|
INDIGO CARMINE 0.8% AMPUL 5 mL, 5 mL
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna of NY Commercial |
$341.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$341.00
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
INDIGO CARMINE 0.8% AMPUL 5 mL, 5 mL
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna of NY Medicare |
$285.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$248.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: CDPHP Medicare |
$229.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$496.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$496.00
|
| Rate for Payer: EmblemHealth Medicaid |
$496.00
|
| Rate for Payer: EmblemHealth Medicare |
$210.80
|
| Rate for Payer: EmblemHealth Select Care |
$446.40
|
| Rate for Payer: Fidelis Medicare |
$248.00
|
| Rate for Payer: Galaxy Health Commercial |
$403.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$248.00
|
| Rate for Payer: Humana Medicare |
$248.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$285.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$349.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$260.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.00
|
| Rate for Payer: United Healthcare Medicare |
$248.00
|
| Rate for Payer: WellCare Medicare |
$341.00
|
|
|
INDIUM IN-111 AUTO PLATELET PER DOSE
|
Facility
|
IP
|
$3,232.14
|
|
|
Service Code
|
HCPCS A9571
|
| Hospital Charge Code |
4210070
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,100.89 |
| Max. Negotiated Rate |
$2,100.89 |
| Rate for Payer: Cash Price |
$2,424.10
|
| Rate for Payer: Galaxy Health Commercial |
$2,100.89
|
|
|
INDIUM IN-111 AUTO PLATELET PER DOSE
|
Facility
|
OP
|
$3,232.14
|
|
|
Service Code
|
HCPCS A9571
|
| Hospital Charge Code |
4210070
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$484.82 |
| Max. Negotiated Rate |
$6,554.23 |
| Rate for Payer: Aetna of NY Medicare |
$1,486.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,292.86
|
| Rate for Payer: Cash Price |
$2,424.10
|
| Rate for Payer: Cash Price |
$2,424.10
|
| Rate for Payer: CDPHP Medicare |
$1,195.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,585.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,585.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,585.71
|
| Rate for Payer: EmblemHealth Medicaid |
$2,585.71
|
| Rate for Payer: EmblemHealth Medicare |
$1,098.93
|
| Rate for Payer: EmblemHealth Select Care |
$2,327.14
|
| Rate for Payer: Fidelis Medicare |
$1,292.86
|
| Rate for Payer: Galaxy Health Commercial |
$2,100.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,292.86
|
| Rate for Payer: Humana Medicare |
$1,292.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,486.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,424.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,819.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,357.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$484.82
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$1,292.86
|
| Rate for Payer: WellCare Medicare |
$1,777.68
|
|
|
INDIUM IN-111 AUTO WBC
|
Facility
|
IP
|
$11,309.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
4211250
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,350.85 |
| Max. Negotiated Rate |
$7,350.85 |
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: Galaxy Health Commercial |
$7,350.85
|
|
|
INDIUM IN-111 AUTO WBC
|
Facility
|
OP
|
$11,309.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
4211250
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,696.35 |
| Max. Negotiated Rate |
$9,047.20 |
| Rate for Payer: Aetna of NY Medicare |
$5,202.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,523.60
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: Cash Price |
$8,481.75
|
| Rate for Payer: CDPHP Medicare |
$4,184.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,047.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicaid |
$9,047.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,845.06
|
| Rate for Payer: EmblemHealth Select Care |
$8,142.48
|
| Rate for Payer: Fidelis Medicare |
$4,523.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,350.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,523.60
|
| Rate for Payer: Humana Medicare |
$4,523.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,202.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,481.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,366.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,749.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6,554.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,696.35
|
| Rate for Payer: United Healthcare Commercial |
$6,554.23
|
| Rate for Payer: United Healthcare Medicare |
$4,523.60
|
| Rate for Payer: WellCare Medicare |
$6,219.95
|
|
|
INDIUM IN-111 PENTETREOTIDE =< 6 MCI
|
Facility
|
OP
|
$6,003.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
4210078
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$900.45 |
| Max. Negotiated Rate |
$10,595.67 |
| Rate for Payer: Aetna of NY Medicare |
$2,761.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,401.20
|
| Rate for Payer: Cash Price |
$4,502.25
|
| Rate for Payer: Cash Price |
$4,502.25
|
| Rate for Payer: CDPHP Medicare |
$2,221.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,802.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,802.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,802.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,802.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,041.02
|
| Rate for Payer: EmblemHealth Select Care |
$4,322.16
|
| Rate for Payer: Fidelis Medicare |
$2,401.20
|
| Rate for Payer: Galaxy Health Commercial |
$3,901.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,401.20
|
| Rate for Payer: Humana Medicare |
$2,401.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,761.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,502.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,379.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,521.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$10,595.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$900.45
|
| Rate for Payer: United Healthcare Commercial |
$10,595.67
|
| Rate for Payer: United Healthcare Medicare |
$2,401.20
|
| Rate for Payer: WellCare Medicare |
$3,301.65
|
|
|
INDIUM IN-111 PENTETREOTIDE =< 6 MCI
|
Facility
|
IP
|
$6,003.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
4210078
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,901.95 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Cash Price |
$4,502.25
|
| Rate for Payer: Galaxy Health Commercial |
$3,901.95
|
|
|
INDOMETHACIN 25MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
4400387
|
|
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
|
|
|
INDOMETHACIN 25MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
4400387
|
|
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
|
|
|
INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
4302032
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna of NY Commercial |
$187.20
|
| Rate for Payer: Aetna of NY Medicare |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: CDPHP Medicare |
$106.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$172.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$230.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$230.40
|
| Rate for Payer: EmblemHealth Medicaid |
$230.40
|
| Rate for Payer: EmblemHealth Medicare |
$97.92
|
| Rate for Payer: EmblemHealth Select Care |
$172.80
|
| Rate for Payer: Fidelis Medicare |
$115.20
|
| Rate for Payer: Galaxy Health Commercial |
$187.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$115.20
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$187.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$132.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$216.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$162.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$120.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$216.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$43.20
|
| Rate for Payer: United Healthcare Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicare |
$115.20
|
| Rate for Payer: WellCare Medicare |
$158.40
|
|
|
INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
4302032
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Galaxy Health Commercial |
$187.20
|
|
|
INFINION 50 CM 16 CONTACT LEAD KIT
|
Facility
|
OP
|
$16,694.24
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,504.14 |
| Max. Negotiated Rate |
$13,355.39 |
| Rate for Payer: Aetna of NY Commercial |
$11,685.97
|
| Rate for Payer: Aetna of NY Medicare |
$7,679.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,677.70
|
| Rate for Payer: Cash Price |
$12,520.68
|
| Rate for Payer: CDPHP Medicare |
$6,176.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,347.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,355.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,355.39
|
| Rate for Payer: EmblemHealth Medicaid |
$13,355.39
|
| Rate for Payer: EmblemHealth Medicare |
$5,676.04
|
| Rate for Payer: EmblemHealth Select Care |
$8,347.12
|
| Rate for Payer: Fidelis Medicare |
$6,677.70
|
| Rate for Payer: Galaxy Health Commercial |
$10,851.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,677.70
|
| Rate for Payer: Humana Medicare |
$6,677.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,685.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,679.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,851.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,851.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7,011.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,504.14
|
| Rate for Payer: United Healthcare Medicare |
$6,677.70
|
| Rate for Payer: WellCare Medicare |
$9,181.83
|
|
|
INFINION 50 CM 16 CONTACT LEAD KIT
|
Facility
|
IP
|
$16,694.24
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,512.41 |
| Max. Negotiated Rate |
$11,685.97 |
| Rate for Payer: Aetna of NY Commercial |
$11,685.97
|
| Rate for Payer: Cash Price |
$12,520.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,347.12
|
| Rate for Payer: EmblemHealth Select Care |
$8,347.12
|
| Rate for Payer: Galaxy Health Commercial |
$10,851.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,685.97
|
| Rate for Payer: Multiplan Commercial |
$7,512.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,851.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,851.26
|
| Rate for Payer: WellCare Medicare |
$9,181.83
|
|
|
INFLECTRA 100 MG VIAL 100 mg, 1 each
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
4401942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$272.80 |
| Rate for Payer: Aetna of NY Medicare |
$156.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$136.40
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: CDPHP Medicare |
$126.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$272.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$272.80
|
| Rate for Payer: EmblemHealth Medicaid |
$272.80
|
| Rate for Payer: EmblemHealth Medicare |
$115.94
|
| Rate for Payer: EmblemHealth Select Care |
$26.04
|
| Rate for Payer: Fidelis Medicare |
$136.40
|
| Rate for Payer: Galaxy Health Commercial |
$221.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$136.40
|
| Rate for Payer: Humana Medicare |
$136.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$143.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.15
|
| Rate for Payer: United Healthcare Commercial |
$30.41
|
| Rate for Payer: United Healthcare Medicare |
$136.40
|
| Rate for Payer: WellCare Medicare |
$187.55
|
|
|
INFLECTRA 100 MG VIAL 100 mg, 1 each
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
4401942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna of NY Commercial |
$187.55
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: Cash Price |
$255.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.04
|
| Rate for Payer: EmblemHealth Select Care |
$26.04
|
| Rate for Payer: Galaxy Health Commercial |
$221.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$187.55
|
| Rate for Payer: WellCare Medicare |
$187.55
|
|
|
INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG
|
Facility
|
OP
|
$420.42
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
4400677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$315.31 |
| Rate for Payer: Aetna of NY Medicare |
$193.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$168.17
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: CDPHP Medicare |
$155.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.66
|
| Rate for Payer: EmblemHealth Medicaid |
$77.66
|
| Rate for Payer: EmblemHealth Medicare |
$142.94
|
| Rate for Payer: EmblemHealth Select Care |
$31.04
|
| Rate for Payer: Fidelis Medicare |
$168.17
|
| Rate for Payer: Galaxy Health Commercial |
$273.27
|
| Rate for Payer: Galaxy Health Workers Comp |
$76.11
|
| Rate for Payer: Hamaspik Choice Medicaid |
$77.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$168.17
|
| Rate for Payer: Humana Medicare |
$168.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$193.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$81.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$166.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$236.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$176.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$54.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
| Rate for Payer: United Healthcare Medicare |
$168.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$81.54
|
| Rate for Payer: WellCare Medicare |
$231.23
|
|
|
INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG
|
Facility
|
IP
|
$420.42
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
4400677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$273.27 |
| Rate for Payer: Aetna of NY Commercial |
$231.23
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.04
|
| Rate for Payer: EmblemHealth Select Care |
$31.04
|
| Rate for Payer: Galaxy Health Commercial |
$273.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$231.23
|
| Rate for Payer: WellCare Medicare |
$231.23
|
|
|
INFLUENZA A ANTIBODY
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
4300486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
INFLUENZA A ANTIBODY
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
4300486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$16.40
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.40
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.15
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
INFLUENZA A/B AG EIA
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 87400
|
| Hospital Charge Code |
4301263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
INFLUENZA A/B AG EIA
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 87400
|
| Hospital Charge Code |
4301263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of NY Commercial |
$27.30
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$16.80
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
INJ ANESTH AGENT PERIPH NERVE
|
Facility
|
IP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4600114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,406.60 |
| Max. Negotiated Rate |
$1,406.60 |
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
|
|
INJ ANESTH AGENT PERIPH NERVE
|
Facility
|
OP
|
$2,164.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
4600114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,731.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$995.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$865.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: CDPHP Medicare |
$800.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,731.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,731.20
|
| Rate for Payer: EmblemHealth Medicare |
$735.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$865.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,406.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$865.60
|
| Rate for Payer: Humana Medicare |
$865.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$995.44
|
| 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 |
$908.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$324.60
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$865.60
|
| Rate for Payer: WellCare Medicare |
$1,190.20
|
|
|
INJ ANESTH ; GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
4602220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
