|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.70
|
| Rate for Payer: EmblemHealth Select Care |
$0.70
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.10
|
| Rate for Payer: WellCare Medicare |
$5.10
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna of NY Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.70
|
| Rate for Payer: EmblemHealth Select Care |
$0.70
|
| Rate for Payer: Galaxy Health Commercial |
$1.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.45
|
| Rate for Payer: WellCare Medicare |
$1.45
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of NY Commercial |
$1.45
|
| Rate for Payer: Aetna of NY Medicare |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.32
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: CDPHP Commercial |
$2.13
|
| Rate for Payer: CDPHP Medicare |
$0.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.11
|
| Rate for Payer: EmblemHealth Medicaid |
$2.11
|
| Rate for Payer: EmblemHealth Medicare |
$0.90
|
| Rate for Payer: EmblemHealth Select Care |
$0.70
|
| Rate for Payer: Fidelis Medicare |
$1.01
|
| Rate for Payer: Galaxy Health Commercial |
$1.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.98
|
| Rate for Payer: Humana Medicare |
$0.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.98
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$0.98
|
| Rate for Payer: WellCare Medicare |
$1.45
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Aetna of NY Commercial |
$5.10
|
| Rate for Payer: Aetna of NY Medicare |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.64
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: CDPHP Commercial |
$7.46
|
| Rate for Payer: CDPHP Medicare |
$3.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.42
|
| Rate for Payer: EmblemHealth Medicaid |
$7.42
|
| Rate for Payer: EmblemHealth Medicare |
$3.15
|
| Rate for Payer: EmblemHealth Select Care |
$0.70
|
| Rate for Payer: Fidelis Medicare |
$3.53
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.43
|
| Rate for Payer: Humana Medicare |
$3.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$3.43
|
| Rate for Payer: WellCare Medicare |
$5.10
|
|
|
KIDNEY IMAGING MORPHOL
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78700
|
| Hospital Charge Code |
4210093
|
|
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
|
|
|
KIDNEY IMAGING MORPHOL
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78700
|
| Hospital Charge Code |
4210093
|
|
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
|
|
|
KIDNEY IMAGING WITH FLOW
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78701
|
| Hospital Charge Code |
4210094
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$50.50 |
| 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 |
$50.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
KIDNEY IMAGING WITH FLOW
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78701
|
| Hospital Charge Code |
4210094
|
|
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
|
|
|
KINEVAC (CCK)
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
4409053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.36 |
| Max. Negotiated Rate |
$220.34 |
| Rate for Payer: Aetna of NY Commercial |
$112.20
|
| Rate for Payer: Aetna of NY Medicare |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$129.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$129.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: CDPHP Commercial |
$164.22
|
| Rate for Payer: CDPHP Medicare |
$75.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$129.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.20
|
| Rate for Payer: EmblemHealth Medicaid |
$163.20
|
| Rate for Payer: EmblemHealth Medicare |
$69.36
|
| Rate for Payer: EmblemHealth Select Care |
$129.74
|
| Rate for Payer: Fidelis Medicare |
$77.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.48
|
| Rate for Payer: Humana Medicare |
$75.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$220.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.74
|
| Rate for Payer: United Healthcare Commercial |
$220.34
|
| Rate for Payer: United Healthcare Medicare |
$75.48
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
|
KINEVAC (CCK)
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
4409053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna of NY Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$129.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$129.74
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$129.74
|
| Rate for Payer: EmblemHealth Select Care |
$129.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.20
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
|
KNEE KIT:CRK-17-100-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
KNEE KIT:CRK-17-100-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
KOBYGARD SINGLE USE BLADES
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
4472239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$543.38 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$486.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
KOBYGARD SINGLE USE BLADES
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
4472239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
K-Phos NeutraL TABLET 250 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
4401527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
K-Phos NeutraL TABLET 250 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
4401527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| 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) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| 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 |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| 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 |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
K WIRE
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4479270
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
K WIRE
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4479270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| 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 |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
KYPHON EXPRESS CURETTE T-TIP 7.0MM SZ 2
|
Facility
|
IP
|
$347.00
|
|
| Hospital Charge Code |
4479245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Cash Price |
$260.25
|
| Rate for Payer: Galaxy Health Commercial |
$225.55
|
|
|
KYPHON EXPRESS CURETTE T-TIP 7.0MM SZ 2
|
Facility
|
OP
|
$347.00
|
|
| Hospital Charge Code |
4479245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$279.34 |
| Rate for Payer: Aetna of NY Commercial |
$242.90
|
| Rate for Payer: Aetna of NY Medicare |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$173.50
|
| Rate for Payer: Cash Price |
$260.25
|
| Rate for Payer: CDPHP Commercial |
$279.34
|
| Rate for Payer: CDPHP Medicare |
$128.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$277.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$277.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$277.60
|
| Rate for Payer: EmblemHealth Medicaid |
$277.60
|
| Rate for Payer: EmblemHealth Medicare |
$117.98
|
| Rate for Payer: EmblemHealth Select Care |
$249.84
|
| Rate for Payer: Fidelis Medicare |
$132.24
|
| Rate for Payer: Galaxy Health Commercial |
$225.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.39
|
| Rate for Payer: Humana Medicare |
$128.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$242.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$159.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$195.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.81
|
| Rate for Payer: United Healthcare Medicare |
$128.39
|
| Rate for Payer: WellCare Medicare |
$190.85
|
|
|
LABETALOL HCL 100MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904592861
|
| Hospital Charge Code |
4400409
|
|
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
|
|
|
LABETALOL HCL 100MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904592861
|
| Hospital Charge Code |
4400409
|
|
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
|
|
|
LABETALOL HCL 5MG/ML CARP 10X4ML
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00409233934
|
| Hospital Charge Code |
4400411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Galaxy Health Commercial |
$15.07
|
| Rate for Payer: WellCare Medicare |
$12.75
|
|
|
LABETALOL HCL 5MG/ML CARP 10X4ML
|
Facility
|
OP
|
$23.18
|
|
|
Service Code
|
NDC 00409233934
|
| Hospital Charge Code |
4400411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna of NY Commercial |
$16.23
|
| Rate for Payer: Aetna of NY Medicare |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.59
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: CDPHP Commercial |
$18.66
|
| Rate for Payer: CDPHP Medicare |
$8.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.54
|
| Rate for Payer: EmblemHealth Medicaid |
$18.54
|
| Rate for Payer: EmblemHealth Medicare |
$7.88
|
| Rate for Payer: EmblemHealth Select Care |
$16.69
|
| Rate for Payer: Fidelis Medicare |
$8.83
|
| Rate for Payer: Galaxy Health Commercial |
$15.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.58
|
| Rate for Payer: Humana Medicare |
$8.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.01
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: WellCare Medicare |
$12.75
|
|
|
LABETALOL HCL 5MG/ML MDV 20 ML
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00409226720
|
| Hospital Charge Code |
4400412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
