|
JUGULAR VENA CAVA FILTER
|
Facility
|
OP
|
$5,706.20
|
|
| Hospital Charge Code |
4471878
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$855.93 |
| Max. Negotiated Rate |
$4,564.96 |
| Rate for Payer: Aetna of NY Commercial |
$3,994.34
|
| Rate for Payer: Aetna of NY Medicare |
$2,624.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,282.48
|
| Rate for Payer: Cash Price |
$4,279.65
|
| Rate for Payer: CDPHP Medicare |
$2,111.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,564.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,564.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,564.96
|
| Rate for Payer: EmblemHealth Medicaid |
$4,564.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,940.11
|
| Rate for Payer: EmblemHealth Select Care |
$4,108.46
|
| Rate for Payer: Fidelis Medicare |
$2,282.48
|
| Rate for Payer: Galaxy Health Commercial |
$3,709.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,282.48
|
| Rate for Payer: Humana Medicare |
$2,282.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,994.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,624.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,279.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,212.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,396.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$855.93
|
| Rate for Payer: United Healthcare Medicare |
$2,282.48
|
| Rate for Payer: WellCare Medicare |
$3,138.41
|
|
|
KCENTRA, PER I.U. OF FACTOR IX ACTIVITY
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
4409216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.00
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: CDPHP Medicare |
$2.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6.00
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$5.40
|
| Rate for Payer: Fidelis Medicare |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.00
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$3.00
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
KCENTRA, PER I.U. OF FACTOR IX ACTIVITY
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
4409216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
KEPPRA (LEVETIRACETAM)
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
4301187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of NY Commercial |
$48.75
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$45.00
|
| Rate for Payer: Fidelis Medicare |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.00
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$56.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$56.25
|
| Rate for Payer: United Healthcare Medicare |
$30.00
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
KEPPRA (LEVETIRACETAM)
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
4301187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
|
|
KETAMINE 100 MG/ML INJECTION
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 67457010810
|
| Hospital Charge Code |
4409206
|
|
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
|
|
|
KETAMINE 100 MG/ML INJECTION
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 67457010810
|
| Hospital Charge Code |
4409206
|
|
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
|
|
|
KETAMINE HCL 50MG/ML SDV 10X10ML
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
NDC 67457000110
|
| Hospital Charge Code |
4400400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna of NY Commercial |
$15.51
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$15.95
|
| Rate for Payer: Fidelis Medicare |
$8.86
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.86
|
| Rate for Payer: Humana Medicare |
$8.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.32
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
KETAMINE HCL 50MG/ML SDV 10X10ML
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
NDC 67457000110
|
| Hospital Charge Code |
4400400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
KETAMINE INJECTION 10 MG/ML
|
Facility
|
IP
|
$54.85
|
|
|
Service Code
|
NDC 67457018120
|
| Hospital Charge Code |
4409172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$35.65 |
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Galaxy Health Commercial |
$35.65
|
| Rate for Payer: WellCare Medicare |
$30.17
|
|
|
KETAMINE INJECTION 10 MG/ML
|
Facility
|
OP
|
$54.85
|
|
|
Service Code
|
NDC 67457018120
|
| Hospital Charge Code |
4409172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna of NY Commercial |
$38.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.94
|
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: CDPHP Medicare |
$20.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.88
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.88
|
| Rate for Payer: EmblemHealth Medicaid |
$43.88
|
| Rate for Payer: EmblemHealth Medicare |
$18.65
|
| Rate for Payer: EmblemHealth Select Care |
$39.49
|
| Rate for Payer: Fidelis Medicare |
$21.94
|
| Rate for Payer: Galaxy Health Commercial |
$35.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.94
|
| Rate for Payer: Humana Medicare |
$21.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.23
|
| Rate for Payer: United Healthcare Medicare |
$21.94
|
| Rate for Payer: WellCare Medicare |
$30.17
|
|
|
KETOCONAZOLE 0.02 CRM 30 GM
|
Facility
|
IP
|
$625.32
|
|
|
Service Code
|
NDC 51672129802
|
| Hospital Charge Code |
4400401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$343.93 |
| Max. Negotiated Rate |
$406.46 |
| Rate for Payer: Cash Price |
$468.99
|
| Rate for Payer: Galaxy Health Commercial |
$406.46
|
| Rate for Payer: WellCare Medicare |
$343.93
|
|
|
KETOCONAZOLE 0.02 CRM 30 GM
|
Facility
|
OP
|
$625.32
|
|
|
Service Code
|
NDC 51672129802
|
| Hospital Charge Code |
4400401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna of NY Commercial |
$437.72
|
| Rate for Payer: Aetna of NY Medicare |
$287.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$250.13
|
| Rate for Payer: Cash Price |
$468.99
|
| Rate for Payer: CDPHP Medicare |
$231.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$500.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$500.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.26
|
| Rate for Payer: EmblemHealth Medicaid |
$500.26
|
| Rate for Payer: EmblemHealth Medicare |
$212.61
|
| Rate for Payer: EmblemHealth Select Care |
$450.23
|
| Rate for Payer: Fidelis Medicare |
$250.13
|
| Rate for Payer: Galaxy Health Commercial |
$406.46
|
| Rate for Payer: Hamaspik Choice Medicare |
$250.13
|
| Rate for Payer: Humana Medicare |
$250.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$437.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$287.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.99
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$352.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$93.80
|
| Rate for Payer: United Healthcare Medicare |
$250.13
|
| Rate for Payer: WellCare Medicare |
$343.93
|
|
|
ketorolac 0.5% OPHTH SOLUTION 1 ea, 5 mL
|
Facility
|
OP
|
$320.61
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
4401424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.09 |
| Max. Negotiated Rate |
$256.49 |
| Rate for Payer: Aetna of NY Commercial |
$224.43
|
| Rate for Payer: Aetna of NY Medicare |
$147.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.24
|
| Rate for Payer: Cash Price |
$240.46
|
| Rate for Payer: CDPHP Medicare |
$118.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.49
|
| Rate for Payer: EmblemHealth Medicaid |
$256.49
|
| Rate for Payer: EmblemHealth Medicare |
$109.01
|
| Rate for Payer: EmblemHealth Select Care |
$230.84
|
| Rate for Payer: Fidelis Medicare |
$128.24
|
| Rate for Payer: Galaxy Health Commercial |
$208.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.24
|
| Rate for Payer: Humana Medicare |
$128.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.09
|
| Rate for Payer: United Healthcare Medicare |
$128.24
|
| Rate for Payer: WellCare Medicare |
$176.34
|
|
|
ketorolac 0.5% OPHTH SOLUTION 1 ea, 5 mL
|
Facility
|
IP
|
$320.61
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
4401424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.34 |
| Max. Negotiated Rate |
$208.40 |
| Rate for Payer: Cash Price |
$240.46
|
| Rate for Payer: Galaxy Health Commercial |
$208.40
|
| Rate for Payer: WellCare Medicare |
$176.34
|
|
|
KETOROLAC TAB 10 MG
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 93031401
|
| Hospital Charge Code |
4409043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
KETOROLAC TAB 10 MG
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 93031401
|
| Hospital Charge Code |
4409043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
KETOROLAC TROMETHAMINE 0.004 DROP 5 ML
|
Facility
|
OP
|
$361.53
|
|
| Hospital Charge Code |
4400404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$289.22 |
| Rate for Payer: Aetna of NY Commercial |
$253.07
|
| Rate for Payer: Aetna of NY Medicare |
$166.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.61
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: CDPHP Medicare |
$133.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.22
|
| Rate for Payer: EmblemHealth Medicaid |
$289.22
|
| Rate for Payer: EmblemHealth Medicare |
$122.92
|
| Rate for Payer: EmblemHealth Select Care |
$260.30
|
| Rate for Payer: Fidelis Medicare |
$144.61
|
| Rate for Payer: Galaxy Health Commercial |
$234.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.61
|
| Rate for Payer: Humana Medicare |
$144.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$253.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$203.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$151.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.23
|
| Rate for Payer: United Healthcare Medicare |
$144.61
|
| Rate for Payer: WellCare Medicare |
$198.84
|
|
|
KETOROLAC TROMETHAMINE 0.004 DROP 5 ML
|
Facility
|
IP
|
$361.53
|
|
| Hospital Charge Code |
4400404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$234.99 |
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Galaxy Health Commercial |
$234.99
|
| Rate for Payer: WellCare Medicare |
$198.84
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of NY Medicare |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: CDPHP Medicare |
$3.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.34
|
| 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 |
$0.34
|
| Rate for Payer: Fidelis Medicare |
$3.71
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| 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 |
$3.89
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.10
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna of NY Medicare |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: CDPHP Medicare |
$0.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.34
|
| 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 |
$0.34
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.06
|
| Rate for Payer: Humana Medicare |
$1.06
|
| 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 |
$1.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WellCare Medicare |
$1.45
|
|
|
KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
4400405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.10
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.34
|
| 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 |
$0.34 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna of NY Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.34
|
| 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
|
|
|
KIDNEY IMAGING MORPHOL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 78700 26
|
| Hospital Charge Code |
5210093
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$45.50
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$45.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
KIDNEY IMAGING MORPHOL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 78700 26
|
| Hospital Charge Code |
5210093
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
