|
ABP MONITORING 24+ HRS; RECORDING
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 93786
|
| Hospital Charge Code |
4480039
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
ABP MONITORING 24+ HRS; SCANNING ANALYSIS
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 93788
|
| Hospital Charge Code |
4480089
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
ABP MONITORING 24+ HRS; SCANNING ANALYSIS
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 93788
|
| Hospital Charge Code |
4480089
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$237.90
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
ABSCESS DRAINAGE UNDER X-RAY
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
4220005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$197.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$158.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: CDPHP Commercial |
$345.34
|
| Rate for Payer: CDPHP Medicare |
$158.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$300.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$343.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$343.20
|
| Rate for Payer: EmblemHealth Medicaid |
$343.20
|
| Rate for Payer: EmblemHealth Medicare |
$145.86
|
| Rate for Payer: EmblemHealth Select Care |
$278.85
|
| Rate for Payer: Fidelis Medicare |
$163.49
|
| Rate for Payer: Galaxy Health Commercial |
$278.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$158.73
|
| Rate for Payer: Humana Medicare |
$158.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$197.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$241.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$166.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$158.73
|
| Rate for Payer: WellCare Medicare |
$235.95
|
|
|
ABSCESS DRAINAGE UNDER X-RAY
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
4220005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Galaxy Health Commercial |
$278.85
|
|
|
ACCESS SYS KII OPTCL THRD 5MMX
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
4471821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
|
|
ACCESS SYS KII OPTCL THRD 5MMX
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
4471821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of NY Commercial |
$46.20
|
| Rate for Payer: Aetna of NY Medicare |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: CDPHP Commercial |
$53.13
|
| Rate for Payer: CDPHP Medicare |
$24.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.80
|
| Rate for Payer: EmblemHealth Medicaid |
$52.80
|
| Rate for Payer: EmblemHealth Medicare |
$22.44
|
| Rate for Payer: EmblemHealth Select Care |
$47.52
|
| Rate for Payer: Fidelis Medicare |
$25.15
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.42
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.64
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WellCare Medicare |
$36.30
|
|
|
ACEPHEN SUPPOS 650 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
4408948
|
|
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
|
|
|
ACEPHEN SUPPOS 650 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
4408948
|
|
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
|
|
|
ACETAMIN/BUTALB/CAFF 325-50-40MG TABS 10
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084039601
|
| Hospital Charge Code |
4400003
|
|
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
|
|
|
ACETAMIN/BUTALB/CAFF 325-50-40MG TABS 10
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084039601
|
| Hospital Charge Code |
4400003
|
|
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
|
|
|
ACETAMINOPHEN
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
4300014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna of NY Commercial |
$234.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$180.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: CDPHP Commercial |
$289.80
|
| Rate for Payer: CDPHP Medicare |
$133.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$216.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
| Rate for Payer: EmblemHealth Medicaid |
$288.00
|
| Rate for Payer: EmblemHealth Medicare |
$122.40
|
| Rate for Payer: EmblemHealth Select Care |
$216.00
|
| Rate for Payer: Fidelis Medicare |
$137.20
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$234.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$270.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$270.00
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$198.00
|
|
|
ACETAMINOPHEN
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
4300014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
|
|
ACETAMINOPHEN 1000MG/100ML BAG 10 mg, 100 mL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 00264410090
|
| Hospital Charge Code |
4401541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna of NY Commercial |
$18.20
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Commercial |
$20.93
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$18.72
|
| Rate for Payer: Fidelis Medicare |
$9.91
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.62
|
| Rate for Payer: Humana Medicare |
$9.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.10
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
ACETAMINOPHEN 1000MG/100ML BAG 10 mg, 100 mL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 00264410090
|
| Hospital Charge Code |
4401541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
ACETAMINOPHEN 120MG SUPP 12 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
4400005
|
|
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
|
|
|
ACETAMINOPHEN 120MG SUPP 12 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
4400005
|
|
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
|
|
|
ACETAMINOPHEN 325MG TABS 20X150EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
4400783
|
|
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
|
|
|
ACETAMINOPHEN 325MG TABS 20X150EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
4400783
|
|
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
|
|
|
ACETAZOLAMIDE 250MG TABS 100 EA
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
4400008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of NY Commercial |
$6.31
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Commercial |
$7.25
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
ACETAZOLAMIDE 250MG TABS 100 EA
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
4400008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
ACETYLCYSTEINE 200MG/ML AMPS 3X30ML
|
Facility
|
OP
|
$77.25
|
|
|
Service Code
|
NDC 00409330803
|
| Hospital Charge Code |
4400011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Aetna of NY Commercial |
$54.08
|
| Rate for Payer: Aetna of NY Medicare |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.62
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: CDPHP Commercial |
$62.19
|
| Rate for Payer: CDPHP Medicare |
$28.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.80
|
| Rate for Payer: EmblemHealth Medicaid |
$61.80
|
| Rate for Payer: EmblemHealth Medicare |
$26.26
|
| Rate for Payer: EmblemHealth Select Care |
$55.62
|
| Rate for Payer: Fidelis Medicare |
$29.44
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.58
|
| Rate for Payer: Humana Medicare |
$28.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.01
|
| Rate for Payer: United Healthcare Medicare |
$28.58
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
ACETYLCYSTEINE 200MG/ML AMPS 3X30ML
|
Facility
|
IP
|
$77.25
|
|
|
Service Code
|
NDC 00409330803
|
| Hospital Charge Code |
4400011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.49 |
| Max. Negotiated Rate |
$50.21 |
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
ACETYLCYSTEINE 20% 4 ML
|
Facility
|
OP
|
$47.38
|
|
|
Service Code
|
NDC 63323069404
|
| Hospital Charge Code |
4401259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$38.14 |
| Rate for Payer: Aetna of NY Commercial |
$33.17
|
| Rate for Payer: Aetna of NY Medicare |
$21.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.69
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: CDPHP Commercial |
$38.14
|
| Rate for Payer: CDPHP Medicare |
$17.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.90
|
| Rate for Payer: EmblemHealth Medicaid |
$37.90
|
| Rate for Payer: EmblemHealth Medicare |
$16.11
|
| Rate for Payer: EmblemHealth Select Care |
$34.11
|
| Rate for Payer: Fidelis Medicare |
$18.06
|
| Rate for Payer: Galaxy Health Commercial |
$30.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.53
|
| Rate for Payer: Humana Medicare |
$17.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.41
|
| Rate for Payer: United Healthcare Medicare |
$17.53
|
| Rate for Payer: WellCare Medicare |
$26.06
|
|
|
ACETYLCYSTEINE 20% 4 ML
|
Facility
|
IP
|
$47.38
|
|
|
Service Code
|
NDC 63323069404
|
| Hospital Charge Code |
4401259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.80
|
| Rate for Payer: WellCare Medicare |
$26.06
|
|
