|
MYCOPLASMA PNEUMONIA AB
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
4300573
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
4300574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
4300574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
MYOGLOBIN-URINE QUALITA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
4300576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
MYOGLOBIN-URINE QUALITA
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
4300576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
MYRBETRIQ ER 25 MG TABLET 25 mg, 30 eaches
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
4401549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MYRBETRIQ ER 25 MG TABLET 25 mg, 30 eaches
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
4401549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MYRBETRIQ ER 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
NDC 469260230
|
| Hospital Charge Code |
4401464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.40
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$24.40
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.40
|
| Rate for Payer: Humana Medicare |
$24.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.15
|
| Rate for Payer: United Healthcare Medicare |
$24.40
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
MYRBETRIQ ER 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
NDC 469260230
|
| Hospital Charge Code |
4401464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
MYXREDLIN 100 UNIT/100 ML BAG 100 unit, 100 mL
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
4401917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna of NY Commercial |
$86.62
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Galaxy Health Commercial |
$102.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.62
|
| Rate for Payer: WellCare Medicare |
$86.62
|
|
|
MYXREDLIN 100 UNIT/100 ML BAG 100 unit, 100 mL
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
4401917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of NY Medicare |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: CDPHP Medicare |
$58.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.00
|
| Rate for Payer: EmblemHealth Medicaid |
$126.00
|
| Rate for Payer: EmblemHealth Medicare |
$53.55
|
| Rate for Payer: EmblemHealth Select Care |
$113.40
|
| Rate for Payer: Fidelis Medicare |
$63.00
|
| Rate for Payer: Galaxy Health Commercial |
$102.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.00
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.62
|
| Rate for Payer: United Healthcare Medicare |
$63.00
|
| Rate for Payer: WellCare Medicare |
$86.62
|
|
|
NAFCILLIN SODIUM 1GM PWVL 10X1EA
|
Facility
|
IP
|
$40.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.38 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Cash Price |
$30.52
|
| 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
|
|
|
NAFCILLIN SODIUM 1GM PWVL 10X1EA
|
Facility
|
OP
|
$40.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| 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: CDPHP Medicare |
$15.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.55
|
| 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 |
$29.30
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
NAFCILLIN SODIUM 2GM PWVL 10X1EA
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 63323032820
|
| Hospital Charge Code |
4400535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
| Rate for Payer: WellCare Medicare |
$58.92
|
|
|
NAFCILLIN SODIUM 2GM PWVL 10X1EA
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 63323032820
|
| Hospital Charge Code |
4400535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$85.70 |
| Rate for Payer: Aetna of NY Commercial |
$74.98
|
| Rate for Payer: Aetna of NY Medicare |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.85
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: CDPHP Medicare |
$39.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.70
|
| Rate for Payer: EmblemHealth Medicaid |
$85.70
|
| Rate for Payer: EmblemHealth Medicare |
$36.42
|
| Rate for Payer: EmblemHealth Select Care |
$77.13
|
| Rate for Payer: Fidelis Medicare |
$42.85
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.85
|
| Rate for Payer: Humana Medicare |
$42.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.07
|
| Rate for Payer: United Healthcare Medicare |
$42.85
|
| Rate for Payer: WellCare Medicare |
$58.92
|
|
|
NALBUPHINE HYDROCHLORIDE INJ, PER 10 MG
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
4400536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: CDPHP Medicare |
$4.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.66
|
| Rate for Payer: EmblemHealth Medicaid |
$8.66
|
| Rate for Payer: EmblemHealth Medicare |
$3.68
|
| Rate for Payer: EmblemHealth Select Care |
$3.42
|
| Rate for Payer: Fidelis Medicare |
$4.33
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.33
|
| Rate for Payer: Humana Medicare |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.62
|
| Rate for Payer: United Healthcare Commercial |
$4.49
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
NALBUPHINE HYDROCHLORIDE INJ, PER 10 MG
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
4400536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.42
|
| Rate for Payer: EmblemHealth Select Care |
$3.42
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
NALOXONE HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
OP
|
$61.16
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
4400539
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$48.93 |
| Rate for Payer: Aetna of NY Medicare |
$28.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.46
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: CDPHP Medicare |
$22.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.20
|
| Rate for Payer: EmblemHealth Medicaid |
$20.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.79
|
| Rate for Payer: EmblemHealth Select Care |
$44.04
|
| Rate for Payer: Fidelis Medicare |
$24.46
|
| Rate for Payer: Galaxy Health Commercial |
$39.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$19.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.46
|
| Rate for Payer: Humana Medicare |
$24.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$21.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$43.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$43.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$15.59
|
| Rate for Payer: United Healthcare Medicare |
$24.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$21.21
|
| Rate for Payer: WellCare Medicare |
$33.64
|
|
|
NALOXONE HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
IP
|
$61.16
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
4400539
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna of NY Commercial |
$33.64
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Galaxy Health Commercial |
$39.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.64
|
| Rate for Payer: WellCare Medicare |
$33.64
|
|
|
NANO BITER STRAIGHT (AR-10913D-1)
|
Facility
|
OP
|
$841.51
|
|
| Hospital Charge Code |
4473025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$673.21 |
| Rate for Payer: Aetna of NY Commercial |
$589.06
|
| Rate for Payer: Aetna of NY Medicare |
$387.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$336.60
|
| Rate for Payer: Cash Price |
$631.13
|
| Rate for Payer: CDPHP Medicare |
$311.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$673.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$673.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$673.21
|
| Rate for Payer: EmblemHealth Medicaid |
$673.21
|
| Rate for Payer: EmblemHealth Medicare |
$286.11
|
| Rate for Payer: EmblemHealth Select Care |
$605.89
|
| Rate for Payer: Fidelis Medicare |
$336.60
|
| Rate for Payer: Galaxy Health Commercial |
$546.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$336.60
|
| Rate for Payer: Humana Medicare |
$336.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$589.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$387.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$473.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$353.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.23
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WellCare Medicare |
$462.83
|
|
|
NANO BITER STRAIGHT (AR-10913D-1)
|
Facility
|
IP
|
$841.51
|
|
| Hospital Charge Code |
4473025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$546.98 |
| Rate for Payer: Cash Price |
$631.13
|
| Rate for Payer: Galaxy Health Commercial |
$546.98
|
|
|
NANO BITER UP (AR-10922D-1)
|
Facility
|
IP
|
$841.51
|
|
| Hospital Charge Code |
4473024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$546.98 |
| Rate for Payer: Cash Price |
$631.13
|
| Rate for Payer: Galaxy Health Commercial |
$546.98
|
|
|
NANO BITER UP (AR-10922D-1)
|
Facility
|
OP
|
$841.51
|
|
| Hospital Charge Code |
4473024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$673.21 |
| Rate for Payer: Aetna of NY Commercial |
$589.06
|
| Rate for Payer: Aetna of NY Medicare |
$387.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$336.60
|
| Rate for Payer: Cash Price |
$631.13
|
| Rate for Payer: CDPHP Medicare |
$311.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$673.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$673.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$673.21
|
| Rate for Payer: EmblemHealth Medicaid |
$673.21
|
| Rate for Payer: EmblemHealth Medicare |
$286.11
|
| Rate for Payer: EmblemHealth Select Care |
$605.89
|
| Rate for Payer: Fidelis Medicare |
$336.60
|
| Rate for Payer: Galaxy Health Commercial |
$546.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$336.60
|
| Rate for Payer: Humana Medicare |
$336.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$589.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$387.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$473.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$353.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.23
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WellCare Medicare |
$462.83
|
|
|
NANO SABRE SHAVER (AR-9280NSR)
|
Facility
|
OP
|
$320.33
|
|
| Hospital Charge Code |
4473029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$256.26 |
| Rate for Payer: Aetna of NY Commercial |
$224.23
|
| Rate for Payer: Aetna of NY Medicare |
$147.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.13
|
| Rate for Payer: Cash Price |
$240.25
|
| Rate for Payer: CDPHP Medicare |
$118.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.26
|
| Rate for Payer: EmblemHealth Medicaid |
$256.26
|
| Rate for Payer: EmblemHealth Medicare |
$108.91
|
| Rate for Payer: EmblemHealth Select Care |
$230.64
|
| Rate for Payer: Fidelis Medicare |
$128.13
|
| Rate for Payer: Galaxy Health Commercial |
$208.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.13
|
| Rate for Payer: Humana Medicare |
$128.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.05
|
| Rate for Payer: United Healthcare Medicare |
$128.13
|
| Rate for Payer: WellCare Medicare |
$176.18
|
|
|
NANO SABRE SHAVER (AR-9280NSR)
|
Facility
|
IP
|
$320.33
|
|
| Hospital Charge Code |
4473029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.21 |
| Max. Negotiated Rate |
$208.21 |
| Rate for Payer: Cash Price |
$240.25
|
| Rate for Payer: Galaxy Health Commercial |
$208.21
|
|
