|
ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP
|
| Hospital Charge Code |
4650027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59
|
| Hospital Charge Code |
4650373
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59
|
| Hospital Charge Code |
4650373
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$69.54
|
| 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 |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59,KX
|
| Hospital Charge Code |
4650425
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59,KX
|
| Hospital Charge Code |
4650425
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$69.54
|
| 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 |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,KX
|
| Hospital Charge Code |
4650318
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$69.54
|
| 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 |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,KX
|
| Hospital Charge Code |
4650318
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
IP
|
$1,720.80
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
4401279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$1,118.52 |
| Rate for Payer: Aetna of NY Commercial |
$946.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.56
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.56
|
| Rate for Payer: EmblemHealth Select Care |
$131.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$946.44
|
| Rate for Payer: WellCare Medicare |
$946.44
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
OP
|
$1,720.80
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
4401279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$1,385.24 |
| Rate for Payer: Aetna of NY Commercial |
$946.44
|
| Rate for Payer: Aetna of NY Medicare |
$791.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$636.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$860.40
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: CDPHP Commercial |
$1,385.24
|
| Rate for Payer: CDPHP Medicare |
$636.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,376.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicaid |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicare |
$585.07
|
| Rate for Payer: EmblemHealth Select Care |
$131.56
|
| Rate for Payer: Fidelis Medicare |
$655.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$636.70
|
| Rate for Payer: Humana Medicare |
$636.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$946.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$791.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,290.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$968.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$668.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$193.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$131.56
|
| Rate for Payer: United Healthcare Commercial |
$193.68
|
| Rate for Payer: United Healthcare Medicare |
$636.70
|
| Rate for Payer: WellCare Medicare |
$946.44
|
|
|
ORTHOWEDGE LARGE
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
4471605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
|
|
ORTHOWEDGE LARGE
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
4471605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
ORTHOWEDGE MEDIUM
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
4471604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
ORTHOWEDGE MEDIUM
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
4471604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
|
|
ORTHOWEDGE SMALL
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
4471603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
ORTHOWEDGE SMALL
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
4471603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
ORTHOWEDGE XL
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
4471606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
ORTHOWEDGE XL
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
4471606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
OSELTAMIVIR PHOS 75 MG CAPSULE 75 mg, 10 eaches
|
Facility
|
IP
|
$46.38
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
4401315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Galaxy Health Commercial |
$30.15
|
| Rate for Payer: WellCare Medicare |
$25.51
|
|
|
OSELTAMIVIR PHOS 75 MG CAPSULE 75 mg, 10 eaches
|
Facility
|
OP
|
$46.38
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
4401315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Aetna of NY Commercial |
$32.47
|
| Rate for Payer: Aetna of NY Medicare |
$21.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.19
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: CDPHP Commercial |
$37.34
|
| Rate for Payer: CDPHP Medicare |
$17.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.10
|
| Rate for Payer: EmblemHealth Medicaid |
$37.10
|
| Rate for Payer: EmblemHealth Medicare |
$15.77
|
| Rate for Payer: EmblemHealth Select Care |
$33.39
|
| Rate for Payer: Fidelis Medicare |
$17.68
|
| Rate for Payer: Galaxy Health Commercial |
$30.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.16
|
| Rate for Payer: Humana Medicare |
$17.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.02
|
| Rate for Payer: United Healthcare Medicare |
$17.16
|
| Rate for Payer: WellCare Medicare |
$25.51
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAPS 10 EA
|
Facility
|
OP
|
$48.67
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
4400744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna of NY Commercial |
$34.07
|
| Rate for Payer: Aetna of NY Medicare |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.34
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: CDPHP Commercial |
$39.18
|
| Rate for Payer: CDPHP Medicare |
$18.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.94
|
| Rate for Payer: EmblemHealth Medicaid |
$38.94
|
| Rate for Payer: EmblemHealth Medicare |
$16.55
|
| Rate for Payer: EmblemHealth Select Care |
$35.04
|
| Rate for Payer: Fidelis Medicare |
$18.55
|
| Rate for Payer: Galaxy Health Commercial |
$31.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.01
|
| Rate for Payer: Humana Medicare |
$18.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.91
|
| Rate for Payer: United Healthcare Medicare |
$18.01
|
| Rate for Payer: WellCare Medicare |
$26.77
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAPS 10 EA
|
Facility
|
IP
|
$48.67
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
4400744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Galaxy Health Commercial |
$31.64
|
|
|
OSMOLALITY-SERUM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
4300597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$29.25
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$27.00
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$33.75
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
OSMOLALITY-SERUM
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
4300597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
|
OSMOLARITY URINE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
4300598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
OSMOLARITY URINE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
4300598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$22.80
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
