|
PHOSPHOLIPID NEUTRALIZATION PLATELET
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
4302012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
PHOSPHORUS
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
4300627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.74 |
| 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 |
$4.74
|
| Rate for Payer: United Healthcare Commercial |
$18.75
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
PHOSPHORUS
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
4300627
|
|
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
|
|
|
PHYSICAL PERFORM TEST EA 15M
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
4650051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
PHYSICAL PERFORM TEST EA 15M
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
4650051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
PHYSICAL PERFORM TEST EA 15M (MOD 59)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,59
|
| Hospital Charge Code |
4650384
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
PHYSICAL PERFORM TEST EA 15M (MOD 59)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,59
|
| Hospital Charge Code |
4650384
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
PHYSICAL PERFORM TEST EA 15M (MOD 59 W KX)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,59,KX
|
| Hospital Charge Code |
4650436
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
PHYSICAL PERFORM TEST EA 15M (MOD 59 W KX)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,59,KX
|
| Hospital Charge Code |
4650436
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
PHYSICAL PERFORM TEST EA 15M (W/ KX)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,KX
|
| Hospital Charge Code |
4650329
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
PHYSICAL PERFORM TEST EA 15M (W/ KX)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GP,KX
|
| Hospital Charge Code |
4650329
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
PHYTONADIONE (VITAMIN K) INJ, PER 1 MG
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
4400809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna of NY Commercial |
$77.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.80
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.80
|
| Rate for Payer: EmblemHealth Select Care |
$2.80
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.04
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
PHYTONADIONE (VITAMIN K) INJ, PER 1 MG
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
4400809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Aetna of NY Commercial |
$77.04
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$51.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$70.04
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Commercial |
$112.76
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.06
|
| Rate for Payer: EmblemHealth Medicaid |
$112.06
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$2.80
|
| Rate for Payer: Fidelis Medicare |
$53.38
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$51.83
|
| Rate for Payer: Humana Medicare |
$51.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$78.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$54.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$4.74
|
| Rate for Payer: United Healthcare Medicare |
$51.83
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
PICC LINE TURBO-JET PICK SET
|
Facility
|
IP
|
$565.00
|
|
| Hospital Charge Code |
4471877
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$367.25 |
| Rate for Payer: Cash Price |
$423.75
|
| Rate for Payer: Galaxy Health Commercial |
$367.25
|
|
|
PICC LINE TURBO-JET PICK SET
|
Facility
|
OP
|
$565.00
|
|
| Hospital Charge Code |
4471877
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$454.82 |
| Rate for Payer: Aetna of NY Commercial |
$395.50
|
| Rate for Payer: Aetna of NY Medicare |
$259.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$423.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$423.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$209.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$282.50
|
| Rate for Payer: Cash Price |
$423.75
|
| Rate for Payer: CDPHP Commercial |
$454.82
|
| Rate for Payer: CDPHP Medicare |
$209.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$452.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$452.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$452.00
|
| Rate for Payer: EmblemHealth Medicaid |
$452.00
|
| Rate for Payer: EmblemHealth Medicare |
$192.10
|
| Rate for Payer: EmblemHealth Select Care |
$406.80
|
| Rate for Payer: Fidelis Medicare |
$215.32
|
| Rate for Payer: Galaxy Health Commercial |
$367.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$209.05
|
| Rate for Payer: Humana Medicare |
$209.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$395.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$259.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$423.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$318.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.50
|
| Rate for Payer: United Healthcare Medicare |
$209.05
|
| Rate for Payer: WellCare Medicare |
$310.75
|
|
|
PILOCARPINE HCL 0.01 DROP 15 ML
|
Facility
|
OP
|
$304.62
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
4400624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$245.22 |
| Rate for Payer: Aetna of NY Commercial |
$213.23
|
| Rate for Payer: Aetna of NY Medicare |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$228.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$228.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$112.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$152.31
|
| Rate for Payer: Cash Price |
$228.47
|
| Rate for Payer: CDPHP Commercial |
$245.22
|
| Rate for Payer: CDPHP Medicare |
$112.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$243.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$243.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$243.70
|
| Rate for Payer: EmblemHealth Medicaid |
$243.70
|
| Rate for Payer: EmblemHealth Medicare |
$103.57
|
| Rate for Payer: EmblemHealth Select Care |
$219.33
|
| Rate for Payer: Fidelis Medicare |
$116.09
|
| Rate for Payer: Galaxy Health Commercial |
$198.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$112.71
|
| Rate for Payer: Humana Medicare |
$112.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$213.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$140.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$171.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$118.34
|
| Rate for Payer: United Healthcare Medicare |
$112.71
|
| Rate for Payer: WellCare Medicare |
$167.54
|
|
|
PILOCARPINE HCL 0.01 DROP 15 ML
|
Facility
|
IP
|
$304.62
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
4400624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.54 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Cash Price |
$228.47
|
| Rate for Payer: Galaxy Health Commercial |
$198.00
|
| Rate for Payer: WellCare Medicare |
$167.54
|
|
|
PIPERACILLIN/TAZOBACTAM INJ, 1 GRAM/0.125 GRAMS (1.125 GRAMS)
|
Facility
|
IP
|
$18.46
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4400826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Galaxy Health Commercial |
$12.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.15
|
| Rate for Payer: WellCare Medicare |
$10.15
|
|
|
PIPERACILLIN/TAZOBACTAM INJ, 1 GRAM/0.125 GRAMS (1.125 GRAMS)
|
Facility
|
OP
|
$18.46
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4400826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna of NY Commercial |
$10.15
|
| Rate for Payer: Aetna of NY Medicare |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.23
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: CDPHP Commercial |
$14.86
|
| Rate for Payer: CDPHP Medicare |
$6.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.77
|
| Rate for Payer: EmblemHealth Medicaid |
$14.77
|
| Rate for Payer: EmblemHealth Medicare |
$6.28
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Fidelis Medicare |
$7.04
|
| Rate for Payer: Galaxy Health Commercial |
$12.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.83
|
| Rate for Payer: Humana Medicare |
$6.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$6.83
|
| Rate for Payer: WellCare Medicare |
$10.15
|
|
|
PIPERACIL-TAZOBACT 2.25 GM VL 2.25 g, 1 each
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4401468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PIPERACIL-TAZOBACT 2.25 GM VL 2.25 g, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4401468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PLACEMENT NEEDLE INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
4601203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Galaxy Health Commercial |
$741.00
|
|
|
PLACEMENT NEEDLE INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
4601203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$421.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: CDPHP Commercial |
$917.70
|
| Rate for Payer: CDPHP Medicare |
$421.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.00
|
| Rate for Payer: EmblemHealth Medicaid |
$912.00
|
| Rate for Payer: EmblemHealth Medicare |
$387.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.45
|
| Rate for Payer: Galaxy Health Commercial |
$741.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$421.80
|
| Rate for Payer: Humana Medicare |
$421.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$442.89
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.63
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$421.80
|
| Rate for Payer: WellCare Medicare |
$627.00
|
|
|
PLAN B
|
Facility
|
IP
|
$29.50
|
|
|
Service Code
|
NDC 00536114263
|
| Hospital Charge Code |
4409025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Galaxy Health Commercial |
$19.18
|
| Rate for Payer: WellCare Medicare |
$16.22
|
|
|
PLAN B
|
Facility
|
OP
|
$29.50
|
|
|
Service Code
|
NDC 00536114263
|
| Hospital Charge Code |
4409025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna of NY Commercial |
$20.65
|
| Rate for Payer: Aetna of NY Medicare |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.75
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: CDPHP Commercial |
$23.75
|
| Rate for Payer: CDPHP Medicare |
$10.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.60
|
| Rate for Payer: EmblemHealth Medicaid |
$23.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.03
|
| Rate for Payer: EmblemHealth Select Care |
$21.24
|
| Rate for Payer: Fidelis Medicare |
$11.24
|
| Rate for Payer: Galaxy Health Commercial |
$19.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.92
|
| Rate for Payer: Humana Medicare |
$10.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.46
|
| Rate for Payer: United Healthcare Medicare |
$10.92
|
| Rate for Payer: WellCare Medicare |
$16.22
|
|
