|
GI BLEEDING
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 78278 26
|
| Hospital Charge Code |
5210001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.30
|
|
|
GI BLEEDING
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
4210001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
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 |
$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
|
|
|
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 2.5MG TABS 30 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084029511
|
| Hospital Charge Code |
4400333
|
|
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
|
|
|
GLIPIZIDE 5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
4400327
|
|
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
|
|
|
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 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
|
|
|
GLIPIZIDE ER 5 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084011101
|
| Hospital Charge Code |
4401266
|
|
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
|
|
|
GLUCAGON HCL INJ, PER 1 MG
|
Facility
|
OP
|
$852.50
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
4400330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of NY Medicare |
$392.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$341.00
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: CDPHP Medicare |
$315.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$146.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$682.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$682.00
|
| Rate for Payer: EmblemHealth Medicaid |
$682.00
|
| Rate for Payer: EmblemHealth Medicare |
$289.85
|
| Rate for Payer: EmblemHealth Select Care |
$146.33
|
| Rate for Payer: Fidelis Medicare |
$341.00
|
| Rate for Payer: Galaxy Health Commercial |
$554.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$341.00
|
| Rate for Payer: Humana Medicare |
$341.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$392.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$639.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$479.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$358.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$322.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$127.88
|
| Rate for Payer: United Healthcare Commercial |
$322.05
|
| Rate for Payer: United Healthcare Medicare |
$341.00
|
| Rate for Payer: WellCare Medicare |
$468.88
|
|
|
GLUCAGON HCL INJ, PER 1 MG
|
Facility
|
IP
|
$852.50
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
4400330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$554.12 |
| Rate for Payer: Aetna of NY Commercial |
$468.88
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$146.33
|
| Rate for Payer: EmblemHealth Select Care |
$146.33
|
| Rate for Payer: Galaxy Health Commercial |
$554.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$468.88
|
| Rate for Payer: WellCare Medicare |
$468.88
|
|
|
GLUCOMETER
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4472205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
GLUCOMETER
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4472205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
GLUCOMETER X2
|
Facility
|
IP
|
$39.14
|
|
| Hospital Charge Code |
4472208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Cash Price |
$29.36
|
| Rate for Payer: Galaxy Health Commercial |
$25.44
|
|
|
GLUCOMETER X2
|
Facility
|
OP
|
$39.14
|
|
| Hospital Charge Code |
4472208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna of NY Commercial |
$27.40
|
| Rate for Payer: Aetna of NY Medicare |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.66
|
| Rate for Payer: Cash Price |
$29.36
|
| Rate for Payer: CDPHP Medicare |
$14.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.31
|
| Rate for Payer: EmblemHealth Medicaid |
$31.31
|
| Rate for Payer: EmblemHealth Medicare |
$13.31
|
| Rate for Payer: EmblemHealth Select Care |
$28.18
|
| Rate for Payer: Fidelis Medicare |
$15.66
|
| Rate for Payer: Galaxy Health Commercial |
$25.44
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.66
|
| Rate for Payer: Humana Medicare |
$15.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.87
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WellCare Medicare |
$21.53
|
|
|
GLUCOMETER X3
|
Facility
|
IP
|
$39.14
|
|
| Hospital Charge Code |
4472209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Cash Price |
$29.36
|
| Rate for Payer: Galaxy Health Commercial |
$25.44
|
|
|
GLUCOMETER X3
|
Facility
|
OP
|
$39.14
|
|
| Hospital Charge Code |
4472209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna of NY Commercial |
$27.40
|
| Rate for Payer: Aetna of NY Medicare |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.66
|
| Rate for Payer: Cash Price |
$29.36
|
| Rate for Payer: CDPHP Medicare |
$14.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.31
|
| Rate for Payer: EmblemHealth Medicaid |
$31.31
|
| Rate for Payer: EmblemHealth Medicare |
$13.31
|
| Rate for Payer: EmblemHealth Select Care |
$28.18
|
| Rate for Payer: Fidelis Medicare |
$15.66
|
| Rate for Payer: Galaxy Health Commercial |
$25.44
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.66
|
| Rate for Payer: Humana Medicare |
$15.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.87
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WellCare Medicare |
$21.53
|
|
|
GLUCOMETER X4
|
Facility
|
OP
|
$48.41
|
|
| Hospital Charge Code |
4472210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna of NY Commercial |
$33.89
|
| Rate for Payer: Aetna of NY Medicare |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.36
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: CDPHP Medicare |
$17.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.73
|
| Rate for Payer: EmblemHealth Medicaid |
$38.73
|
| Rate for Payer: EmblemHealth Medicare |
$16.46
|
| Rate for Payer: EmblemHealth Select Care |
$34.86
|
| Rate for Payer: Fidelis Medicare |
$19.36
|
| Rate for Payer: Galaxy Health Commercial |
$31.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.36
|
| Rate for Payer: Humana Medicare |
$19.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.26
|
| Rate for Payer: United Healthcare Medicare |
$19.36
|
| Rate for Payer: WellCare Medicare |
$26.63
|
|
|
GLUCOMETER X4
|
Facility
|
IP
|
$48.41
|
|
| Hospital Charge Code |
4472210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$31.47 |
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Galaxy Health Commercial |
$31.47
|
|
|
GLUCOSE; BLD BY MONITOR DEVICE (POC)
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
4602200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
GLUCOSE; BLD BY MONITOR DEVICE (POC)
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
4602200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
GLUCOSE BLOOD BY MONITOR
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
4304864
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of NY Commercial |
$6.50
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$6.00
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
GLUCOSE BLOOD BY MONITOR
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
4304864
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
GLUCOSE BODY FLUID
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
4300382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
