|
AIR-STIRRUP ANKLE BRACE UNIVE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
4471040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
|
|
AIR-STIRRUP ANKLE BRACE UNIVE
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
4471040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$48.30 |
| Rate for Payer: Aetna of NY Commercial |
$42.00
|
| Rate for Payer: Aetna of NY Medicare |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: CDPHP Commercial |
$48.30
|
| Rate for Payer: CDPHP Medicare |
$22.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.00
|
| Rate for Payer: EmblemHealth Medicaid |
$48.00
|
| Rate for Payer: EmblemHealth Medicare |
$20.40
|
| Rate for Payer: EmblemHealth Select Care |
$43.20
|
| Rate for Payer: Fidelis Medicare |
$22.87
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.20
|
| Rate for Payer: Humana Medicare |
$22.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.31
|
| Rate for Payer: United Healthcare Medicare |
$22.20
|
| Rate for Payer: WellCare Medicare |
$33.00
|
|
|
AIRWAY RESISTANCE
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
4530002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
AIRWAY RESISTANCE
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
4530002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$312.90
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$223.50
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$312.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$290.55
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$312.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.46
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
ALBUMIN FLUID
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
4301065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
ALBUMIN FLUID
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
4301065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
ALBUMIN SERUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
4300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$16.25
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$15.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$18.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$18.75
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
ALBUMIN SERUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
4300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
|
|
ALBUTEROL/IPRATROPIUM 2.5-0.5MG/3ML AMIH
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 00487020103
|
| Hospital Charge Code |
4400028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| 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 |
$3.68
|
|
|
ALBUTEROL/IPRATROPIUM 2.5-0.5MG/3ML AMIH
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 00487020103
|
| Hospital Charge Code |
4400028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| 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) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| 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 |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| 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 |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
ALBUTEROL SULFATE 0.83MG/ML AMIH 60X3ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00487950101
|
| Hospital Charge Code |
4400026
|
|
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
|
|
|
ALBUTEROL SULFATE 0.83MG/ML AMIH 60X3ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00487950101
|
| Hospital Charge Code |
4400026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ALBUTEROL SULFATE 90MCG ARIN 8 GM
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
4400795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
ALBUTEROL SULFATE 90MCG ARIN 8 GM
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
4400795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Aetna of NY Commercial |
$32.20
|
| Rate for Payer: Aetna of NY Medicare |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: CDPHP Commercial |
$37.03
|
| Rate for Payer: CDPHP Medicare |
$17.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.80
|
| Rate for Payer: EmblemHealth Medicaid |
$36.80
|
| Rate for Payer: EmblemHealth Medicare |
$15.64
|
| Rate for Payer: EmblemHealth Select Care |
$33.12
|
| Rate for Payer: Fidelis Medicare |
$17.53
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.02
|
| Rate for Payer: Humana Medicare |
$17.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.87
|
| Rate for Payer: United Healthcare Medicare |
$17.02
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
ALBUTEROL SULFATE ARIN 8 GM
|
Facility
|
IP
|
$79.41
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
4400794
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Galaxy Health Commercial |
$51.62
|
| Rate for Payer: WellCare Medicare |
$43.68
|
|
|
ALBUTEROL SULFATE ARIN 8 GM
|
Facility
|
OP
|
$79.41
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
4400794
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna of NY Commercial |
$55.59
|
| Rate for Payer: Aetna of NY Medicare |
$36.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.70
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: CDPHP Commercial |
$63.93
|
| Rate for Payer: CDPHP Medicare |
$29.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.53
|
| Rate for Payer: EmblemHealth Medicaid |
$63.53
|
| Rate for Payer: EmblemHealth Medicare |
$27.00
|
| Rate for Payer: EmblemHealth Select Care |
$57.18
|
| Rate for Payer: Fidelis Medicare |
$30.26
|
| Rate for Payer: Galaxy Health Commercial |
$51.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.38
|
| Rate for Payer: Humana Medicare |
$29.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.59
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.56
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.85
|
| Rate for Payer: United Healthcare Medicare |
$29.38
|
| Rate for Payer: WellCare Medicare |
$43.68
|
|
|
ALDOLASE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
4300030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
ALDOLASE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
4300030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$33.60
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
ALDOSTERONE & RENIN
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
4300031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
|
|
ALDOSTERONE & RENIN
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
4300031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$127.19 |
| Rate for Payer: Aetna of NY Commercial |
$102.70
|
| Rate for Payer: Aetna of NY Medicare |
$72.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$118.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$118.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$79.00
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: CDPHP Commercial |
$127.19
|
| Rate for Payer: CDPHP Medicare |
$58.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$94.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.40
|
| Rate for Payer: EmblemHealth Medicaid |
$126.40
|
| Rate for Payer: EmblemHealth Medicare |
$53.72
|
| Rate for Payer: EmblemHealth Select Care |
$94.80
|
| Rate for Payer: Fidelis Medicare |
$60.21
|
| Rate for Payer: Galaxy Health Commercial |
$102.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.46
|
| Rate for Payer: Humana Medicare |
$58.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$102.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$118.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.75
|
| Rate for Payer: United Healthcare Commercial |
$118.50
|
| Rate for Payer: United Healthcare Medicare |
$58.46
|
| Rate for Payer: WellCare Medicare |
$86.90
|
|
|
ALFUZOSIN HCL ER 10 MG TABLET 10 mg, 100 eaches
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 47335095688
|
| Hospital Charge Code |
4401363
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
ALFUZOSIN HCL ER 10 MG TABLET 10 mg, 100 eaches
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 47335095688
|
| Hospital Charge Code |
4401363
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
4300034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
4300034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
ALLIANCE_ II INFLATION SYSTEM
|
Facility
|
OP
|
$1,631.00
|
|
| Hospital Charge Code |
4471399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$554.54 |
| Max. Negotiated Rate |
$1,312.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,141.70
|
| Rate for Payer: Aetna of NY Medicare |
$750.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,223.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,223.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$603.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$815.50
|
| Rate for Payer: Cash Price |
$1,223.25
|
| Rate for Payer: CDPHP Commercial |
$1,312.96
|
| Rate for Payer: CDPHP Medicare |
$603.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,304.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,304.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,304.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,304.80
|
| Rate for Payer: EmblemHealth Medicare |
$554.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,174.32
|
| Rate for Payer: Fidelis Medicare |
$621.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,060.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$603.47
|
| Rate for Payer: Humana Medicare |
$603.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,141.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$750.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,223.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$633.64
|
| Rate for Payer: United Healthcare Medicare |
$603.47
|
| Rate for Payer: WellCare Medicare |
$897.05
|
|
