|
N BLOCK INJ PLANTAR DIGIT
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
4850663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
N BLOCK INJ PLANTAR DIGIT
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
4850663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: EmblemHealth Select Care |
$609.84
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
NEBULIZER TERATMENT 1
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
NEBULIZER TERATMENT 1
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$491.05 |
| Rate for Payer: Aetna of NY Commercial |
$427.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$305.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$439.20
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$427.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
NEBULIZER TREATMENT 2
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$491.05 |
| Rate for Payer: Aetna of NY Commercial |
$427.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$305.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$439.20
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$427.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
NEBULIZER TREATMENT 2
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
NEBULIZER TREATMENT 3
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$491.05 |
| Rate for Payer: Aetna of NY Commercial |
$427.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$305.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$439.20
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$427.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
NEBULIZER TREATMENT 3
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
NEBULIZER TREATMENT 4
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
NEBULIZER TREATMENT 4
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4530041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$491.05 |
| Rate for Payer: Aetna of NY Commercial |
$427.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$305.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$439.20
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$427.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
NEEDLE EPIDURAL 18GX6IN DETAC
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4472115
|
|
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
|
|
|
NEEDLE EPIDURAL 18GX6IN DETAC
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4472115
|
|
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
|
|
|
NEEDLE SPINAL 20GX6 YELLOW
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
4471403
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$14.40
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
NEEDLE SPINAL 20GX6 YELLOW
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
4471403
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
|
NEISSERIA AMPLIF NA PROBE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
4300895
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$90.96 |
| Rate for Payer: Aetna of NY Commercial |
$73.45
|
| Rate for Payer: Aetna of NY Medicare |
$51.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$84.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$84.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$56.50
|
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: CDPHP Commercial |
$90.96
|
| Rate for Payer: CDPHP Medicare |
$41.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$67.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$90.40
|
| Rate for Payer: EmblemHealth Medicaid |
$90.40
|
| Rate for Payer: EmblemHealth Medicare |
$38.42
|
| Rate for Payer: EmblemHealth Select Care |
$67.80
|
| Rate for Payer: Fidelis Medicare |
$43.06
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$41.81
|
| Rate for Payer: Humana Medicare |
$41.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$51.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$63.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$43.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$84.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$84.75
|
| Rate for Payer: United Healthcare Medicare |
$41.81
|
| Rate for Payer: WellCare Medicare |
$62.15
|
|
|
NEISSERIA AMPLIF NA PROBE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
4300895
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Cash Price |
$84.75
|
| Rate for Payer: Galaxy Health Commercial |
$73.45
|
|
|
NEOMYCIN/POLYMYXIN/DEXAMETH 0.001 DROP 5
|
Facility
|
OP
|
$135.96
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
4400549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$109.45 |
| Rate for Payer: Aetna of NY Commercial |
$95.17
|
| Rate for Payer: Aetna of NY Medicare |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.98
|
| Rate for Payer: Cash Price |
$101.97
|
| Rate for Payer: CDPHP Commercial |
$109.45
|
| Rate for Payer: CDPHP Medicare |
$50.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.77
|
| Rate for Payer: EmblemHealth Medicaid |
$108.77
|
| Rate for Payer: EmblemHealth Medicare |
$46.23
|
| Rate for Payer: EmblemHealth Select Care |
$97.89
|
| Rate for Payer: Fidelis Medicare |
$51.81
|
| Rate for Payer: Galaxy Health Commercial |
$88.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.31
|
| Rate for Payer: Humana Medicare |
$50.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.82
|
| Rate for Payer: United Healthcare Medicare |
$50.31
|
| Rate for Payer: WellCare Medicare |
$74.78
|
|
|
NEOMYCIN/POLYMYXIN/DEXAMETH 0.001 DROP 5
|
Facility
|
IP
|
$135.96
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
4400549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$88.37 |
| Rate for Payer: Cash Price |
$101.97
|
| Rate for Payer: Galaxy Health Commercial |
$88.37
|
| Rate for Payer: WellCare Medicare |
$74.78
|
|
|
NEOMYCIN/POLYMYXIN/GRAMIC DROP 10 ML
|
Facility
|
OP
|
$191.32
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
4400550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$154.01 |
| Rate for Payer: Aetna of NY Commercial |
$133.92
|
| Rate for Payer: Aetna of NY Medicare |
$88.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$143.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$143.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$95.66
|
| Rate for Payer: Cash Price |
$143.49
|
| Rate for Payer: CDPHP Commercial |
$154.01
|
| Rate for Payer: CDPHP Medicare |
$70.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$153.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$153.06
|
| Rate for Payer: EmblemHealth Medicaid |
$153.06
|
| Rate for Payer: EmblemHealth Medicare |
$65.05
|
| Rate for Payer: EmblemHealth Select Care |
$137.75
|
| Rate for Payer: Fidelis Medicare |
$72.91
|
| Rate for Payer: Galaxy Health Commercial |
$124.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.79
|
| Rate for Payer: Humana Medicare |
$70.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$133.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.49
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$107.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.33
|
| Rate for Payer: United Healthcare Medicare |
$70.79
|
| Rate for Payer: WellCare Medicare |
$105.23
|
|
|
NEOMYCIN/POLYMYXIN/GRAMIC DROP 10 ML
|
Facility
|
IP
|
$191.32
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
4400550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Cash Price |
$143.49
|
| Rate for Payer: Galaxy Health Commercial |
$124.36
|
| Rate for Payer: WellCare Medicare |
$105.23
|
|
|
NEOMYCIN/POLYMYXIN/HC 0.01 DROP 10 ML
|
Facility
|
IP
|
$311.06
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
4400551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Cash Price |
$233.30
|
| Rate for Payer: Galaxy Health Commercial |
$202.19
|
| Rate for Payer: WellCare Medicare |
$171.08
|
|
|
NEOMYCIN/POLYMYXIN/HC 0.01 DROP 10 ML
|
Facility
|
OP
|
$311.06
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
4400551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$250.40 |
| Rate for Payer: Aetna of NY Commercial |
$217.74
|
| Rate for Payer: Aetna of NY Medicare |
$143.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$233.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$233.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$115.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$155.53
|
| Rate for Payer: Cash Price |
$233.30
|
| Rate for Payer: CDPHP Commercial |
$250.40
|
| Rate for Payer: CDPHP Medicare |
$115.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$248.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$248.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$248.85
|
| Rate for Payer: EmblemHealth Medicaid |
$248.85
|
| Rate for Payer: EmblemHealth Medicare |
$105.76
|
| Rate for Payer: EmblemHealth Select Care |
$223.96
|
| Rate for Payer: Fidelis Medicare |
$118.54
|
| Rate for Payer: Galaxy Health Commercial |
$202.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$115.09
|
| Rate for Payer: Humana Medicare |
$115.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$217.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$143.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$175.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$120.85
|
| Rate for Payer: United Healthcare Medicare |
$115.09
|
| Rate for Payer: WellCare Medicare |
$171.08
|
|
|
NEO-POLYCIN EYE OINTMENT 3.5 g, 3.5 g
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 00574425035
|
| Hospital Charge Code |
4401367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
NEO-POLYCIN EYE OINTMENT 3.5 g, 3.5 g
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
NDC 00574425035
|
| Hospital Charge Code |
4401367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$80.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Commercial |
$128.80
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$115.20
|
| Rate for Payer: Fidelis Medicare |
$60.98
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.20
|
| Rate for Payer: Humana Medicare |
$59.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.16
|
| Rate for Payer: United Healthcare Medicare |
$59.20
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
NERVE BLOCK ILIOING/ILIOHYPOGASTRIC
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
4850253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,385.30
|
| Rate for Payer: Aetna of NY Medicare |
$910.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$732.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$989.50
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: CDPHP Commercial |
$1,593.10
|
| Rate for Payer: CDPHP Medicare |
$732.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,583.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,583.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,583.20
|
| Rate for Payer: EmblemHealth Medicare |
$672.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,424.88
|
| Rate for Payer: Fidelis Medicare |
$754.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$732.23
|
| Rate for Payer: Humana Medicare |
$732.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,385.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$910.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,484.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,114.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$768.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Medicare |
$732.23
|
| Rate for Payer: WellCare Medicare |
$1,088.45
|
|
