|
CALCITRIOL CAPSULE 0.25 MCG
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409138
|
|
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
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409182
|
|
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
|
|
|
CALCIUM CARBONATE 500MG CHEW 150 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400122
|
|
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
|
|
|
CALCIUM CHLORIDE 100MG/ML ANSY 10X10ML
|
Facility
OP
|
$33.48
|
|
| Hospital Charge Code |
4400123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of NY Commercial |
$23.44
|
| Rate for Payer: Aetna of NY Medicare |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.74
|
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: CDPHP Commercial |
$26.95
|
| Rate for Payer: CDPHP Medicare |
$12.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.78
|
| Rate for Payer: EmblemHealth Medicaid |
$26.78
|
| Rate for Payer: EmblemHealth Medicare |
$11.38
|
| Rate for Payer: EmblemHealth Select Care |
$24.11
|
| Rate for Payer: Fidelis Medicare |
$12.76
|
| Rate for Payer: Galaxy Health Commercial |
$21.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.01
|
| Rate for Payer: United Healthcare Medicare |
$12.39
|
| Rate for Payer: WellCare Medicare |
$18.41
|
|
|
CALCIUM GLUCONATE, PER 10 ML
|
Facility
OP
|
$20.09
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
4408957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Aetna of NY Commercial |
$11.05
|
| Rate for Payer: Aetna of NY Medicare |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.04
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: CDPHP Commercial |
$16.17
|
| Rate for Payer: CDPHP Medicare |
$7.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.07
|
| Rate for Payer: EmblemHealth Medicaid |
$16.07
|
| Rate for Payer: EmblemHealth Medicare |
$6.83
|
| Rate for Payer: EmblemHealth Select Care |
$14.46
|
| Rate for Payer: Fidelis Medicare |
$7.66
|
| Rate for Payer: Galaxy Health Commercial |
$13.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.43
|
| Rate for Payer: Humana Medicare |
$7.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.80
|
| Rate for Payer: United Healthcare Medicare |
$7.43
|
| Rate for Payer: WellCare Medicare |
$11.05
|
|
|
CALCIUM SERUM
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
4300141
|
|
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 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: 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
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
4302025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
CALDOLOR 800 MG/200 ML BAG 1 ea, 200 mL
|
Facility
OP
|
$74.00
|
|
| Hospital Charge Code |
4401437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Aetna of NY Commercial |
$51.80
|
| Rate for Payer: Aetna of NY Medicare |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$55.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$55.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.00
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: CDPHP Commercial |
$59.57
|
| Rate for Payer: CDPHP Medicare |
$27.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$59.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$59.20
|
| Rate for Payer: EmblemHealth Medicaid |
$59.20
|
| Rate for Payer: EmblemHealth Medicare |
$25.16
|
| Rate for Payer: EmblemHealth Select Care |
$53.28
|
| Rate for Payer: Fidelis Medicare |
$28.20
|
| Rate for Payer: Galaxy Health Commercial |
$48.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.38
|
| Rate for Payer: Humana Medicare |
$27.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.75
|
| Rate for Payer: United Healthcare Medicare |
$27.38
|
| Rate for Payer: WellCare Medicare |
$40.70
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP
|
| Hospital Charge Code |
4650076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| 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 |
$50.50
|
| 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 |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
CANALITH REPOSITIONING PROC (MOD 59)
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP,59
|
| Hospital Charge Code |
4650391
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| 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 |
$50.50
|
| 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 |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
CANALITH REPOSITIONING PROC (MOD 59 W KX)
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP,59,KX
|
| Hospital Charge Code |
4650443
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| 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 |
$50.50
|
| 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 |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
CANALITH REPOSITIONING PROC (W/ KX)
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP,KX
|
| Hospital Charge Code |
4650339
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| 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 |
$50.50
|
| 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 |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
CANE
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
4479076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
CANE
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
4602606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
CANNULA 20GX100MMX10MM
|
Facility
OP
|
$795.00
|
|
| Hospital Charge Code |
4479216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$639.98 |
| Rate for Payer: Aetna of NY Commercial |
$556.50
|
| Rate for Payer: Aetna of NY Medicare |
$365.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$294.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$397.50
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: CDPHP Commercial |
$639.98
|
| Rate for Payer: CDPHP Medicare |
$294.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$636.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$636.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$636.00
|
| Rate for Payer: EmblemHealth Medicaid |
$636.00
|
| Rate for Payer: EmblemHealth Medicare |
$270.30
|
| Rate for Payer: EmblemHealth Select Care |
$572.40
|
| Rate for Payer: Fidelis Medicare |
$302.97
|
| Rate for Payer: Galaxy Health Commercial |
$516.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$294.15
|
| Rate for Payer: Humana Medicare |
$294.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$556.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$365.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$447.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$308.86
|
| Rate for Payer: United Healthcare Medicare |
$294.15
|
| Rate for Payer: WellCare Medicare |
$437.25
|
|
|
CAPSUREFIX NOVUS
|
Facility
OP
|
$2,407.00
|
|
| Hospital Charge Code |
4471352
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$818.38 |
| Max. Negotiated Rate |
$1,937.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
| Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
| Rate for Payer: Cash Price |
$1,805.25
|
| Rate for Payer: CDPHP Commercial |
$1,937.64
|
| Rate for Payer: CDPHP Medicare |
$890.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicare |
$818.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
| Rate for Payer: Fidelis Medicare |
$917.31
|
| Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
| Rate for Payer: Humana Medicare |
$890.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
| Rate for Payer: United Healthcare Medicare |
$890.59
|
| Rate for Payer: WellCare Medicare |
$1,323.85
|
|
|
CAPSUREFIX NOVUS II
|
Facility
OP
|
$2,407.00
|
|
| Hospital Charge Code |
4471351
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$818.38 |
| Max. Negotiated Rate |
$1,937.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
| Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
| Rate for Payer: Cash Price |
$1,805.25
|
| Rate for Payer: CDPHP Commercial |
$1,937.64
|
| Rate for Payer: CDPHP Medicare |
$890.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicare |
$818.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
| Rate for Payer: Fidelis Medicare |
$917.31
|
| Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
| Rate for Payer: Humana Medicare |
$890.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
| Rate for Payer: United Healthcare Medicare |
$890.59
|
| Rate for Payer: WellCare Medicare |
$1,323.85
|
|
|
CAPSUREFIX NOVUS III
|
Facility
OP
|
$2,407.00
|
|
| Hospital Charge Code |
4471350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$818.38 |
| Max. Negotiated Rate |
$1,937.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
| Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
| Rate for Payer: Cash Price |
$1,805.25
|
| Rate for Payer: CDPHP Commercial |
$1,937.64
|
| Rate for Payer: CDPHP Medicare |
$890.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
| Rate for Payer: EmblemHealth Medicare |
$818.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
| Rate for Payer: Fidelis Medicare |
$917.31
|
| Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
| Rate for Payer: Humana Medicare |
$890.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
| Rate for Payer: United Healthcare Medicare |
$890.59
|
| Rate for Payer: WellCare Medicare |
$1,323.85
|
|
|
CAPTOPRIL 12.5MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400128
|
|
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
|
|
|
CAPTOPRIL RENAL
|
Facility
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
4210034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.00
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
CARBAMAZEPINE 200MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400131
|
|
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
|
|
|
carBAMazepine ER 100 MG TABLET 100 mcg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| 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: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| 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 |
$4.32
|
| 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 |
$4.20
|
| 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: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
carBAMazepine ER 400 MG TABLET 400 mg, 100 eaches
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
4401935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$8.40
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
CARBAMIDE PEROXIDE 0.065 DROP 15 ML
|
Facility
OP
|
$15.36
|
|
| Hospital Charge Code |
4400264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$12.36 |
| Rate for Payer: Aetna of NY Commercial |
$10.75
|
| Rate for Payer: Aetna of NY Medicare |
$7.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.68
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: CDPHP Commercial |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$5.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.29
|
| Rate for Payer: EmblemHealth Medicaid |
$12.29
|
| Rate for Payer: EmblemHealth Medicare |
$5.22
|
| Rate for Payer: EmblemHealth Select Care |
$11.06
|
| Rate for Payer: Fidelis Medicare |
$5.85
|
| Rate for Payer: Galaxy Health Commercial |
$9.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.68
|
| Rate for Payer: Humana Medicare |
$5.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.97
|
| Rate for Payer: United Healthcare Medicare |
$5.68
|
| Rate for Payer: WellCare Medicare |
$8.45
|
|
|
CARBIDOPA/LEVODOPA 25-100MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400132
|
|
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
|
|
