|
NERVE BLOCK ILIOING/ILIOHYPOGASTRIC
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
4850253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,286.35 |
| Max. Negotiated Rate |
$1,286.35 |
| Rate for Payer: Cash Price |
$1,484.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,286.35
|
|
|
NERVER BLOCK TRAY W/O DRUGS-SUPPLY ONLY
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
4471696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
|
|
NERVER BLOCK TRAY W/O DRUGS-SUPPLY ONLY
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
4471696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Commercial |
$46.90
|
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$48.24
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
NEUROMUSC REEDUCATION 15 MIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4650025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4650025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59
|
| Hospital Charge Code |
4650371
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59
|
| Hospital Charge Code |
4650371
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59,KX
|
| Hospital Charge Code |
4650423
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROMUSC REEDUCATION 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,59,KX
|
| Hospital Charge Code |
4650423
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (W/ KX)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,KX
|
| Hospital Charge Code |
4650316
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (W/ KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,KX
|
| Hospital Charge Code |
4650316
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,839.63
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
NEUTRON NEEDLEFREE CATHETER LIFESHIELD
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
4479087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
|
|
NEUTRON NEEDLEFREE CATHETER LIFESHIELD
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
4479087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
NEXTERONE 150 MG/100 ML BAG 150 mg, 100 mL
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4401916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$25.82 |
| Rate for Payer: Aetna of NY Commercial |
$17.64
|
| Rate for Payer: Aetna of NY Medicare |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.04
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: CDPHP Commercial |
$25.82
|
| Rate for Payer: CDPHP Medicare |
$11.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.66
|
| Rate for Payer: EmblemHealth Medicaid |
$25.66
|
| Rate for Payer: EmblemHealth Medicare |
$10.91
|
| Rate for Payer: EmblemHealth Select Care |
$23.10
|
| Rate for Payer: Fidelis Medicare |
$12.23
|
| Rate for Payer: Galaxy Health Commercial |
$20.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.87
|
| Rate for Payer: Humana Medicare |
$11.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$11.87
|
| Rate for Payer: WellCare Medicare |
$17.64
|
|
|
NEXTERONE 150 MG/100 ML BAG 150 mg, 100 mL
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4401916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Aetna of NY Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.44
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Galaxy Health Commercial |
$20.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.64
|
| Rate for Payer: WellCare Medicare |
$17.64
|
|
|
NIACIN (VITA B3) 500MG TABS 90 EA
|
Facility
|
OP
|
$19.06
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
4400558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$15.34 |
| Rate for Payer: Aetna of NY Commercial |
$13.34
|
| Rate for Payer: Aetna of NY Medicare |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.53
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: CDPHP Commercial |
$15.34
|
| Rate for Payer: CDPHP Medicare |
$7.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.25
|
| Rate for Payer: EmblemHealth Medicaid |
$15.25
|
| Rate for Payer: EmblemHealth Medicare |
$6.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.72
|
| Rate for Payer: Fidelis Medicare |
$7.26
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.05
|
| Rate for Payer: Humana Medicare |
$7.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.40
|
| Rate for Payer: United Healthcare Medicare |
$7.05
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
NIACIN (VITA B3) 500MG TABS 90 EA
|
Facility
|
IP
|
$19.06
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
4400558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
niCARdipin 20MG/200ML-0.9%NACL 20 mg, 200 mL
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
NDC 00143963401
|
| Hospital Charge Code |
4401512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Galaxy Health Commercial |
$276.25
|
| Rate for Payer: WellCare Medicare |
$233.75
|
|
|
niCARdipin 20MG/200ML-0.9%NACL 20 mg, 200 mL
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
NDC 00143963401
|
| Hospital Charge Code |
4401512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$342.12 |
| Rate for Payer: Aetna of NY Commercial |
$297.50
|
| Rate for Payer: Aetna of NY Medicare |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$157.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$212.50
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: CDPHP Commercial |
$342.12
|
| Rate for Payer: CDPHP Medicare |
$157.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$340.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$340.00
|
| Rate for Payer: EmblemHealth Medicare |
$144.50
|
| Rate for Payer: EmblemHealth Select Care |
$306.00
|
| Rate for Payer: Fidelis Medicare |
$161.97
|
| Rate for Payer: Galaxy Health Commercial |
$276.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$157.25
|
| Rate for Payer: Humana Medicare |
$157.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$297.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$195.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$239.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$165.11
|
| Rate for Payer: United Healthcare Medicare |
$157.25
|
| Rate for Payer: WellCare Medicare |
$233.75
|
|
|
NICOTINE 14MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
4400560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$5.41
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
NICOTINE 14MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
4400560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
NICOTINE 21MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
4400559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| 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 |
$3.68
|
|
|
NICOTINE 21MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
4400559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| 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) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| 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 |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| 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 |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
NICOTINE 7MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 00536589488
|
| Hospital Charge Code |
4400563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| 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 |
$3.68
|
|
