|
ADULT PACER PADS
|
Facility
|
IP
|
$65.92
|
|
| Hospital Charge Code |
4479115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
|
|
ADULT PACER PADS
|
Facility
|
OP
|
$65.92
|
|
| Hospital Charge Code |
4479115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of NY Commercial |
$46.14
|
| Rate for Payer: Aetna of NY Medicare |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.37
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: CDPHP Medicare |
$24.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.74
|
| Rate for Payer: EmblemHealth Medicaid |
$52.74
|
| Rate for Payer: EmblemHealth Medicare |
$22.41
|
| Rate for Payer: EmblemHealth Select Care |
$47.46
|
| Rate for Payer: Fidelis Medicare |
$26.37
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.37
|
| Rate for Payer: Humana Medicare |
$26.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.14
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.69
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.89
|
| Rate for Payer: United Healthcare Medicare |
$26.37
|
| Rate for Payer: WellCare Medicare |
$36.26
|
|
|
AEROBIC/ANAEROBIC CULTURE
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4304875
|
|
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
|
|
|
AEROBIC/ANAEROBIC CULTURE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4304875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$61.60 |
| 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) Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$57.75
|
| 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 |
$30.80
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$30.80
|
| 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 |
$32.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$30.80
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
AFLEX VERTEBRAL BALLOON TRAY10X20AFB1020
|
Facility
|
IP
|
$9,598.57
|
|
| Hospital Charge Code |
4479295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6,239.07 |
| Max. Negotiated Rate |
$6,239.07 |
| Rate for Payer: Cash Price |
$7,198.93
|
| Rate for Payer: Galaxy Health Commercial |
$6,239.07
|
|
|
AFLEX VERTEBRAL BALLOON TRAY10X20AFB1020
|
Facility
|
OP
|
$9,598.57
|
|
| Hospital Charge Code |
4479295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,439.79 |
| Max. Negotiated Rate |
$7,678.86 |
| Rate for Payer: Aetna of NY Commercial |
$6,719.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,415.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,839.43
|
| Rate for Payer: Cash Price |
$7,198.93
|
| Rate for Payer: CDPHP Medicare |
$3,551.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,678.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,678.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,678.86
|
| Rate for Payer: EmblemHealth Medicaid |
$7,678.86
|
| Rate for Payer: EmblemHealth Medicare |
$3,263.51
|
| Rate for Payer: EmblemHealth Select Care |
$6,910.97
|
| Rate for Payer: Fidelis Medicare |
$3,839.43
|
| Rate for Payer: Galaxy Health Commercial |
$6,239.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,839.43
|
| Rate for Payer: Humana Medicare |
$3,839.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,719.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,415.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,198.93
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,403.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,031.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,439.79
|
| Rate for Payer: United Healthcare Medicare |
$3,839.43
|
| Rate for Payer: WellCare Medicare |
$5,279.21
|
|
|
AFP TUMOR MARKER SERUM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
|
|
AFP TUMOR MARKER SERUM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of NY Commercial |
$32.50
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$30.00
|
| Rate for Payer: Fidelis Medicare |
$20.00
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.00
|
| Rate for Payer: Humana Medicare |
$20.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$37.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$37.50
|
| Rate for Payer: United Healthcare Medicare |
$20.00
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
AIR MATTRESS
|
Facility
|
OP
|
$192.61
|
|
| Hospital Charge Code |
4472143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$154.09 |
| Rate for Payer: Aetna of NY Commercial |
$134.83
|
| Rate for Payer: Aetna of NY Medicare |
$88.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$77.04
|
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: CDPHP Medicare |
$71.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$154.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$154.09
|
| Rate for Payer: EmblemHealth Medicaid |
$154.09
|
| Rate for Payer: EmblemHealth Medicare |
$65.49
|
| Rate for Payer: EmblemHealth Select Care |
$138.68
|
| Rate for Payer: Fidelis Medicare |
$77.04
|
| Rate for Payer: Galaxy Health Commercial |
$125.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$77.04
|
| Rate for Payer: Humana Medicare |
$77.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$134.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$108.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.89
|
| Rate for Payer: United Healthcare Medicare |
$77.04
|
| Rate for Payer: WellCare Medicare |
$105.94
|
|
|
AIR MATTRESS
|
Facility
|
IP
|
$192.61
|
|
| Hospital Charge Code |
4472143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$125.20 |
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: Galaxy Health Commercial |
$125.20
|
|
|
AIR-STIRRUP ANKLE BRACE UNIVE
|
Facility
|
IP
|
$61.80
|
|
| Hospital Charge Code |
4471040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$40.17 |
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Galaxy Health Commercial |
$40.17
|
|
|
AIR-STIRRUP ANKLE BRACE UNIVE
|
Facility
|
OP
|
$61.80
|
|
| Hospital Charge Code |
4471040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$49.44 |
| Rate for Payer: Aetna of NY Commercial |
$43.26
|
| Rate for Payer: Aetna of NY Medicare |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.72
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: CDPHP Medicare |
$22.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$49.44
|
| Rate for Payer: EmblemHealth Medicaid |
$49.44
|
| Rate for Payer: EmblemHealth Medicare |
$21.01
|
| Rate for Payer: EmblemHealth Select Care |
$44.50
|
| Rate for Payer: Fidelis Medicare |
$24.72
|
| Rate for Payer: Galaxy Health Commercial |
$40.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.72
|
| Rate for Payer: Humana Medicare |
$24.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$43.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.27
|
| Rate for Payer: United Healthcare Medicare |
$24.72
|
| Rate for Payer: WellCare Medicare |
$33.99
|
|
|
AIRWAY RESISTANCE
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
4530002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
|
|
AIRWAY RESISTANCE
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
4530002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna of NY Commercial |
$328.30
|
| Rate for Payer: Aetna of NY Medicare |
$215.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: CDPHP Medicare |
$173.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$328.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$375.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$375.20
|
| Rate for Payer: EmblemHealth Medicaid |
$375.20
|
| Rate for Payer: EmblemHealth Medicare |
$159.46
|
| Rate for Payer: EmblemHealth Select Care |
$304.85
|
| Rate for Payer: Fidelis Medicare |
$187.60
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$187.60
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$328.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$215.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$264.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$196.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Medicare |
$187.60
|
| Rate for Payer: WellCare Medicare |
$257.95
|
|
|
ALBUMIN FLUID
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
4301065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
ALBUMIN FLUID
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
4301065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Commercial |
$14.95
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$13.80
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$17.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
ALBUMIN SERUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
4300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
ALBUMIN SERUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
4300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
ALBUTEROL/IPRATROPIUM 2.5-0.5MG/3ML AMIH
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 487020103
|
| Hospital Charge Code |
4400028
|
|
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
|
|
|
ALBUTEROL/IPRATROPIUM 2.5-0.5MG/3ML AMIH
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 487020103
|
| Hospital Charge Code |
4400028
|
|
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
|
|
|
ALBUTEROL SULFATE 0.83MG/ML AMIH 60X3ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 487950101
|
| 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 487950101
|
| Hospital Charge Code |
4400026
|
|
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
|
|
|
ALBUTEROL SULFATE 90MCG ARIN 8 GM
|
Facility
|
IP
|
$47.38
|
|
| Hospital Charge Code |
4400795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Galaxy Health Commercial |
$30.80
|
| Rate for Payer: WellCare Medicare |
$26.06
|
|
|
ALBUTEROL SULFATE 90MCG ARIN 8 GM
|
Facility
|
OP
|
$47.38
|
|
| Hospital Charge Code |
4400795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna of NY Commercial |
$33.17
|
| Rate for Payer: Aetna of NY Medicare |
$21.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.95
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: CDPHP Medicare |
$17.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.90
|
| Rate for Payer: EmblemHealth Medicaid |
$37.90
|
| Rate for Payer: EmblemHealth Medicare |
$16.11
|
| Rate for Payer: EmblemHealth Select Care |
$34.11
|
| Rate for Payer: Fidelis Medicare |
$18.95
|
| Rate for Payer: Galaxy Health Commercial |
$30.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.95
|
| Rate for Payer: Humana Medicare |
$18.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.11
|
| Rate for Payer: United Healthcare Medicare |
$18.95
|
| Rate for Payer: WellCare Medicare |
$26.06
|
|
|
ALBUTEROL SULFATE ARIN 8 GM
|
Facility
|
OP
|
$79.41
|
|
|
Service Code
|
NDC 173068224
|
| Hospital Charge Code |
4400794
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$63.53 |
| 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) Medicare |
$31.76
|
| Rate for Payer: Cash Price |
$59.56
|
| 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 |
$31.76
|
| Rate for Payer: Galaxy Health Commercial |
$51.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.76
|
| Rate for Payer: Humana Medicare |
$31.76
|
| 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 |
$33.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare |
$31.76
|
| Rate for Payer: WellCare Medicare |
$43.68
|
|
