|
OBSERVATION ROOM 1 HR-EMER RM
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
4760002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.30
|
|
|
OBSERVATION ROOM 1 HR-MED SURG
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
4760003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$4,175.13 |
| Rate for Payer: Aetna of NY Commercial |
$3,629.00
|
| Rate for Payer: Aetna of NY Medicare |
$65.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,339.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,175.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,255.00
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: CDPHP Commercial |
$114.31
|
| Rate for Payer: CDPHP Medicare |
$52.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,700.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$113.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.60
|
| Rate for Payer: EmblemHealth Medicaid |
$113.60
|
| Rate for Payer: EmblemHealth Medicare |
$48.28
|
| Rate for Payer: EmblemHealth Select Care |
$2,430.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,825.00
|
| Rate for Payer: Fidelis Medicare |
$54.12
|
| Rate for Payer: Galaxy Health Commercial |
$92.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.54
|
| Rate for Payer: Humana Medicare |
$52.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,629.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,652.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,989.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3,134.00
|
| Rate for Payer: United Healthcare Commercial |
$3,134.00
|
| Rate for Payer: United Healthcare Medicare |
$52.54
|
| Rate for Payer: WellCare Medicare |
$78.10
|
|
|
OBSERVATION ROOM 1 HR-MED SURG
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
4760003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Galaxy Health Commercial |
$92.30
|
|
|
OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
4301241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Galaxy Health Commercial |
$52.00
|
|
|
OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
4301241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna of NY Commercial |
$52.00
|
| Rate for Payer: Aetna of NY Medicare |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: CDPHP Commercial |
$64.40
|
| Rate for Payer: CDPHP Medicare |
$29.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.00
|
| Rate for Payer: EmblemHealth Medicaid |
$64.00
|
| Rate for Payer: EmblemHealth Medicare |
$27.20
|
| Rate for Payer: EmblemHealth Select Care |
$48.00
|
| Rate for Payer: Fidelis Medicare |
$30.49
|
| Rate for Payer: Galaxy Health Commercial |
$52.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.60
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$60.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.32
|
| Rate for Payer: United Healthcare Commercial |
$60.00
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: WellCare Medicare |
$44.00
|
|
|
OCCULT BLOOD-STOOL
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
4300588
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$8.45
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$7.80
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
OCCULT BLOOD-STOOL
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
4300588
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
OCTREOTIDE 1,000 MCG/5 ML VIAL 200 mcg, 5 mL
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
4401408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$4.95
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| 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 |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$2.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
OCTREOTIDE 1,000 MCG/5 ML VIAL 200 mcg, 5 mL
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
4401408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna of NY Commercial |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.95
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
OCTREOTIDE NOT DEPOT 25 MCG INJ
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
4400583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna of NY Commercial |
$20.25
|
| Rate for Payer: Aetna of NY Medicare |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.41
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: CDPHP Commercial |
$29.64
|
| Rate for Payer: CDPHP Medicare |
$13.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.46
|
| Rate for Payer: EmblemHealth Medicaid |
$29.46
|
| Rate for Payer: EmblemHealth Medicare |
$12.52
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Fidelis Medicare |
$14.03
|
| Rate for Payer: Galaxy Health Commercial |
$23.93
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.62
|
| Rate for Payer: Humana Medicare |
$13.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$13.62
|
| Rate for Payer: WellCare Medicare |
$20.25
|
|
|
OCTREOTIDE NOT DEPOT 25 MCG INJ
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
4400583
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna of NY Commercial |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$23.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.25
|
| Rate for Payer: WellCare Medicare |
$20.25
|
|
|
OCTRODE PERM LEAD
|
Facility
|
IP
|
$10,244.00
|
|
| Hospital Charge Code |
4471276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6,658.60 |
| Max. Negotiated Rate |
$6,658.60 |
| Rate for Payer: Cash Price |
$7,683.00
|
| Rate for Payer: Galaxy Health Commercial |
$6,658.60
|
|
|
OCTRODE PERM LEAD
|
Facility
|
OP
|
$10,244.00
|
|
| Hospital Charge Code |
4471276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,482.96 |
| Max. Negotiated Rate |
$8,246.42 |
| Rate for Payer: Aetna of NY Commercial |
$7,170.80
|
| Rate for Payer: Aetna of NY Medicare |
$4,712.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,683.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,683.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,790.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,122.00
|
| Rate for Payer: Cash Price |
$7,683.00
|
| Rate for Payer: CDPHP Commercial |
$8,246.42
|
| Rate for Payer: CDPHP Medicare |
$3,790.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,195.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,195.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,195.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,195.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,482.96
|
| Rate for Payer: EmblemHealth Select Care |
$7,375.68
|
| Rate for Payer: Fidelis Medicare |
$3,903.99
|
| Rate for Payer: Galaxy Health Commercial |
$6,658.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,790.28
|
| Rate for Payer: Humana Medicare |
$3,790.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,170.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,712.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,683.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,767.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,979.79
|
| Rate for Payer: United Healthcare Medicare |
$3,790.28
|
| Rate for Payer: WellCare Medicare |
$5,634.20
|
|
|
OFLOXACIN 0.003 DROP 5 ML
|
Facility
|
OP
|
$69.53
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
4400584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$55.97 |
| Rate for Payer: Aetna of NY Commercial |
$48.67
|
| Rate for Payer: Aetna of NY Medicare |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$52.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$52.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.76
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: CDPHP Commercial |
$55.97
|
| Rate for Payer: CDPHP Medicare |
$25.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.62
|
| Rate for Payer: EmblemHealth Medicaid |
$55.62
|
| Rate for Payer: EmblemHealth Medicare |
$23.64
|
| Rate for Payer: EmblemHealth Select Care |
$50.06
|
| Rate for Payer: Fidelis Medicare |
$26.50
|
| Rate for Payer: Galaxy Health Commercial |
$45.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.73
|
| Rate for Payer: Humana Medicare |
$25.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.67
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.01
|
| Rate for Payer: United Healthcare Medicare |
$25.73
|
| Rate for Payer: WellCare Medicare |
$38.24
|
|
|
OFLOXACIN 0.003 DROP 5 ML
|
Facility
|
IP
|
$69.53
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
4400584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.24 |
| Max. Negotiated Rate |
$45.19 |
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Galaxy Health Commercial |
$45.19
|
| Rate for Payer: WellCare Medicare |
$38.24
|
|
|
OFLOXACIN Otic Sol
|
Facility
|
IP
|
$229.43
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
4409005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.19 |
| Max. Negotiated Rate |
$149.13 |
| Rate for Payer: Cash Price |
$172.07
|
| Rate for Payer: Galaxy Health Commercial |
$149.13
|
| Rate for Payer: WellCare Medicare |
$126.19
|
|
|
OFLOXACIN Otic Sol
|
Facility
|
OP
|
$229.43
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
4409005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.01 |
| Max. Negotiated Rate |
$184.69 |
| Rate for Payer: Aetna of NY Commercial |
$160.60
|
| Rate for Payer: Aetna of NY Medicare |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$172.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$172.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$114.72
|
| Rate for Payer: Cash Price |
$172.07
|
| Rate for Payer: CDPHP Commercial |
$184.69
|
| Rate for Payer: CDPHP Medicare |
$84.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$183.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$183.54
|
| Rate for Payer: EmblemHealth Medicaid |
$183.54
|
| Rate for Payer: EmblemHealth Medicare |
$78.01
|
| Rate for Payer: EmblemHealth Select Care |
$165.19
|
| Rate for Payer: Fidelis Medicare |
$87.44
|
| Rate for Payer: Galaxy Health Commercial |
$149.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.89
|
| Rate for Payer: Humana Medicare |
$84.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$129.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.13
|
| Rate for Payer: United Healthcare Medicare |
$84.89
|
| Rate for Payer: WellCare Medicare |
$126.19
|
|
|
OIL EMULSION 3IN X 3IN
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
4471626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
|
|
OIL EMULSION 3IN X 3IN
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
4471626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.50
|
| Rate for Payer: Aetna of NY Medicare |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.50
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: CDPHP Commercial |
$4.02
|
| Rate for Payer: CDPHP Medicare |
$1.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4.00
|
| Rate for Payer: EmblemHealth Medicare |
$1.70
|
| Rate for Payer: EmblemHealth Select Care |
$3.60
|
| Rate for Payer: Fidelis Medicare |
$1.91
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.85
|
| Rate for Payer: Humana Medicare |
$1.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.94
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
OLANZAPINE 5MG TABS 30 EA
|
Facility
|
OP
|
$40.94
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
4400829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$32.96 |
| Rate for Payer: Aetna of NY Commercial |
$28.66
|
| Rate for Payer: Aetna of NY Medicare |
$18.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.47
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: CDPHP Commercial |
$32.96
|
| Rate for Payer: CDPHP Medicare |
$15.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.75
|
| Rate for Payer: EmblemHealth Medicaid |
$32.75
|
| Rate for Payer: EmblemHealth Medicare |
$13.92
|
| Rate for Payer: EmblemHealth Select Care |
$29.48
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$26.61
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.15
|
| Rate for Payer: Humana Medicare |
$15.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.66
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.91
|
| Rate for Payer: United Healthcare Medicare |
$15.15
|
| Rate for Payer: WellCare Medicare |
$22.52
|
|
|
OLANZAPINE 5MG TABS 30 EA
|
Facility
|
IP
|
$40.94
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
4400829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$26.61 |
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Galaxy Health Commercial |
$26.61
|
| Rate for Payer: WellCare Medicare |
$22.52
|
|
|
OLIVE STABILIZER
|
Facility
|
OP
|
$1,341.00
|
|
| Hospital Charge Code |
4471666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.94 |
| Max. Negotiated Rate |
$1,079.50 |
| Rate for Payer: Aetna of NY Commercial |
$938.70
|
| Rate for Payer: Aetna of NY Medicare |
$616.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$603.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$603.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$496.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$670.50
|
| Rate for Payer: Cash Price |
$1,005.75
|
| Rate for Payer: CDPHP Commercial |
$1,079.50
|
| Rate for Payer: CDPHP Medicare |
$496.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$670.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,072.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,072.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,072.80
|
| Rate for Payer: EmblemHealth Medicare |
$455.94
|
| Rate for Payer: EmblemHealth Select Care |
$670.50
|
| Rate for Payer: Fidelis Medicare |
$511.06
|
| Rate for Payer: Galaxy Health Commercial |
$871.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$496.17
|
| Rate for Payer: Humana Medicare |
$496.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$938.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$616.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$871.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$871.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$520.98
|
| Rate for Payer: United Healthcare Medicare |
$496.17
|
| Rate for Payer: WellCare Medicare |
$737.55
|
|
|
OLIVE STABILIZER
|
Facility
|
IP
|
$1,341.00
|
|
| Hospital Charge Code |
4471666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.45 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Aetna of NY Commercial |
$938.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$603.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$603.45
|
| Rate for Payer: Cash Price |
$1,005.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$670.50
|
| Rate for Payer: EmblemHealth Select Care |
$670.50
|
| Rate for Payer: Galaxy Health Commercial |
$871.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$603.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$871.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$871.65
|
| Rate for Payer: WellCare Medicare |
$737.55
|
|
|
OLOPATADINE HCL 0.001 DROP 5 ML
|
Facility
|
IP
|
$880.65
|
|
|
Service Code
|
NDC 00065027105
|
| Hospital Charge Code |
4400610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$484.36 |
| Max. Negotiated Rate |
$572.42 |
| Rate for Payer: Cash Price |
$660.49
|
| Rate for Payer: Galaxy Health Commercial |
$572.42
|
| Rate for Payer: WellCare Medicare |
$484.36
|
|
|
OLOPATADINE HCL 0.001 DROP 5 ML
|
Facility
|
OP
|
$880.65
|
|
|
Service Code
|
NDC 00065027105
|
| Hospital Charge Code |
4400610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$708.92 |
| Rate for Payer: Aetna of NY Commercial |
$616.46
|
| Rate for Payer: Aetna of NY Medicare |
$405.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$660.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$660.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$325.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$440.32
|
| Rate for Payer: Cash Price |
$660.49
|
| Rate for Payer: CDPHP Commercial |
$708.92
|
| Rate for Payer: CDPHP Medicare |
$325.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$704.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$704.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$704.52
|
| Rate for Payer: EmblemHealth Medicaid |
$704.52
|
| Rate for Payer: EmblemHealth Medicare |
$299.42
|
| Rate for Payer: EmblemHealth Select Care |
$634.07
|
| Rate for Payer: Fidelis Medicare |
$335.62
|
| Rate for Payer: Galaxy Health Commercial |
$572.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$325.84
|
| Rate for Payer: Humana Medicare |
$325.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$616.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$405.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$660.49
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$495.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$342.13
|
| Rate for Payer: United Healthcare Medicare |
$325.84
|
| Rate for Payer: WellCare Medicare |
$484.36
|
|
