|
OT WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GO,KX
|
| Hospital Charge Code |
4690190
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO
|
| Hospital Charge Code |
4690027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO
|
| Hospital Charge Code |
4690027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,59
|
| Hospital Charge Code |
4690229
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,59
|
| Hospital Charge Code |
4690229
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59 W KX)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,59,KX
|
| Hospital Charge Code |
4690260
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59 W KX)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,59,KX
|
| Hospital Charge Code |
4690260
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (W/ KX)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,KX
|
| Hospital Charge Code |
4690194
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (W/ KX)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 97602 GO,KX
|
| Hospital Charge Code |
4690194
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
OVA AND PARASITES & GIARDIA AG
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
4300599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna of NY Commercial |
$57.20
|
| Rate for Payer: Aetna of NY Medicare |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: CDPHP Commercial |
$70.84
|
| Rate for Payer: CDPHP Medicare |
$32.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$70.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.40
|
| Rate for Payer: EmblemHealth Medicaid |
$70.40
|
| Rate for Payer: EmblemHealth Medicare |
$29.92
|
| Rate for Payer: EmblemHealth Select Care |
$52.80
|
| Rate for Payer: Fidelis Medicare |
$33.54
|
| Rate for Payer: Galaxy Health Commercial |
$57.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.56
|
| Rate for Payer: Humana Medicare |
$32.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$57.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$49.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$66.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.90
|
| Rate for Payer: United Healthcare Commercial |
$66.00
|
| Rate for Payer: United Healthcare Medicare |
$32.56
|
| Rate for Payer: WellCare Medicare |
$48.40
|
|
|
OVA AND PARASITES & GIARDIA AG
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
4300599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Galaxy Health Commercial |
$57.20
|
|
|
OVOSAPIAN FBROPTC AIRWAY #236075
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
4479279
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| 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 |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| 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 |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
OVOSAPIAN FBROPTC AIRWAY #236075
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
4479279
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
OXACILLIN 2 GM VIAL 2 g, 1 each
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
4401524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$2.75
|
| Rate for Payer: Aetna of NY Medicare |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.50
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: CDPHP Commercial |
$4.02
|
| Rate for Payer: CDPHP Medicare |
$1.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4.00
|
| Rate for Payer: EmblemHealth Medicare |
$1.70
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Fidelis Medicare |
$1.91
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.85
|
| Rate for Payer: Humana Medicare |
$1.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
OXACILLIN 2 GM VIAL 2 g, 1 each
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
4401524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna of NY Commercial |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.12
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.12
|
| Rate for Payer: EmblemHealth Select Care |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.75
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
OXCARBAZEPINE 150 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
4408939
|
|
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
|
|
|
OXCARBAZEPINE 150 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
4408939
|
|
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
|
|
|
OXYBUTYNIN 5 MG extended release
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 68084048001
|
| Hospital Charge Code |
4409211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Galaxy Health Commercial |
$8.42
|
| Rate for Payer: WellCare Medicare |
$7.12
|
|
|
OXYBUTYNIN 5 MG extended release
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 68084048001
|
| Hospital Charge Code |
4409211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$10.42 |
| Rate for Payer: Aetna of NY Commercial |
$9.06
|
| Rate for Payer: Aetna of NY Medicare |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.48
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: CDPHP Commercial |
$10.42
|
| Rate for Payer: CDPHP Medicare |
$4.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.36
|
| Rate for Payer: EmblemHealth Medicaid |
$10.36
|
| Rate for Payer: EmblemHealth Medicare |
$4.40
|
| Rate for Payer: EmblemHealth Select Care |
$9.32
|
| Rate for Payer: Fidelis Medicare |
$4.94
|
| Rate for Payer: Galaxy Health Commercial |
$8.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.79
|
| Rate for Payer: Humana Medicare |
$4.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.71
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.03
|
| Rate for Payer: United Healthcare Medicare |
$4.79
|
| Rate for Payer: WellCare Medicare |
$7.12
|
|
|
OXYBUTYNIN CHLORIDE 5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
4400598
|
|
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
|
|
|
OXYBUTYNIN CHLORIDE 5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
4400598
|
|
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
|
|
|
OXYCODONE/ACETAMIN 5-325MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
4400601
|
|
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
|
|
|
OXYCODONE/ACETAMIN 5-325MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
4400601
|
|
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
|
|
|
OXYCODONE HCL 10MG TABS 2X10EA
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
4400602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.80
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Commercial |
$9.33
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.42
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
OXYCODONE HCL 10MG TABS 2X10EA
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
4400602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
