|
NEUROMUSC REEDUCATION 15 MIN (W/ KX)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,KX
|
| Hospital Charge Code |
4650316
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.80
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$54.80
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.80
|
| Rate for Payer: Humana Medicare |
$54.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
NEUROMUSC REEDUCATION 15 MIN (W/ KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GP,KX
|
| Hospital Charge Code |
4650316
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,839.63 |
| Max. Negotiated Rate |
$2,097.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,839.63
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
|
|
NEUTRON NEEDLEFREE CATHETER LIFESHIELD
|
Facility
|
IP
|
$11.33
|
|
| Hospital Charge Code |
4479087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
|
|
NEUTRON NEEDLEFREE CATHETER LIFESHIELD
|
Facility
|
OP
|
$11.33
|
|
| Hospital Charge Code |
4479087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of NY Commercial |
$7.93
|
| Rate for Payer: Aetna of NY Medicare |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.53
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: CDPHP Medicare |
$4.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.06
|
| Rate for Payer: EmblemHealth Medicaid |
$9.06
|
| Rate for Payer: EmblemHealth Medicare |
$3.85
|
| Rate for Payer: EmblemHealth Select Care |
$8.16
|
| Rate for Payer: Fidelis Medicare |
$4.53
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.53
|
| Rate for Payer: Humana Medicare |
$4.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.70
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WellCare Medicare |
$6.23
|
|
|
NEXTERONE 150 MG/100 ML BAG 150 mg, 100 mL
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4401916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$25.66 |
| Rate for Payer: Aetna of NY Medicare |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: CDPHP Medicare |
$11.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.66
|
| Rate for Payer: EmblemHealth Medicaid |
$25.66
|
| Rate for Payer: EmblemHealth Medicare |
$10.91
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Fidelis Medicare |
$12.83
|
| Rate for Payer: Galaxy Health Commercial |
$20.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.83
|
| Rate for Payer: Humana Medicare |
$12.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.47
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.81
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$12.83
|
| Rate for Payer: WellCare Medicare |
$17.64
|
|
|
NEXTERONE 150 MG/100 ML BAG 150 mg, 100 mL
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4401916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Aetna of NY Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Galaxy Health Commercial |
$20.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.64
|
| Rate for Payer: WellCare Medicare |
$17.64
|
|
|
NIACIN (VITA B3) 500MG TABS 90 EA
|
Facility
|
OP
|
$19.06
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
4400558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna of NY Commercial |
$13.34
|
| Rate for Payer: Aetna of NY Medicare |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.62
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: CDPHP Medicare |
$7.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.25
|
| Rate for Payer: EmblemHealth Medicaid |
$15.25
|
| Rate for Payer: EmblemHealth Medicare |
$6.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.72
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.62
|
| Rate for Payer: Humana Medicare |
$7.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$7.62
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
NIACIN (VITA B3) 500MG TABS 90 EA
|
Facility
|
IP
|
$19.06
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
4400558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
niCARdipin 20MG/200ML-0.9%NACL 20 mg, 200 mL
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
NDC 143963401
|
| Hospital Charge Code |
4401512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Galaxy Health Commercial |
$276.25
|
| Rate for Payer: WellCare Medicare |
$233.75
|
|
|
niCARdipin 20MG/200ML-0.9%NACL 20 mg, 200 mL
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
NDC 143963401
|
| Hospital Charge Code |
4401512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of NY Commercial |
$297.50
|
| Rate for Payer: Aetna of NY Medicare |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$170.00
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: CDPHP Medicare |
$157.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$340.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$340.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$340.00
|
| Rate for Payer: EmblemHealth Medicaid |
$340.00
|
| Rate for Payer: EmblemHealth Medicare |
$144.50
|
| Rate for Payer: EmblemHealth Select Care |
$306.00
|
| Rate for Payer: Fidelis Medicare |
$170.00
|
| Rate for Payer: Galaxy Health Commercial |
$276.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$170.00
|
| Rate for Payer: Humana Medicare |
$170.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$297.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$195.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$239.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$178.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$63.75
|
| Rate for Payer: United Healthcare Medicare |
$170.00
|
| Rate for Payer: WellCare Medicare |
$233.75
|
|
|
NICOTINE 14MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
4400560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna of NY Commercial |
$5.41
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.09
|
| 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 Aetna Signature Administrators |
$5.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.16
|
| Rate for Payer: United Healthcare Medicare |
$3.09
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
NICOTINE 14MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
4400560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
NICOTINE 21MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
4400559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
NICOTINE 21MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
4400559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
NICOTINE 7MG/24HR PTCH 14 EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 536589488
|
| Hospital Charge Code |
4400563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
NICOTINE 7MG/24HR PTCH 14 EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 536589488
|
| Hospital Charge Code |
4400563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
NIFEDIPINE 30MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079040020
|
| Hospital Charge Code |
4400564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
NIFEDIPINE 30MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079040020
|
| Hospital Charge Code |
4400564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
NITINOL WIRE GUIDE
|
Facility
|
OP
|
$88.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$70.86 |
| Rate for Payer: Aetna of NY Commercial |
$62.01
|
| Rate for Payer: Aetna of NY Medicare |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.43
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: CDPHP Medicare |
$32.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$70.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.86
|
| Rate for Payer: EmblemHealth Medicaid |
$70.86
|
| Rate for Payer: EmblemHealth Medicare |
$30.12
|
| Rate for Payer: EmblemHealth Select Care |
$63.78
|
| Rate for Payer: Fidelis Medicare |
$35.43
|
| Rate for Payer: Galaxy Health Commercial |
$57.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.43
|
| Rate for Payer: Humana Medicare |
$35.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.29
|
| Rate for Payer: United Healthcare Medicare |
$35.43
|
| Rate for Payer: WellCare Medicare |
$48.72
|
|
|
NITINOL WIRE GUIDE
|
Facility
|
IP
|
$88.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4471126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$57.58 |
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: Galaxy Health Commercial |
$57.58
|
|
|
NITROFURANTOIN 50 MG CAP
|
Facility
|
IP
|
$7.21
|
|
| Hospital Charge Code |
4409027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
NITROFURANTOIN 50 MG CAP
|
Facility
|
OP
|
$7.21
|
|
| Hospital Charge Code |
4409027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.88
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.88
|
| Rate for Payer: Humana Medicare |
$2.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
NITROFURANTOIN MONOHYDRATE MACROCRYSTALS
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
4409169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.88
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.88
|
| Rate for Payer: Humana Medicare |
$2.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
NITROFURANTOIN MONOHYDRATE MACROCRYSTALS
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
4409169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
