|
GEN COOLED RF PROBE TIP CRP 17-100-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479258
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
GENET VIRUS ISOLATE HSV
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
4304883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of NY Commercial |
$85.80
|
| Rate for Payer: Aetna of NY Medicare |
$60.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$66.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: CDPHP Commercial |
$106.26
|
| Rate for Payer: CDPHP Medicare |
$48.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$105.60
|
| Rate for Payer: EmblemHealth Medicare |
$44.88
|
| Rate for Payer: EmblemHealth Select Care |
$79.20
|
| Rate for Payer: Fidelis Medicare |
$50.31
|
| Rate for Payer: Galaxy Health Commercial |
$85.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.84
|
| Rate for Payer: Humana Medicare |
$48.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$85.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$60.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$74.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$51.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$99.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Medicare |
$48.84
|
| Rate for Payer: WellCare Medicare |
$72.60
|
|
|
GENET VIRUS ISOLATE HSV
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
4304878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of NY Commercial |
$85.80
|
| Rate for Payer: Aetna of NY Medicare |
$60.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$66.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: CDPHP Commercial |
$106.26
|
| Rate for Payer: CDPHP Medicare |
$48.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$105.60
|
| Rate for Payer: EmblemHealth Medicare |
$44.88
|
| Rate for Payer: EmblemHealth Select Care |
$79.20
|
| Rate for Payer: Fidelis Medicare |
$50.31
|
| Rate for Payer: Galaxy Health Commercial |
$85.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.84
|
| Rate for Payer: Humana Medicare |
$48.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$85.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$60.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$74.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$51.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$99.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Medicare |
$48.84
|
| Rate for Payer: WellCare Medicare |
$72.60
|
|
|
GENET VIRUS ISOLATE HSV
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
4304878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Galaxy Health Commercial |
$85.80
|
|
|
GENET VIRUS ISOLATE HSV
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
4304883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Galaxy Health Commercial |
$85.80
|
|
|
GENTAMICIN SULFATE 0.001 OINT 15 GM
|
Facility
|
IP
|
$152.70
|
|
|
Service Code
|
NDC 45802004635
|
| Hospital Charge Code |
4400320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$99.26 |
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Galaxy Health Commercial |
$99.26
|
| Rate for Payer: WellCare Medicare |
$83.98
|
|
|
GENTAMICIN SULFATE 0.001 OINT 15 GM
|
Facility
|
OP
|
$152.70
|
|
|
Service Code
|
NDC 45802004635
|
| Hospital Charge Code |
4400320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Aetna of NY Commercial |
$106.89
|
| Rate for Payer: Aetna of NY Medicare |
$70.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$114.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$114.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$76.35
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: CDPHP Commercial |
$122.92
|
| Rate for Payer: CDPHP Medicare |
$56.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$122.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.16
|
| Rate for Payer: EmblemHealth Medicaid |
$122.16
|
| Rate for Payer: EmblemHealth Medicare |
$51.92
|
| Rate for Payer: EmblemHealth Select Care |
$109.94
|
| Rate for Payer: Fidelis Medicare |
$58.19
|
| Rate for Payer: Galaxy Health Commercial |
$99.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.50
|
| Rate for Payer: Humana Medicare |
$56.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$106.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$85.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.32
|
| Rate for Payer: United Healthcare Medicare |
$56.50
|
| Rate for Payer: WellCare Medicare |
$83.98
|
|
|
GENTAMICIN SULFATE 0.003 DROP 5 ML
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
4400321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$106.55 |
| Rate for Payer: Aetna of NY Commercial |
$92.65
|
| Rate for Payer: Aetna of NY Medicare |
$60.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$99.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$99.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$66.18
|
| Rate for Payer: Cash Price |
$99.27
|
| Rate for Payer: CDPHP Commercial |
$106.55
|
| Rate for Payer: CDPHP Medicare |
$48.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$105.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$105.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.89
|
| Rate for Payer: EmblemHealth Medicaid |
$105.89
|
| Rate for Payer: EmblemHealth Medicare |
$45.00
|
| Rate for Payer: EmblemHealth Select Care |
$95.30
|
| Rate for Payer: Fidelis Medicare |
$50.44
|
| Rate for Payer: Galaxy Health Commercial |
$86.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.97
|
| Rate for Payer: Humana Medicare |
$48.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$92.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$60.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$74.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$51.42
|
| Rate for Payer: United Healthcare Medicare |
$48.97
|
| Rate for Payer: WellCare Medicare |
$72.80
|
|
|
GENTAMICIN SULFATE 0.003 DROP 5 ML
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
4400321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$86.03 |
| Rate for Payer: Cash Price |
$99.27
|
| Rate for Payer: Galaxy Health Commercial |
$86.03
|
| Rate for Payer: WellCare Medicare |
$72.80
|
|
|
GENTAMICIN SULFATE 0.003 OINT 3.5 GM
|
Facility
|
OP
|
$60.77
|
|
|
Service Code
|
NDC 17478028435
|
| Hospital Charge Code |
4400319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Aetna of NY Commercial |
$42.54
|
| Rate for Payer: Aetna of NY Medicare |
$27.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.38
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: CDPHP Commercial |
$48.92
|
| Rate for Payer: CDPHP Medicare |
$22.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.62
|
| Rate for Payer: EmblemHealth Medicaid |
$48.62
|
| Rate for Payer: EmblemHealth Medicare |
$20.66
|
| Rate for Payer: EmblemHealth Select Care |
$43.75
|
| Rate for Payer: Fidelis Medicare |
$23.16
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.48
|
| Rate for Payer: Humana Medicare |
$22.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.61
|
| Rate for Payer: United Healthcare Medicare |
$22.48
|
| Rate for Payer: WellCare Medicare |
$33.42
|
|
|
GENTAMICIN SULFATE 0.003 OINT 3.5 GM
|
Facility
|
IP
|
$60.77
|
|
|
Service Code
|
NDC 17478028435
|
| Hospital Charge Code |
4400319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Galaxy Health Commercial |
$39.50
|
| Rate for Payer: WellCare Medicare |
$33.42
|
|
|
GENTAMICIN TROUGH
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
4300369
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna of NY Commercial |
$41.60
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$38.40
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$48.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$48.00
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
GENTAMICIN TROUGH
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
4300369
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
GIARDIA LAMBLIA ABS EIA
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 86674
|
| Hospital Charge Code |
4300372
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Cash Price |
$120.75
|
| Rate for Payer: Galaxy Health Commercial |
$104.65
|
|
|
GIARDIA LAMBLIA ABS EIA
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 86674
|
| Hospital Charge Code |
4300372
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of NY Commercial |
$104.65
|
| Rate for Payer: Aetna of NY Medicare |
$74.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$120.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$120.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$80.50
|
| Rate for Payer: Cash Price |
$120.75
|
| Rate for Payer: Cash Price |
$120.75
|
| Rate for Payer: CDPHP Commercial |
$129.60
|
| Rate for Payer: CDPHP Medicare |
$59.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.80
|
| Rate for Payer: EmblemHealth Medicaid |
$128.80
|
| Rate for Payer: EmblemHealth Medicare |
$54.74
|
| Rate for Payer: EmblemHealth Select Care |
$96.60
|
| Rate for Payer: Fidelis Medicare |
$61.36
|
| Rate for Payer: Galaxy Health Commercial |
$104.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.57
|
| Rate for Payer: Humana Medicare |
$59.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.55
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.72
|
| Rate for Payer: United Healthcare Commercial |
$120.75
|
| Rate for Payer: United Healthcare Medicare |
$59.57
|
| Rate for Payer: WellCare Medicare |
$88.55
|
|
|
GI BLEEDING
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
4210001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
GI BLEEDING
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
4210001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
GLIMEPERIDE 1 MG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 16729000101
|
| Hospital Charge Code |
4409158
|
|
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
|
|
|
GLIMEPERIDE 1 MG TABLET
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 16729000101
|
| Hospital Charge Code |
4409158
|
|
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
|
|
|
GLIPIZIDE 2.5MG TABS 30 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084029511
|
| Hospital Charge Code |
4400333
|
|
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
|
|
|
GLIPIZIDE 2.5MG TABS 30 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084029511
|
| Hospital Charge Code |
4400333
|
|
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
|
|
|
GLIPIZIDE 5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
4400327
|
|
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
|
|
|
GLIPIZIDE 5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
4400327
|
|
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
|
|
|
GLIPIZIDE ER 5 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084011101
|
| Hospital Charge Code |
4401266
|
|
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
|
|
|
GLIPIZIDE ER 5 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084011101
|
| Hospital Charge Code |
4401266
|
|
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
|
|
