|
ACYCLOVIR 200 MG CAPSULE 200 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 904578961
|
| Hospital Charge Code |
44001376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ACYCLOVIR 400MG TABS 100 EA
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 50268006115
|
| Hospital Charge Code |
4400016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
ACYCLOVIR 400MG TABS 100 EA
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 50268006115
|
| Hospital Charge Code |
4400016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.64
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.64
|
| Rate for Payer: Humana Medicare |
$4.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
ACYCLOVIR 5% OINTMENT 1 ea, 15 g
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
NDC 65162083594
|
| Hospital Charge Code |
4401426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna of NY Commercial |
$837.20
|
| Rate for Payer: Aetna of NY Medicare |
$550.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$478.40
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: CDPHP Medicare |
$442.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$956.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$956.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$956.80
|
| Rate for Payer: EmblemHealth Medicaid |
$956.80
|
| Rate for Payer: EmblemHealth Medicare |
$406.64
|
| Rate for Payer: EmblemHealth Select Care |
$861.12
|
| Rate for Payer: Fidelis Medicare |
$478.40
|
| Rate for Payer: Galaxy Health Commercial |
$777.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$478.40
|
| Rate for Payer: Humana Medicare |
$478.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$837.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$550.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$897.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$673.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$502.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$179.40
|
| Rate for Payer: United Healthcare Medicare |
$478.40
|
| Rate for Payer: WellCare Medicare |
$657.80
|
|
|
ACYCLOVIR 5% OINTMENT 1 ea, 15 g
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
NDC 65162083594
|
| Hospital Charge Code |
4401426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$657.80 |
| Max. Negotiated Rate |
$777.40 |
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Galaxy Health Commercial |
$777.40
|
| Rate for Payer: WellCare Medicare |
$657.80
|
|
|
ACYCLOVIR INJECTION 5 MG
|
Facility
|
OP
|
$69.78
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
4409180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$55.82 |
| Rate for Payer: Aetna of NY Medicare |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.91
|
| Rate for Payer: Cash Price |
$52.34
|
| Rate for Payer: Cash Price |
$52.34
|
| Rate for Payer: CDPHP Medicare |
$25.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.82
|
| Rate for Payer: EmblemHealth Medicaid |
$55.82
|
| Rate for Payer: EmblemHealth Medicare |
$23.73
|
| Rate for Payer: EmblemHealth Select Care |
$0.02
|
| Rate for Payer: Fidelis Medicare |
$27.91
|
| Rate for Payer: Galaxy Health Commercial |
$45.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.91
|
| Rate for Payer: Humana Medicare |
$27.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
| Rate for Payer: WellCare Medicare |
$38.38
|
|
|
ACYCLOVIR INJECTION 5 MG
|
Facility
|
IP
|
$69.78
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
4409180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna of NY Commercial |
$38.38
|
| Rate for Payer: Cash Price |
$52.34
|
| Rate for Payer: Cash Price |
$52.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.02
|
| Rate for Payer: EmblemHealth Select Care |
$0.02
|
| Rate for Payer: Galaxy Health Commercial |
$45.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.38
|
| Rate for Payer: WellCare Medicare |
$38.38
|
|
|
ADAPTA DR
|
Facility
|
IP
|
$20,569.10
|
|
| Hospital Charge Code |
4471709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,256.09 |
| Max. Negotiated Rate |
$14,398.37 |
| Rate for Payer: Aetna of NY Commercial |
$14,398.37
|
| Rate for Payer: Cash Price |
$15,426.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,284.55
|
| Rate for Payer: EmblemHealth Select Care |
$10,284.55
|
| Rate for Payer: Galaxy Health Commercial |
$13,369.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14,398.37
|
| Rate for Payer: Multiplan Commercial |
$9,256.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13,369.92
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13,369.92
|
| Rate for Payer: WellCare Medicare |
$11,313.00
|
|
|
ADAPTA DR
|
Facility
|
OP
|
$20,569.10
|
|
| Hospital Charge Code |
4471709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,085.36 |
| Max. Negotiated Rate |
$16,455.28 |
| Rate for Payer: Aetna of NY Commercial |
$14,398.37
|
| Rate for Payer: Aetna of NY Medicare |
$9,461.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8,227.64
|
| Rate for Payer: Cash Price |
$15,426.82
|
| Rate for Payer: CDPHP Medicare |
$7,610.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,284.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16,455.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16,455.28
|
| Rate for Payer: EmblemHealth Medicaid |
$16,455.28
|
| Rate for Payer: EmblemHealth Medicare |
$6,993.49
|
| Rate for Payer: EmblemHealth Select Care |
$10,284.55
|
| Rate for Payer: Fidelis Medicare |
$8,227.64
|
| Rate for Payer: Galaxy Health Commercial |
$13,369.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$8,227.64
|
| Rate for Payer: Humana Medicare |
$8,227.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14,398.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$9,461.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13,369.92
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13,369.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8,639.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,085.36
|
| Rate for Payer: United Healthcare Medicare |
$8,227.64
|
| Rate for Payer: WellCare Medicare |
$11,313.00
|
|
|
ADDITIONAL IVP SAME DRUG INJ SEQ
|
Facility
|
OP
|
$197.76
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
4450109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$158.21 |
| Rate for Payer: Aetna of NY Commercial |
$138.43
|
| Rate for Payer: Aetna of NY Medicare |
$90.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.10
|
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: CDPHP Medicare |
$73.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$158.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$158.21
|
| Rate for Payer: EmblemHealth Medicaid |
$158.21
|
| Rate for Payer: EmblemHealth Medicare |
$67.24
|
| Rate for Payer: EmblemHealth Select Care |
$142.39
|
| Rate for Payer: Fidelis Medicare |
$79.10
|
| Rate for Payer: Galaxy Health Commercial |
$128.54
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.10
|
| Rate for Payer: Humana Medicare |
$79.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$138.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$90.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$111.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$148.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.66
|
| Rate for Payer: United Healthcare Commercial |
$148.32
|
| Rate for Payer: United Healthcare Medicare |
$79.10
|
| Rate for Payer: WellCare Medicare |
$108.77
|
|
|
ADDITIONAL IVP SAME DRUG INJ SEQ
|
Facility
|
IP
|
$197.76
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
4450109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$128.54 |
| Rate for Payer: Cash Price |
$148.32
|
| Rate for Payer: Galaxy Health Commercial |
$128.54
|
|
|
ADENOSINE INJ 1MG
|
Facility
|
IP
|
$40.69
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
4400018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.48
|
| Rate for Payer: EmblemHealth Select Care |
$0.48
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.38
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
ADENOSINE INJ 1MG
|
Facility
|
OP
|
$40.69
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
4400018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna of NY Medicare |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.28
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: CDPHP Medicare |
$15.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.55
|
| Rate for Payer: EmblemHealth Medicaid |
$32.55
|
| Rate for Payer: EmblemHealth Medicare |
$13.83
|
| Rate for Payer: EmblemHealth Select Care |
$0.48
|
| Rate for Payer: Fidelis Medicare |
$16.28
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.28
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
ADENOVIRUS AG EIA
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
4301409
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
ADENOVIRUS AG EIA
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
4301409
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
4403000
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
4403000
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of NY Commercial |
$87.50
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: EmblemHealth Select Care |
$90.00
|
| Rate for Payer: Fidelis Medicare |
$50.00
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.00
|
| Rate for Payer: Humana Medicare |
$50.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$87.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare |
$50.00
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4408984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.09
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cash Price |
$5.80
|
| 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 |
$3.09
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.09
|
| Rate for Payer: Humana Medicare |
$3.09
|
| 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 |
$3.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$3.09
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4409190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Aetna of NY Commercial |
$25.49
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.49
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4408984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4400274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4409190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.54
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.08
|
| Rate for Payer: EmblemHealth Medicaid |
$37.08
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$33.37
|
| Rate for Payer: Fidelis Medicare |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.54
|
| Rate for Payer: Humana Medicare |
$18.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$18.54
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4400274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$15.95
|
| Rate for Payer: Fidelis Medicare |
$8.86
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.86
|
| Rate for Payer: Humana Medicare |
$8.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.32
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ADULT BREATHING CIRCUIT
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4478196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
ADULT BREATHING CIRCUIT
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4478196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
