|
FOLEY KIT W/TOWER BAG,16FR
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
4471989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$22.54 |
| 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) Blue Access/Small Group |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Commercial |
$22.54
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$20.16
|
| Rate for Payer: Fidelis Medicare |
$10.67
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
| Rate for Payer: Humana Medicare |
$10.36
|
| 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 Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
FOLEY KIT W/TOWER BAG,16FR
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
4471989
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
FOLIC ACID 1MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
4400307
|
|
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
|
|
|
FOLIC ACID 1MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
4400307
|
|
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
|
|
|
FOLIC ACID 5MG/ML MDV 10 ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
4400308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$8.40
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
FOLIC ACID 5MG/ML MDV 10 ML
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
4400308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
FOLIC ACID (FOLATES)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$34.20
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
FOLIC ACID (FOLATES)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
FOLIC ACID; SERUM
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$34.20
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
FOLIC ACID; SERUM
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
FOLY SILICON 5CC 16FR
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
4471331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
FOLY SILICON 5CC 16FR
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
4471331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
FOMEPIZOLE INJ, 15 MG
|
Facility
|
OP
|
$4,094.50
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
4400309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$3,296.07 |
| Rate for Payer: Aetna of NY Commercial |
$2,251.98
|
| Rate for Payer: Aetna of NY Medicare |
$1,883.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,842.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,842.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,514.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,047.25
|
| Rate for Payer: Cash Price |
$3,070.88
|
| Rate for Payer: Cash Price |
$3,070.88
|
| Rate for Payer: CDPHP Commercial |
$3,296.07
|
| Rate for Payer: CDPHP Medicare |
$1,514.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,275.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,275.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,275.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,275.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,392.13
|
| Rate for Payer: EmblemHealth Select Care |
$2,948.04
|
| Rate for Payer: Fidelis Medicare |
$1,560.41
|
| Rate for Payer: Galaxy Health Commercial |
$2,661.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,514.96
|
| Rate for Payer: Humana Medicare |
$1,514.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,251.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,883.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,070.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,305.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,590.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.58
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$1,514.96
|
| Rate for Payer: WellCare Medicare |
$2,251.98
|
|
|
FOMEPIZOLE INJ, 15 MG
|
Facility
|
IP
|
$4,094.50
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
4400309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,842.52 |
| Max. Negotiated Rate |
$2,661.42 |
| Rate for Payer: Aetna of NY Commercial |
$2,251.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,842.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,842.52
|
| Rate for Payer: Cash Price |
$3,070.88
|
| Rate for Payer: Galaxy Health Commercial |
$2,661.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,251.98
|
| Rate for Payer: WellCare Medicare |
$2,251.98
|
|
|
FONDAPARINUX 10 MG/0.8 ML SYR 0.5 mg, 0.8 mL
|
Facility
|
IP
|
$33.55
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
4401439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna of NY Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.03
|
| Rate for Payer: EmblemHealth Select Care |
$1.03
|
| Rate for Payer: Galaxy Health Commercial |
$21.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.45
|
| Rate for Payer: WellCare Medicare |
$18.45
|
|
|
FONDAPARINUX 10 MG/0.8 ML SYR 0.5 mg, 0.8 mL
|
Facility
|
OP
|
$33.55
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
4401439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$27.01 |
| Rate for Payer: Aetna of NY Commercial |
$18.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.78
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: CDPHP Commercial |
$27.01
|
| Rate for Payer: CDPHP Medicare |
$12.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.84
|
| Rate for Payer: EmblemHealth Medicaid |
$26.84
|
| Rate for Payer: EmblemHealth Medicare |
$11.41
|
| Rate for Payer: EmblemHealth Select Care |
$1.03
|
| Rate for Payer: Fidelis Medicare |
$12.79
|
| Rate for Payer: Galaxy Health Commercial |
$21.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.41
|
| Rate for Payer: Humana Medicare |
$12.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.77
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
| Rate for Payer: United Healthcare Medicare |
$12.41
|
| Rate for Payer: WellCare Medicare |
$18.45
|
|
|
FONDAPARINUX SODIUM 2.5MG/0.5ML SYRN 10X
|
Facility
|
IP
|
$206.26
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
4400069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$134.07 |
| Rate for Payer: Aetna of NY Commercial |
$113.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.03
|
| Rate for Payer: EmblemHealth Select Care |
$1.03
|
| Rate for Payer: Galaxy Health Commercial |
$134.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.44
|
| Rate for Payer: WellCare Medicare |
$113.44
|
|
|
FONDAPARINUX SODIUM 2.5MG/0.5ML SYRN 10X
|
Facility
|
OP
|
$206.26
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
4400069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$166.04 |
| Rate for Payer: Aetna of NY Commercial |
$113.44
|
| Rate for Payer: Aetna of NY Medicare |
$94.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$76.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$103.13
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: CDPHP Commercial |
$166.04
|
| Rate for Payer: CDPHP Medicare |
$76.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$165.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$165.01
|
| Rate for Payer: EmblemHealth Medicaid |
$165.01
|
| Rate for Payer: EmblemHealth Medicare |
$70.13
|
| Rate for Payer: EmblemHealth Select Care |
$1.03
|
| Rate for Payer: Fidelis Medicare |
$78.61
|
| Rate for Payer: Galaxy Health Commercial |
$134.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.32
|
| Rate for Payer: Humana Medicare |
$76.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$116.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.77
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
| Rate for Payer: United Healthcare Medicare |
$76.32
|
| Rate for Payer: WellCare Medicare |
$113.44
|
|
|
FO PIP DIP JNT/SPRNG PRE OTS
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
4690267
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$247.94 |
| Rate for Payer: Aetna of NY Commercial |
$215.60
|
| Rate for Payer: Aetna of NY Medicare |
$141.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$154.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: CDPHP Commercial |
$247.94
|
| Rate for Payer: CDPHP Medicare |
$113.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$246.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$246.40
|
| Rate for Payer: EmblemHealth Medicaid |
$246.40
|
| Rate for Payer: EmblemHealth Medicare |
$104.72
|
| Rate for Payer: EmblemHealth Select Care |
$154.00
|
| Rate for Payer: Fidelis Medicare |
$117.38
|
| Rate for Payer: Galaxy Health Commercial |
$200.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$113.96
|
| Rate for Payer: Humana Medicare |
$113.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$215.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$141.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$173.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$119.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$113.96
|
| Rate for Payer: WellCare Medicare |
$169.40
|
|
|
FO PIP DIP JNT/SPRNG PRE OTS
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
4690267
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.60
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.00
|
| Rate for Payer: EmblemHealth Select Care |
$154.00
|
| Rate for Payer: Galaxy Health Commercial |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$138.60
|
| Rate for Payer: WellCare Medicare |
$169.40
|
|
|
FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
4002049
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$509.04
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
4002049
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
FREE THROXINE INDEX
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
4300359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
|
|
FREE THROXINE INDEX
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
4300359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$31.20
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$28.80
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
FRESH FROZEN PLASMA
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4304876
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$503.93 |
| Rate for Payer: Aetna of NY Commercial |
$438.20
|
| Rate for Payer: Aetna of NY Medicare |
$287.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$469.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$469.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$231.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$313.00
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: CDPHP Commercial |
$503.93
|
| Rate for Payer: CDPHP Medicare |
$231.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$500.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.80
|
| Rate for Payer: EmblemHealth Medicaid |
$500.80
|
| Rate for Payer: EmblemHealth Medicare |
$212.84
|
| Rate for Payer: EmblemHealth Select Care |
$313.00
|
| Rate for Payer: Fidelis Medicare |
$238.57
|
| Rate for Payer: Galaxy Health Commercial |
$406.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$231.62
|
| Rate for Payer: Humana Medicare |
$231.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$438.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$287.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$469.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$352.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$243.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$469.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$136.51
|
| Rate for Payer: United Healthcare Commercial |
$469.50
|
| Rate for Payer: United Healthcare Medicare |
$231.62
|
| Rate for Payer: WellCare Medicare |
$344.30
|
|
