|
MEDROL 4 MG DOSEPAK 4 mg, 21 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4401462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.25
|
| 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: 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 |
$0.25
|
| 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 |
$0.25
|
| 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 |
$3.30
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.25
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MED SPECIALTY ARM SLING
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A4566
|
| Hospital Charge Code |
4471557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
MED SPECIALTY ARM SLING
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A4566
|
| Hospital Charge Code |
4471557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
MED STOCKING ANTI-EMB THIGH
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
4471182
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
MED STOCKING ANTI-EMB THIGH
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
4471182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.70
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| 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 |
$29.52
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.70
|
| 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 |
$15.93
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
MEDTRONIC ACESSORY KIT 377860
|
Facility
|
OP
|
$10,169.00
|
|
| Hospital Charge Code |
4479089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,457.46 |
| Max. Negotiated Rate |
$8,186.04 |
| Rate for Payer: Aetna of NY Commercial |
$7,118.30
|
| Rate for Payer: Aetna of NY Medicare |
$4,677.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,576.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,576.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,762.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,084.50
|
| Rate for Payer: Cash Price |
$7,626.75
|
| Rate for Payer: CDPHP Commercial |
$8,186.04
|
| Rate for Payer: CDPHP Medicare |
$3,762.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,084.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,135.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,457.46
|
| Rate for Payer: EmblemHealth Select Care |
$5,084.50
|
| Rate for Payer: Fidelis Medicare |
$3,875.41
|
| Rate for Payer: Galaxy Health Commercial |
$6,609.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,762.53
|
| Rate for Payer: Humana Medicare |
$3,762.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,118.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,677.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,609.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,609.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,950.66
|
| Rate for Payer: United Healthcare Medicare |
$3,762.53
|
| Rate for Payer: WellCare Medicare |
$5,592.95
|
|
|
MEDTRONIC ACESSORY KIT 377860
|
Facility
|
IP
|
$10,169.00
|
|
| Hospital Charge Code |
4479089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,576.05 |
| Max. Negotiated Rate |
$7,118.30 |
| Rate for Payer: Aetna of NY Commercial |
$7,118.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,576.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,576.05
|
| Rate for Payer: Cash Price |
$7,626.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,084.50
|
| Rate for Payer: EmblemHealth Select Care |
$5,084.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,609.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,118.30
|
| Rate for Payer: Multiplan Commercial |
$4,576.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,609.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,609.85
|
| Rate for Payer: WellCare Medicare |
$5,592.95
|
|
|
MEDTRONIC IMPLANT LEAD KIT
|
Facility
|
OP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.98 |
| Max. Negotiated Rate |
$7,202.34 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.50
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: CDPHP Commercial |
$7,202.34
|
| Rate for Payer: CDPHP Medicare |
$3,310.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,157.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.98
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Fidelis Medicare |
$3,409.70
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.39
|
| Rate for Payer: Humana Medicare |
$3,310.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.91
|
| Rate for Payer: United Healthcare Medicare |
$3,310.39
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
MEDTRONIC IMPLANT LEAD KIT
|
Facility
|
IP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,026.15 |
| Max. Negotiated Rate |
$6,262.90 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Multiplan Commercial |
$4,026.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
MEDTRONIC LEAD KIT
|
Facility
|
OP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.98 |
| Max. Negotiated Rate |
$7,202.34 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.50
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: CDPHP Commercial |
$7,202.34
|
| Rate for Payer: CDPHP Medicare |
$3,310.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,157.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.98
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Fidelis Medicare |
$3,409.70
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.39
|
| Rate for Payer: Humana Medicare |
$3,310.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.91
|
| Rate for Payer: United Healthcare Medicare |
$3,310.39
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
MEDTRONIC LEAD KIT
|
Facility
|
IP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,026.15 |
| Max. Negotiated Rate |
$6,262.90 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Multiplan Commercial |
$4,026.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
MEDTRONIC POCKET ADAPTOR
|
Facility
|
OP
|
$1,720.00
|
|
| Hospital Charge Code |
4471486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$584.80 |
| Max. Negotiated Rate |
$1,384.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,204.00
|
| Rate for Payer: Aetna of NY Medicare |
$791.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,290.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,290.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$636.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$860.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: CDPHP Commercial |
$1,384.60
|
| Rate for Payer: CDPHP Medicare |
$636.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,376.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,376.00
|
| Rate for Payer: EmblemHealth Medicare |
$584.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,238.40
|
| Rate for Payer: Fidelis Medicare |
$655.49
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$636.40
|
| Rate for Payer: Humana Medicare |
$636.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,204.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$791.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,290.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$968.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$668.22
|
| Rate for Payer: United Healthcare Medicare |
$636.40
|
| Rate for Payer: WellCare Medicare |
$946.00
|
|
|
MEDTRONIC POCKET ADAPTOR
|
Facility
|
IP
|
$1,720.00
|
|
| Hospital Charge Code |
4471486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,118.00 |
| Max. Negotiated Rate |
$1,118.00 |
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.00
|
|
|
MEDTRONIC SCS IMPLANT
|
Facility
|
IP
|
$75,783.00
|
|
| Hospital Charge Code |
4479088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34,102.35 |
| Max. Negotiated Rate |
$53,048.10 |
| Rate for Payer: Aetna of NY Commercial |
$53,048.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34,102.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34,102.35
|
| Rate for Payer: Cash Price |
$56,837.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37,891.50
|
| Rate for Payer: EmblemHealth Select Care |
$37,891.50
|
| Rate for Payer: Galaxy Health Commercial |
$49,258.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53,048.10
|
| Rate for Payer: Multiplan Commercial |
$34,102.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49,258.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49,258.95
|
| Rate for Payer: WellCare Medicare |
$41,680.65
|
|
|
MEDTRONIC SCS IMPLANT
|
Facility
|
OP
|
$75,783.00
|
|
| Hospital Charge Code |
4479088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,766.22 |
| Max. Negotiated Rate |
$61,005.32 |
| Rate for Payer: Aetna of NY Commercial |
$53,048.10
|
| Rate for Payer: Aetna of NY Medicare |
$34,860.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34,102.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34,102.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28,039.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37,891.50
|
| Rate for Payer: Cash Price |
$56,837.25
|
| Rate for Payer: CDPHP Commercial |
$61,005.32
|
| Rate for Payer: CDPHP Medicare |
$28,039.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37,891.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60,626.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60,626.40
|
| Rate for Payer: EmblemHealth Medicaid |
$60,626.40
|
| Rate for Payer: EmblemHealth Medicare |
$25,766.22
|
| Rate for Payer: EmblemHealth Select Care |
$37,891.50
|
| Rate for Payer: Fidelis Medicare |
$28,880.90
|
| Rate for Payer: Galaxy Health Commercial |
$49,258.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$28,039.71
|
| Rate for Payer: Humana Medicare |
$28,039.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53,048.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$34,860.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49,258.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49,258.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29,441.70
|
| Rate for Payer: United Healthcare Medicare |
$28,039.71
|
| Rate for Payer: WellCare Medicare |
$41,680.65
|
|
|
MEDTRONIC TRIAL LEAD
|
Facility
|
IP
|
$1,215.00
|
|
| Hospital Charge Code |
4471325
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$789.75 |
| Max. Negotiated Rate |
$789.75 |
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Galaxy Health Commercial |
$789.75
|
|
|
MEDTRONIC TRIAL LEAD
|
Facility
|
OP
|
$1,215.00
|
|
| Hospital Charge Code |
4471325
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$978.08 |
| Rate for Payer: Aetna of NY Commercial |
$850.50
|
| Rate for Payer: Aetna of NY Medicare |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$911.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$911.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$449.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$607.50
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: CDPHP Commercial |
$978.08
|
| Rate for Payer: CDPHP Medicare |
$449.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$972.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$972.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$972.00
|
| Rate for Payer: EmblemHealth Medicaid |
$972.00
|
| Rate for Payer: EmblemHealth Medicare |
$413.10
|
| Rate for Payer: EmblemHealth Select Care |
$874.80
|
| Rate for Payer: Fidelis Medicare |
$463.04
|
| Rate for Payer: Galaxy Health Commercial |
$789.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$449.55
|
| Rate for Payer: Humana Medicare |
$449.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$850.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$558.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$911.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$684.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$472.03
|
| Rate for Payer: United Healthcare Medicare |
$449.55
|
| Rate for Payer: WellCare Medicare |
$668.25
|
|
|
MEGESTEROL UNIT DOSE 400 MG / 10 ML
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 00121477610
|
| Hospital Charge Code |
4409223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of NY Commercial |
$5.25
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.75
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: CDPHP Commercial |
$6.04
|
| Rate for Payer: CDPHP Medicare |
$2.78
|
| 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 |
$2.86
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.25
|
| 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 |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
MEGESTEROL UNIT DOSE 400 MG / 10 ML
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
NDC 00121477610
|
| Hospital Charge Code |
4409223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
MELATONIN 5 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
4409028
|
|
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
|
|
|
MELATONIN 5 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
4409028
|
|
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
|
|
|
MELATONON 5MG TABLET
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4408025
|
|
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
|
|
|
MELATONON 5MG TABLET
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4408025
|
|
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
|
|
|
MELOXICAM TAB 7.5 MG
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
4409146
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna of NY Commercial |
$6.85
|
| Rate for Payer: Aetna of NY Medicare |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.90
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: CDPHP Commercial |
$7.88
|
| Rate for Payer: CDPHP Medicare |
$3.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.83
|
| Rate for Payer: EmblemHealth Medicaid |
$7.83
|
| Rate for Payer: EmblemHealth Medicare |
$3.33
|
| Rate for Payer: EmblemHealth Select Care |
$7.05
|
| Rate for Payer: Fidelis Medicare |
$3.73
|
| Rate for Payer: Galaxy Health Commercial |
$6.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.62
|
| Rate for Payer: Humana Medicare |
$3.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$3.62
|
| Rate for Payer: WellCare Medicare |
$5.38
|
|
|
MELOXICAM TAB 7.5 MG
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
4409146
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Galaxy Health Commercial |
$6.36
|
| Rate for Payer: WellCare Medicare |
$5.38
|
|
