|
FOLEY KIT W/TOWER BAG,16FR
|
Facility
|
OP
|
$28.84
|
|
| Hospital Charge Code |
4471989
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
FOLEY KIT W/TOWER BAG,16FR
|
Facility
|
IP
|
$28.84
|
|
| Hospital Charge Code |
4471989
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
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 1MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
4400307
|
|
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
|
|
|
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 5MG/ML MDV 10 ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
4400308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$9.60 |
| 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) Medicare |
$4.80
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 |
$4.80
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.80
|
| Rate for Payer: Humana Medicare |
$4.80
|
| 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 |
$5.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
FOLIC ACID (FOLATES)
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
|
|
FOLIC ACID (FOLATES)
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$35.20 |
| Rate for Payer: Aetna of NY Commercial |
$28.60
|
| Rate for Payer: Aetna of NY Medicare |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$16.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.20
|
| Rate for Payer: EmblemHealth Medicaid |
$35.20
|
| Rate for Payer: EmblemHealth Medicare |
$14.96
|
| Rate for Payer: EmblemHealth Select Care |
$26.40
|
| Rate for Payer: Fidelis Medicare |
$17.60
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.60
|
| Rate for Payer: Humana Medicare |
$17.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.60
|
| Rate for Payer: United Healthcare Commercial |
$33.00
|
| Rate for Payer: United Healthcare Medicare |
$17.60
|
| Rate for Payer: WellCare Medicare |
$24.20
|
|
|
FOLIC ACID; SERUM
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
4300110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$45.60 |
| 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) Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$42.75
|
| 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 |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| 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 |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| 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
|
IP
|
$24.72
|
|
| Hospital Charge Code |
4471331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
|
|
FOLY SILICON 5CC 16FR
|
Facility
|
OP
|
$24.72
|
|
| Hospital Charge Code |
4471331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.89
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.89
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.71
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
FOMEPIZOLE INJ, 15 MG
|
Facility
|
IP
|
$4,094.50
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
4400309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,251.97 |
| Max. Negotiated Rate |
$2,661.43 |
| Rate for Payer: Aetna of NY Commercial |
$2,251.97
|
| Rate for Payer: Cash Price |
$3,070.88
|
| Rate for Payer: Galaxy Health Commercial |
$2,661.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,251.97
|
| Rate for Payer: WellCare Medicare |
$2,251.97
|
|
|
FOMEPIZOLE INJ, 15 MG
|
Facility
|
OP
|
$4,094.50
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
4400309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$3,275.60 |
| Rate for Payer: Aetna of NY Medicare |
$1,883.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,637.80
|
| Rate for Payer: Cash Price |
$3,070.88
|
| Rate for Payer: Cash Price |
$3,070.88
|
| 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 |
$1,637.80
|
| Rate for Payer: Galaxy Health Commercial |
$2,661.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,637.80
|
| Rate for Payer: Humana Medicare |
$1,637.80
|
| 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 |
$1,719.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$614.17
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$1,637.80
|
| Rate for Payer: WellCare Medicare |
$2,251.97
|
|
|
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 |
$0.80 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna of NY Medicare |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: CDPHP Medicare |
$12.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| 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 |
$0.80
|
| Rate for Payer: Fidelis Medicare |
$13.42
|
| Rate for Payer: Galaxy Health Commercial |
$21.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.42
|
| Rate for Payer: Humana Medicare |
$13.42
|
| 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 |
$14.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
| Rate for Payer: United Healthcare Medicare |
$13.42
|
| Rate for Payer: WellCare Medicare |
$18.45
|
|
|
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 |
$0.80 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna of NY Commercial |
$18.45
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| Rate for Payer: EmblemHealth Select Care |
$0.80
|
| 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 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 |
$0.80 |
| Max. Negotiated Rate |
$165.01 |
| Rate for Payer: Aetna of NY Medicare |
$94.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: CDPHP Medicare |
$76.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| 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 |
$0.80
|
| Rate for Payer: Fidelis Medicare |
$82.50
|
| Rate for Payer: Galaxy Health Commercial |
$134.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.50
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$116.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$86.63
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.94
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WellCare Medicare |
$113.44
|
|
|
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 |
$0.80 |
| Max. Negotiated Rate |
$134.07 |
| Rate for Payer: Aetna of NY Commercial |
$113.44
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| Rate for Payer: EmblemHealth Select Care |
$0.80
|
| 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
|
|
|
FO PIP DIP JNT/SPRNG PRE OTS
|
Facility
|
IP
|
$317.24
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
4690267
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$206.21 |
| Rate for Payer: Cash Price |
$237.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$158.62
|
| Rate for Payer: EmblemHealth Select Care |
$158.62
|
| Rate for Payer: Galaxy Health Commercial |
$206.21
|
| Rate for Payer: Multiplan Commercial |
$142.76
|
| Rate for Payer: WellCare Medicare |
$174.48
|
|
|
FO PIP DIP JNT/SPRNG PRE OTS
|
Facility
|
OP
|
$317.24
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
4690267
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$253.79 |
| Rate for Payer: Aetna of NY Commercial |
$222.07
|
| Rate for Payer: Aetna of NY Medicare |
$145.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$237.93
|
| Rate for Payer: CDPHP Medicare |
$117.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$158.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$253.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$253.79
|
| Rate for Payer: EmblemHealth Medicaid |
$253.79
|
| Rate for Payer: EmblemHealth Medicare |
$107.86
|
| Rate for Payer: EmblemHealth Select Care |
$158.62
|
| Rate for Payer: Fidelis Medicare |
$126.90
|
| Rate for Payer: Galaxy Health Commercial |
$206.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.90
|
| Rate for Payer: Humana Medicare |
$126.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$222.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$145.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.93
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$178.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.59
|
| Rate for Payer: United Healthcare Medicare |
$126.90
|
| Rate for Payer: WellCare Medicare |
$174.48
|
|
|
FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
4002049
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
4002049
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$551.52
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$431.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
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 |
$7.20 |
| Max. Negotiated Rate |
$38.40 |
| 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) Medicare |
$19.20
|
| Rate for Payer: Cash Price |
$36.00
|
| 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 |
$19.20
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.20
|
| Rate for Payer: Humana Medicare |
$19.20
|
| 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 |
$20.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.20
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$19.20
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
FRESH FROZEN PLASMA
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4304876
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of NY Commercial |
$316.40
|
| Rate for Payer: Aetna of NY Medicare |
$207.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.80
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: CDPHP Medicare |
$167.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$226.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$361.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$361.60
|
| Rate for Payer: EmblemHealth Medicaid |
$361.60
|
| Rate for Payer: EmblemHealth Medicare |
$153.68
|
| Rate for Payer: EmblemHealth Select Care |
$226.00
|
| Rate for Payer: Fidelis Medicare |
$180.80
|
| Rate for Payer: Galaxy Health Commercial |
$293.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.80
|
| Rate for Payer: Humana Medicare |
$180.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$316.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$254.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$339.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$67.80
|
| Rate for Payer: United Healthcare Commercial |
$339.00
|
| Rate for Payer: United Healthcare Medicare |
$180.80
|
| Rate for Payer: WellCare Medicare |
$248.60
|
|
