOOTH PADING 4-6+"
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
4472165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna of NY Commercial |
$11.54
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$11.87
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
ER SMOOTH PADING 4-6+"
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
4472165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
|
|
ER SOFT CAST JONES
|
Facility
|
OP
|
$20.60
|
|
| Hospital Charge Code |
4472167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of NY Commercial |
$14.42
|
| Rate for Payer: Aetna of NY Medicare |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.24
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Medicare |
$7.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.48
|
| Rate for Payer: EmblemHealth Medicaid |
$16.48
|
| Rate for Payer: EmblemHealth Medicare |
$7.00
|
| Rate for Payer: EmblemHealth Select Care |
$14.83
|
| Rate for Payer: Fidelis Medicare |
$8.24
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.24
|
| Rate for Payer: Humana Medicare |
$8.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
ER SOFT CAST JONES
|
Facility
|
IP
|
$20.60
|
|
| Hospital Charge Code |
4472167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
|
|
ER SPINAL NEEDLE ANY SIZE
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4472196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
ER SPINAL NEEDLE ANY SIZE
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4472196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
ER STERI STRIPS
|
Facility
|
OP
|
$28.84
|
|
| Hospital Charge Code |
4472182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna of NY Commercial |
$20.19
|
| Rate for Payer: Aetna of NY Medicare |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.54
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: CDPHP Medicare |
$10.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.07
|
| Rate for Payer: EmblemHealth Medicaid |
$23.07
|
| Rate for Payer: EmblemHealth Medicare |
$9.81
|
| Rate for Payer: EmblemHealth Select Care |
$20.76
|
| Rate for Payer: Fidelis Medicare |
$11.54
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
ER STERI STRIPS
|
Facility
|
IP
|
$28.84
|
|
| Hospital Charge Code |
4472182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
|
|
ERTAPENEM SODIUM 500 MG INJ
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
4400392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of NY Medicare |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.00
|
| Rate for Payer: Cash Price |
$176.25
|
| Rate for Payer: Cash Price |
$176.25
|
| Rate for Payer: CDPHP Medicare |
$86.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$188.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$188.00
|
| Rate for Payer: EmblemHealth Medicaid |
$188.00
|
| Rate for Payer: EmblemHealth Medicare |
$79.90
|
| Rate for Payer: EmblemHealth Select Care |
$7.22
|
| Rate for Payer: Fidelis Medicare |
$94.00
|
| Rate for Payer: Galaxy Health Commercial |
$152.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.00
|
| Rate for Payer: Humana Medicare |
$94.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$108.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$132.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$98.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$21.98
|
| Rate for Payer: United Healthcare Medicare |
$94.00
|
| Rate for Payer: WellCare Medicare |
$129.25
|
|
|
ERTAPENEM SODIUM 500 MG INJ
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
4400392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna of NY Commercial |
$129.25
|
| Rate for Payer: Cash Price |
$176.25
|
| Rate for Payer: Cash Price |
$176.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.22
|
| Rate for Payer: EmblemHealth Select Care |
$7.22
|
| Rate for Payer: Galaxy Health Commercial |
$152.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$129.25
|
| Rate for Payer: WellCare Medicare |
$129.25
|
|
|
ER VENIPUNCTURE FEE
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
4604032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
ER VENIPUNCTURE FEE
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
4604032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.15
|
| Rate for Payer: EmblemHealth Medicaid |
$7.15
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$16.80
|
| Rate for Payer: Fidelis Medicare |
$11.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$7.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.51
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
ER WRIST IMMOB/SPLINT
|
Facility
|
OP
|
$37.08
|
|
| Hospital Charge Code |
4472176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna of NY Commercial |
$25.96
|
| Rate for Payer: Aetna of NY Medicare |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.83
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: CDPHP Medicare |
$13.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.66
|
| Rate for Payer: EmblemHealth Medicaid |
$29.66
|
| Rate for Payer: EmblemHealth Medicare |
$12.61
|
| Rate for Payer: EmblemHealth Select Care |
$26.70
|
| Rate for Payer: Fidelis Medicare |
$14.83
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.83
|
| Rate for Payer: Humana Medicare |
$14.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.56
|
| Rate for Payer: United Healthcare Medicare |
$14.83
|
| Rate for Payer: WellCare Medicare |
$20.39
|
|
|
ER WRIST IMMOB/SPLINT
|
Facility
|
IP
|
$37.08
|
|
| Hospital Charge Code |
4472176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
|
|
ERYTHROMYCIN 0.5% EYE OINTMENT 5 mg, 1 g
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
4401551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
ERYTHROMYCIN 0.5% EYE OINTMENT 5 mg, 1 g
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
4401551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.80
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.55
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
ERYTHROMYCIN BASE 250MG TABS 100 EA
|
Facility
|
OP
|
$22.66
|
|
|
Service Code
|
NDC 24338012213
|
| Hospital Charge Code |
4400275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.06
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$9.06
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.06
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$9.06
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
ERYTHROMYCIN BASE 250MG TABS 100 EA
|
Facility
|
IP
|
$22.66
|
|
|
Service Code
|
NDC 24338012213
|
| Hospital Charge Code |
4400275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
ERYTHROMYCIN BASE 5MG/GM OINT 3.5 GM
|
Facility
|
IP
|
$58.71
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
4400277
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
ERYTHROMYCIN BASE 5MG/GM OINT 3.5 GM
|
Facility
|
OP
|
$58.71
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
4400277
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
ERYTHROMYCIN LACTOBIONATE, PER 500 MG
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
4400276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.23 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna of NY Commercial |
$123.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.23
|
| Rate for Payer: EmblemHealth Select Care |
$91.23
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$123.75
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
|
ERYTHROMYCIN LACTOBIONATE, PER 500 MG
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
4400276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of NY Medicare |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: CDPHP Medicare |
$83.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$180.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$180.00
|
| Rate for Payer: EmblemHealth Medicaid |
$180.00
|
| Rate for Payer: EmblemHealth Medicare |
$76.50
|
| Rate for Payer: EmblemHealth Select Care |
$91.23
|
| Rate for Payer: Fidelis Medicare |
$90.00
|
| Rate for Payer: Galaxy Health Commercial |
$146.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$90.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$94.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$144.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$144.09
|
| Rate for Payer: United Healthcare Medicare |
$90.00
|
| Rate for Payer: WellCare Medicare |
$123.75
|
|
