|
FENTANYL 50MCG/HR PTCH 5 EA
|
Facility
|
IP
|
$81.37
|
|
|
Service Code
|
NDC 378912298
|
| Hospital Charge Code |
4400288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
FENTANYL 50MCG/HR PTCH 5 EA
|
Facility
|
OP
|
$81.37
|
|
|
Service Code
|
NDC 378912298
|
| Hospital Charge Code |
4400288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna of NY Commercial |
$56.96
|
| Rate for Payer: Aetna of NY Medicare |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: CDPHP Medicare |
$30.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.10
|
| Rate for Payer: EmblemHealth Medicaid |
$65.10
|
| Rate for Payer: EmblemHealth Medicare |
$27.67
|
| Rate for Payer: EmblemHealth Select Care |
$58.59
|
| Rate for Payer: Fidelis Medicare |
$32.55
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.55
|
| Rate for Payer: Humana Medicare |
$32.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.21
|
| Rate for Payer: United Healthcare Medicare |
$32.55
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
FENTANYL CITRATE INJ 0.05 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
4400289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.16
|
| 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 |
$1.16
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FENTANYL CITRATE INJ 0.05 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
4400289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.16
|
| Rate for Payer: EmblemHealth Select Care |
$1.16
|
| 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
|
|
|
FENTANYL PATCH
|
Facility
|
IP
|
$60.91
|
|
|
Service Code
|
NDC 378911998
|
| Hospital Charge Code |
4401625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Galaxy Health Commercial |
$39.59
|
| Rate for Payer: WellCare Medicare |
$33.50
|
|
|
FENTANYL PATCH
|
Facility
|
OP
|
$60.91
|
|
|
Service Code
|
NDC 378911998
|
| Hospital Charge Code |
4401625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$48.73 |
| Rate for Payer: Aetna of NY Commercial |
$42.64
|
| Rate for Payer: Aetna of NY Medicare |
$28.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.36
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: CDPHP Medicare |
$22.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.73
|
| Rate for Payer: EmblemHealth Medicaid |
$48.73
|
| Rate for Payer: EmblemHealth Medicare |
$20.71
|
| Rate for Payer: EmblemHealth Select Care |
$43.86
|
| Rate for Payer: Fidelis Medicare |
$24.36
|
| Rate for Payer: Galaxy Health Commercial |
$39.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.36
|
| Rate for Payer: Humana Medicare |
$24.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.14
|
| Rate for Payer: United Healthcare Medicare |
$24.36
|
| Rate for Payer: WellCare Medicare |
$33.50
|
|
|
FENTANYL PATCH 75 MCG/HR
|
Facility
|
OP
|
$143.69
|
|
|
Service Code
|
NDC 60505700802
|
| Hospital Charge Code |
4408955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna of NY Commercial |
$100.58
|
| Rate for Payer: Aetna of NY Medicare |
$66.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.48
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: CDPHP Medicare |
$53.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$114.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$114.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.95
|
| Rate for Payer: EmblemHealth Medicaid |
$114.95
|
| Rate for Payer: EmblemHealth Medicare |
$48.85
|
| Rate for Payer: EmblemHealth Select Care |
$103.46
|
| Rate for Payer: Fidelis Medicare |
$57.48
|
| Rate for Payer: Galaxy Health Commercial |
$93.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.48
|
| Rate for Payer: Humana Medicare |
$57.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.55
|
| Rate for Payer: United Healthcare Medicare |
$57.48
|
| Rate for Payer: WellCare Medicare |
$79.03
|
|
|
FENTANYL PATCH 75 MCG/HR
|
Facility
|
IP
|
$143.69
|
|
|
Service Code
|
NDC 60505700802
|
| Hospital Charge Code |
4408955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.03 |
| Max. Negotiated Rate |
$93.40 |
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Galaxy Health Commercial |
$93.40
|
| Rate for Payer: WellCare Medicare |
$79.03
|
|
|
FERAHEME 510 MG/17 ML VIAL 510 mg, 17 mL
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
4401919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.00
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: CDPHP Medicare |
$2.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.90
|
| Rate for Payer: EmblemHealth Medicaid |
$0.90
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Fidelis Medicare |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Galaxy Health Workers Comp |
$0.88
|
| Rate for Payer: Hamaspik Choice Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.00
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$0.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$3.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$0.95
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
FERAHEME 510 MG/17 ML VIAL 510 mg, 17 mL
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
4401919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
FERRITIN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
4300349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
FERRITIN
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
4300349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
FERRLECIT INJ 12.5 MG
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
4409235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of NY Medicare |
$10.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: CDPHP Medicare |
$8.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.66
|
| Rate for Payer: EmblemHealth Medicaid |
$2.66
|
| Rate for Payer: EmblemHealth Medicare |
$8.02
|
| Rate for Payer: EmblemHealth Select Care |
$2.39
|
| Rate for Payer: Fidelis Medicare |
$9.44
|
| Rate for Payer: Galaxy Health Commercial |
$15.33
|
| Rate for Payer: Galaxy Health Workers Comp |
$2.61
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.44
|
| Rate for Payer: Humana Medicare |
$9.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.54
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$9.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2.79
|
| Rate for Payer: WellCare Medicare |
$12.97
|
|
|
FERRLECIT INJ 12.5 MG
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
4409235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna of NY Commercial |
$12.97
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.39
|
| Rate for Payer: EmblemHealth Select Care |
$2.39
|
| Rate for Payer: Galaxy Health Commercial |
$15.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.97
|
| Rate for Payer: WellCare Medicare |
$12.97
|
|
|
FERROUS SULFATE 325MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904759161
|
| Hospital Charge Code |
4400290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FERROUS SULFATE 325MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904759161
|
| Hospital Charge Code |
4400290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Hospital Charge Code |
4200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Hospital Charge Code |
5200024
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Galaxy Health Commercial |
$72.80
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Hospital Charge Code |
4200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$224.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Hospital Charge Code |
5200024
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$89.60 |
| Rate for Payer: Aetna of NY Commercial |
$78.40
|
| Rate for Payer: Aetna of NY Medicare |
$51.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: CDPHP Medicare |
$41.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$89.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$89.60
|
| Rate for Payer: EmblemHealth Medicaid |
$89.60
|
| Rate for Payer: EmblemHealth Medicare |
$38.08
|
| Rate for Payer: Fidelis Medicare |
$44.80
|
| Rate for Payer: Galaxy Health Commercial |
$72.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.80
|
| Rate for Payer: Humana Medicare |
$44.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$78.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$51.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$63.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.80
|
| Rate for Payer: United Healthcare Medicare |
$44.80
|
| Rate for Payer: WellCare Medicare |
$61.60
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4200199
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of NY Commercial |
$224.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 76818 26
|
| Hospital Charge Code |
5200199
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Galaxy Health Commercial |
$100.10
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4200199
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 76818 26
|
| Hospital Charge Code |
5200199
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: Aetna of NY Commercial |
$107.80
|
| Rate for Payer: Aetna of NY Medicare |
$70.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.60
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: CDPHP Medicare |
$56.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$123.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$123.20
|
| Rate for Payer: EmblemHealth Medicaid |
$123.20
|
| Rate for Payer: EmblemHealth Medicare |
$52.36
|
| Rate for Payer: Fidelis Medicare |
$61.60
|
| Rate for Payer: Galaxy Health Commercial |
$100.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.60
|
| Rate for Payer: Humana Medicare |
$61.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$107.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.10
|
| Rate for Payer: United Healthcare Medicare |
$61.60
|
| Rate for Payer: WellCare Medicare |
$84.70
|
|
|
FEVERALL 80 MG SUPPOSITORY 80 mg, 6 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51672211402
|
| Hospital Charge Code |
4401544
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
