|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
IP
|
$10.04
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of NY Commercial |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.52
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
IP
|
$10.04
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of NY Commercial |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.52
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of NY Commercial |
$5.52
|
| Rate for Payer: Aetna of NY Medicare |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.02
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: CDPHP Commercial |
$8.08
|
| Rate for Payer: CDPHP Medicare |
$3.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.03
|
| Rate for Payer: EmblemHealth Medicaid |
$8.03
|
| Rate for Payer: EmblemHealth Medicare |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$3.83
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna of NY Commercial |
$5.38
|
| Rate for Payer: Aetna of NY Medicare |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.90
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: CDPHP Commercial |
$7.88
|
| Rate for Payer: CDPHP Medicare |
$3.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.83
|
| Rate for Payer: EmblemHealth Medicaid |
$7.83
|
| Rate for Payer: EmblemHealth Medicare |
$3.33
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$3.73
|
| Rate for Payer: Galaxy Health Commercial |
$6.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.62
|
| Rate for Payer: Humana Medicare |
$3.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$3.62
|
| Rate for Payer: WellCare Medicare |
$5.38
|
|
|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna of NY Commercial |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$6.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.38
|
| Rate for Payer: WellCare Medicare |
$5.38
|
|
|
POTASSIUM CHLORIDE INJ, PER 2 MEQ
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4450026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of NY Commercial |
$5.52
|
| Rate for Payer: Aetna of NY Medicare |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.02
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: CDPHP Commercial |
$8.08
|
| Rate for Payer: CDPHP Medicare |
$3.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.03
|
| Rate for Payer: EmblemHealth Medicaid |
$8.03
|
| Rate for Payer: EmblemHealth Medicare |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$3.83
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
POTASSIUM CL 10 MEQ/100 ML SOL 10 mEq, 100 mL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4401938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$11.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
POTASSIUM CL 10 MEQ/100 ML SOL 10 mEq, 100 mL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
4401938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna of NY Commercial |
$11.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.11
|
| Rate for Payer: EmblemHealth Select Care |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.00
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
PRAMIPEXOLE 0.125 MG TABLETS
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 68084079325
|
| Hospital Charge Code |
4409082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of NY Commercial |
$6.31
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Commercial |
$7.25
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
PRAMIPEXOLE 0.125 MG TABLETS
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 68084079325
|
| Hospital Charge Code |
4409082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
PRAMIPEXOLE 0.5 MG TABLET 0.5 mg, 90 eaches
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
4401530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.48
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
PRAMIPEXOLE 0.5 MG TABLET 0.5 mg, 90 eaches
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
4401530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
PRAMIPEXOLE 1 MG TABLET 1 mg, 30 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084098225
|
| Hospital Charge Code |
4401322
|
|
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
|
|
|
PRAMIPEXOLE 1 MG TABLET 1 mg, 30 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084098225
|
| Hospital Charge Code |
4401322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PRAVASTATIN SODIUM 20MG TABS 10X10EA
|
Facility
|
IP
|
$10.04
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
4400643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
PRAVASTATIN SODIUM 20MG TABS 10X10EA
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
4400643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of NY Commercial |
$7.03
|
| Rate for Payer: Aetna of NY Medicare |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.02
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: CDPHP Commercial |
$8.08
|
| Rate for Payer: CDPHP Medicare |
$3.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.03
|
| Rate for Payer: EmblemHealth Medicaid |
$8.03
|
| Rate for Payer: EmblemHealth Medicare |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$7.23
|
| Rate for Payer: Fidelis Medicare |
$3.83
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.90
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
PRAZOSIN 1 MG CAPSULE 1 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
4401567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PRAZOSIN 1 MG CAPSULE 1 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
4401567
|
|
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
|
|
|
PREALBUMIN
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
4300647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Galaxy Health Commercial |
$65.65
|
|
|
PREALBUMIN
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
4300647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$81.30 |
| Rate for Payer: Aetna of NY Commercial |
$65.65
|
| Rate for Payer: Aetna of NY Medicare |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50.50
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: CDPHP Commercial |
$81.30
|
| Rate for Payer: CDPHP Medicare |
$37.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.80
|
| Rate for Payer: EmblemHealth Medicaid |
$80.80
|
| Rate for Payer: EmblemHealth Medicare |
$34.34
|
| Rate for Payer: EmblemHealth Select Care |
$60.60
|
| Rate for Payer: Fidelis Medicare |
$38.49
|
| Rate for Payer: Galaxy Health Commercial |
$65.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.37
|
| Rate for Payer: Humana Medicare |
$37.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.39
|
| Rate for Payer: United Healthcare Commercial |
$75.75
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
| Rate for Payer: WellCare Medicare |
$55.55
|
|
|
PRECISION CHARGING KIT 2.0 SN128768
|
Facility
|
OP
|
$7,049.00
|
|
| Hospital Charge Code |
4472066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,396.66 |
| Max. Negotiated Rate |
$5,674.44 |
| Rate for Payer: Aetna of NY Commercial |
$4,934.30
|
| Rate for Payer: Aetna of NY Medicare |
$3,242.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5,286.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5,286.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,608.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,524.50
|
| Rate for Payer: Cash Price |
$5,286.75
|
| Rate for Payer: CDPHP Commercial |
$5,674.44
|
| Rate for Payer: CDPHP Medicare |
$2,608.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,639.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,639.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,639.20
|
| Rate for Payer: EmblemHealth Medicaid |
$5,639.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,396.66
|
| Rate for Payer: EmblemHealth Select Care |
$5,075.28
|
| Rate for Payer: Fidelis Medicare |
$2,686.37
|
| Rate for Payer: Galaxy Health Commercial |
$4,581.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,608.13
|
| Rate for Payer: Humana Medicare |
$2,608.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,934.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,242.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,286.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,968.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,738.54
|
| Rate for Payer: United Healthcare Medicare |
$2,608.13
|
| Rate for Payer: WellCare Medicare |
$3,876.95
|
|
|
PRECISION CHARGING KIT 2.0 SN128768
|
Facility
|
IP
|
$7,049.00
|
|
| Hospital Charge Code |
4472066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,581.85 |
| Max. Negotiated Rate |
$4,581.85 |
| Rate for Payer: Cash Price |
$5,286.75
|
| Rate for Payer: Galaxy Health Commercial |
$4,581.85
|
|
|
PRECISION CHARGING SYSTEM KIT
|
Facility
|
IP
|
$14,423.00
|
|
| Hospital Charge Code |
4472068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9,374.95 |
| Max. Negotiated Rate |
$9,374.95 |
| Rate for Payer: Cash Price |
$10,817.25
|
| Rate for Payer: Galaxy Health Commercial |
$9,374.95
|
|
|
PRECISION CHARGING SYSTEM KIT
|
Facility
|
OP
|
$14,423.00
|
|
| Hospital Charge Code |
4472068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,903.82 |
| Max. Negotiated Rate |
$11,610.52 |
| Rate for Payer: Aetna of NY Commercial |
$10,096.10
|
| Rate for Payer: Aetna of NY Medicare |
$6,634.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10,817.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10,817.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,336.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,211.50
|
| Rate for Payer: Cash Price |
$10,817.25
|
| Rate for Payer: CDPHP Commercial |
$11,610.52
|
| Rate for Payer: CDPHP Medicare |
$5,336.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,538.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,538.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,538.40
|
| Rate for Payer: EmblemHealth Medicaid |
$11,538.40
|
| Rate for Payer: EmblemHealth Medicare |
$4,903.82
|
| Rate for Payer: EmblemHealth Select Care |
$10,384.56
|
| Rate for Payer: Fidelis Medicare |
$5,496.61
|
| Rate for Payer: Galaxy Health Commercial |
$9,374.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,336.51
|
| Rate for Payer: Humana Medicare |
$5,336.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,096.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,634.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,817.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,120.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,603.34
|
| Rate for Payer: United Healthcare Medicare |
$5,336.51
|
| Rate for Payer: WellCare Medicare |
$7,932.65
|
|
|
PRECISION CHARGING SYSTEM KIT SN128768
|
Facility
|
OP
|
$11,772.00
|
|
| Hospital Charge Code |
4472067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,002.48 |
| Max. Negotiated Rate |
$9,476.46 |
| Rate for Payer: Aetna of NY Commercial |
$8,240.40
|
| Rate for Payer: Aetna of NY Medicare |
$5,415.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8,829.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8,829.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,355.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,886.00
|
| Rate for Payer: Cash Price |
$8,829.00
|
| Rate for Payer: CDPHP Commercial |
$9,476.46
|
| Rate for Payer: CDPHP Medicare |
$4,355.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,417.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9,417.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,002.48
|
| Rate for Payer: EmblemHealth Select Care |
$8,475.84
|
| Rate for Payer: Fidelis Medicare |
$4,486.31
|
| Rate for Payer: Galaxy Health Commercial |
$7,651.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,355.64
|
| Rate for Payer: Humana Medicare |
$4,355.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8,240.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,415.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,829.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,627.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,573.42
|
| Rate for Payer: United Healthcare Medicare |
$4,355.64
|
| Rate for Payer: WellCare Medicare |
$6,474.60
|
|
