|
NICOTINE 7MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 00536589488
|
| Hospital Charge Code |
4400563
|
|
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
|
|
|
NIFEDIPINE 30MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079040020
|
| Hospital Charge Code |
4400564
|
|
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
|
|
|
NIFEDIPINE 30MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079040020
|
| Hospital Charge Code |
4400564
|
|
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
|
|
|
NITINOL WIRE GUIDE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna of NY Commercial |
$60.20
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: EmblemHealth Select Care |
$61.92
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$60.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
NITINOL WIRE GUIDE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
|
|
NITROFURANTOIN 50 MG CAP
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
4409027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.72
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
NITROFURANTOIN 50 MG CAP
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
4409027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
NITROFURANTOIN MONOHYDRATE MACROCRYSTALS
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
4409169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
NITROFURANTOIN MONOHYDRATE MACROCRYSTALS
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
4409169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.60
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Commercial |
$5.80
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.75
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.80
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
NITROGLYCERIN 0.02 OINT 48X1GM
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
4400565
|
|
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
|
|
|
NITROGLYCERIN 0.02 OINT 48X1GM
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
4400565
|
|
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
|
|
|
NITROGLYCERIN 0.4MG/HR PTCH 30 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 47781029803
|
| Hospital Charge Code |
4400567
|
|
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
|
|
|
NITROGLYCERIN 0.4MG/HR PTCH 30 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 47781029803
|
| Hospital Charge Code |
4400567
|
|
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
|
|
|
NITROGLYCERIN 0.4MG TABS 4X25EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
4400573
|
|
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
|
|
|
NITROGLYCERIN 0.4MG TABS 4X25EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
4400573
|
|
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
|
|
|
NITROGLYCERIN 5MG/ML SDV 25X10ML
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 00517481025
|
| Hospital Charge Code |
4400568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Galaxy Health Commercial |
$25.11
|
| Rate for Payer: WellCare Medicare |
$21.25
|
|
|
NITROGLYCERIN 5MG/ML SDV 25X10ML
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00517481025
|
| Hospital Charge Code |
4400568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna of NY Commercial |
$27.04
|
| Rate for Payer: Aetna of NY Medicare |
$17.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.32
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: CDPHP Commercial |
$31.10
|
| Rate for Payer: CDPHP Medicare |
$14.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.90
|
| Rate for Payer: EmblemHealth Medicaid |
$30.90
|
| Rate for Payer: EmblemHealth Medicare |
$13.13
|
| Rate for Payer: EmblemHealth Select Care |
$27.81
|
| Rate for Payer: Fidelis Medicare |
$14.72
|
| Rate for Payer: Galaxy Health Commercial |
$25.11
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.01
|
| Rate for Payer: United Healthcare Medicare |
$14.29
|
| Rate for Payer: WellCare Medicare |
$21.25
|
|
|
NITROGLYCERIN/D5W 0.1MG/ML BTTL 12X250ML
|
Facility
|
IP
|
$59.23
|
|
|
Service Code
|
NDC 00338104702
|
| Hospital Charge Code |
4400570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: Galaxy Health Commercial |
$38.50
|
| Rate for Payer: WellCare Medicare |
$32.58
|
|
|
NITROGLYCERIN/D5W 0.1MG/ML BTTL 12X250ML
|
Facility
|
OP
|
$59.23
|
|
|
Service Code
|
NDC 00338104702
|
| Hospital Charge Code |
4400570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$47.68 |
| Rate for Payer: Aetna of NY Commercial |
$41.46
|
| Rate for Payer: Aetna of NY Medicare |
$27.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.62
|
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: CDPHP Commercial |
$47.68
|
| Rate for Payer: CDPHP Medicare |
$21.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.38
|
| Rate for Payer: EmblemHealth Medicaid |
$47.38
|
| Rate for Payer: EmblemHealth Medicare |
$20.14
|
| Rate for Payer: EmblemHealth Select Care |
$42.65
|
| Rate for Payer: Fidelis Medicare |
$22.57
|
| Rate for Payer: Galaxy Health Commercial |
$38.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.92
|
| Rate for Payer: Humana Medicare |
$21.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.01
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
| Rate for Payer: WellCare Medicare |
$32.58
|
|
|
NITROPRUSSIDE SODIUM 25MG/ML SDV 2 ML
|
Facility
|
IP
|
$970.92
|
|
|
Service Code
|
NDC 00409302401
|
| Hospital Charge Code |
4400572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$534.01 |
| Max. Negotiated Rate |
$631.10 |
| Rate for Payer: Cash Price |
$728.19
|
| Rate for Payer: Galaxy Health Commercial |
$631.10
|
| Rate for Payer: WellCare Medicare |
$534.01
|
|
|
NITROPRUSSIDE SODIUM 25MG/ML SDV 2 ML
|
Facility
|
OP
|
$970.92
|
|
|
Service Code
|
NDC 00409302401
|
| Hospital Charge Code |
4400572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$330.11 |
| Max. Negotiated Rate |
$781.59 |
| Rate for Payer: Aetna of NY Commercial |
$679.64
|
| Rate for Payer: Aetna of NY Medicare |
$446.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$728.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$728.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$359.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$485.46
|
| Rate for Payer: Cash Price |
$728.19
|
| Rate for Payer: CDPHP Commercial |
$781.59
|
| Rate for Payer: CDPHP Medicare |
$359.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$776.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$776.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$776.74
|
| Rate for Payer: EmblemHealth Medicaid |
$776.74
|
| Rate for Payer: EmblemHealth Medicare |
$330.11
|
| Rate for Payer: EmblemHealth Select Care |
$699.06
|
| Rate for Payer: Fidelis Medicare |
$370.02
|
| Rate for Payer: Galaxy Health Commercial |
$631.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$359.24
|
| Rate for Payer: Humana Medicare |
$359.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$679.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$446.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.19
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$546.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$377.20
|
| Rate for Payer: United Healthcare Medicare |
$359.24
|
| Rate for Payer: WellCare Medicare |
$534.01
|
|
|
NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
4002008
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$554.76
|
| 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 |
$446.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: CDPHP Commercial |
$970.83
|
| Rate for Payer: CDPHP Medicare |
$446.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$964.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$964.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$964.80
|
| Rate for Payer: EmblemHealth Medicaid |
$964.80
|
| Rate for Payer: EmblemHealth Medicare |
$410.04
|
| Rate for Payer: EmblemHealth Select Care |
$868.32
|
| Rate for Payer: Fidelis Medicare |
$459.61
|
| Rate for Payer: Galaxy Health Commercial |
$783.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$446.22
|
| Rate for Payer: Humana Medicare |
$446.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$964.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$904.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$678.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$468.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$446.22
|
| Rate for Payer: WellCare Medicare |
$663.30
|
|
|
NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
4002008
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$783.90 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Galaxy Health Commercial |
$783.90
|
|
|
NJX RETROGRADE URETHROCSTOGRAPY
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
4002009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$554.76
|
| 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 |
$446.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: CDPHP Commercial |
$970.83
|
| Rate for Payer: CDPHP Medicare |
$446.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$964.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$964.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$964.80
|
| Rate for Payer: EmblemHealth Medicaid |
$964.80
|
| Rate for Payer: EmblemHealth Medicare |
$410.04
|
| Rate for Payer: EmblemHealth Select Care |
$868.32
|
| Rate for Payer: Fidelis Medicare |
$459.61
|
| Rate for Payer: Galaxy Health Commercial |
$783.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$446.22
|
| Rate for Payer: Humana Medicare |
$446.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$964.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$904.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$678.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$468.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$63.58
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
| Rate for Payer: United Healthcare Medicare |
$446.22
|
| Rate for Payer: WellCare Medicare |
$663.30
|
|
|
NJX RETROGRADE URETHROCSTOGRAPY
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
4002009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$783.90 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Galaxy Health Commercial |
$783.90
|
|
