|
PRECISION CHARGING SYSTEM KIT SN128768
|
Facility
|
IP
|
$11,772.00
|
|
| Hospital Charge Code |
4472067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7,651.80 |
| Max. Negotiated Rate |
$7,651.80 |
| Rate for Payer: Cash Price |
$8,829.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,651.80
|
|
|
PRECISION IMPLANTABLE PULSE GE
|
Facility
|
IP
|
$101,220.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
4472054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45,549.00 |
| Max. Negotiated Rate |
$70,854.00 |
| Rate for Payer: Aetna of NY Commercial |
$70,854.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45,549.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45,549.00
|
| Rate for Payer: Cash Price |
$75,915.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,610.00
|
| Rate for Payer: EmblemHealth Select Care |
$50,610.00
|
| Rate for Payer: Galaxy Health Commercial |
$65,793.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70,854.00
|
| Rate for Payer: Multiplan Commercial |
$45,549.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65,793.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65,793.00
|
| Rate for Payer: WellCare Medicare |
$55,671.00
|
|
|
PRECISION IMPLANTABLE PULSE GE
|
Facility
|
OP
|
$101,220.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
4472054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34,414.80 |
| Max. Negotiated Rate |
$81,482.10 |
| Rate for Payer: Aetna of NY Commercial |
$70,854.00
|
| Rate for Payer: Aetna of NY Medicare |
$46,561.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45,549.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45,549.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37,451.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$50,610.00
|
| Rate for Payer: Cash Price |
$75,915.00
|
| Rate for Payer: CDPHP Commercial |
$81,482.10
|
| Rate for Payer: CDPHP Medicare |
$37,451.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,610.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80,976.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80,976.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80,976.00
|
| Rate for Payer: EmblemHealth Medicare |
$34,414.80
|
| Rate for Payer: EmblemHealth Select Care |
$50,610.00
|
| Rate for Payer: Fidelis Medicare |
$38,574.94
|
| Rate for Payer: Galaxy Health Commercial |
$65,793.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$37,451.40
|
| Rate for Payer: Humana Medicare |
$37,451.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70,854.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46,561.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65,793.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65,793.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39,323.97
|
| Rate for Payer: United Healthcare Medicare |
$37,451.40
|
| Rate for Payer: WellCare Medicare |
$55,671.00
|
|
|
PRECISION IMPLANTABLE PULSE GE SN115645
|
Facility
|
OP
|
$111,253.00
|
|
| Hospital Charge Code |
4472053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37,826.02 |
| Max. Negotiated Rate |
$89,558.66 |
| Rate for Payer: Aetna of NY Commercial |
$77,877.10
|
| Rate for Payer: Aetna of NY Medicare |
$51,176.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$83,439.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$83,439.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41,163.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$55,626.50
|
| Rate for Payer: Cash Price |
$83,439.75
|
| Rate for Payer: CDPHP Commercial |
$89,558.66
|
| Rate for Payer: CDPHP Medicare |
$41,163.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$89,002.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$89,002.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$89,002.40
|
| Rate for Payer: EmblemHealth Medicaid |
$89,002.40
|
| Rate for Payer: EmblemHealth Medicare |
$37,826.02
|
| Rate for Payer: EmblemHealth Select Care |
$80,102.16
|
| Rate for Payer: Fidelis Medicare |
$42,398.52
|
| Rate for Payer: Galaxy Health Commercial |
$72,314.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$41,163.61
|
| Rate for Payer: Humana Medicare |
$41,163.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77,877.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$51,176.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83,439.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$62,635.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$43,221.79
|
| Rate for Payer: United Healthcare Medicare |
$41,163.61
|
| Rate for Payer: WellCare Medicare |
$61,189.15
|
|
|
PRECISION IMPLANTABLE PULSE GE SN115645
|
Facility
|
IP
|
$111,253.00
|
|
| Hospital Charge Code |
4472053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72,314.45 |
| Max. Negotiated Rate |
$72,314.45 |
| Rate for Payer: Cash Price |
$83,439.75
|
| Rate for Payer: Galaxy Health Commercial |
$72,314.45
|
|
|
PREC SPEC REMOTE CONTROL KIT SN201138
|
Facility
|
IP
|
$5,755.00
|
|
| Hospital Charge Code |
4479297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,589.75 |
| Max. Negotiated Rate |
$4,028.50 |
| Rate for Payer: Aetna of NY Commercial |
$4,028.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,589.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,589.75
|
| Rate for Payer: Cash Price |
$4,316.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,877.50
|
| Rate for Payer: EmblemHealth Select Care |
$2,877.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,740.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,028.50
|
| Rate for Payer: Multiplan Commercial |
$2,589.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,740.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,740.75
|
| Rate for Payer: WellCare Medicare |
$3,165.25
|
|
|
PREC SPEC REMOTE CONTROL KIT SN201138
|
Facility
|
OP
|
$5,755.00
|
|
| Hospital Charge Code |
4479297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,956.70 |
| Max. Negotiated Rate |
$4,632.78 |
| Rate for Payer: Aetna of NY Commercial |
$4,028.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,647.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,589.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,589.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,129.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,877.50
|
| Rate for Payer: Cash Price |
$4,316.25
|
| Rate for Payer: CDPHP Commercial |
$4,632.78
|
| Rate for Payer: CDPHP Medicare |
$2,129.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,877.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,604.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,604.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,604.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,956.70
|
| Rate for Payer: EmblemHealth Select Care |
$2,877.50
|
| Rate for Payer: Fidelis Medicare |
$2,193.23
|
| Rate for Payer: Galaxy Health Commercial |
$3,740.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,129.35
|
| Rate for Payer: Humana Medicare |
$2,129.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,028.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,647.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,740.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,740.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,235.82
|
| Rate for Payer: United Healthcare Medicare |
$2,129.35
|
| Rate for Payer: WellCare Medicare |
$3,165.25
|
|
|
PREDNISOLONE ACETATE 0.01 DROP 5 ML
|
Facility
|
OP
|
$170.98
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
4400645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna of NY Commercial |
$119.69
|
| Rate for Payer: Aetna of NY Medicare |
$78.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$128.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$128.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.49
|
| Rate for Payer: Cash Price |
$128.24
|
| Rate for Payer: CDPHP Commercial |
$137.64
|
| Rate for Payer: CDPHP Medicare |
$63.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.78
|
| Rate for Payer: EmblemHealth Medicaid |
$136.78
|
| Rate for Payer: EmblemHealth Medicare |
$58.13
|
| Rate for Payer: EmblemHealth Select Care |
$123.11
|
| Rate for Payer: Fidelis Medicare |
$65.16
|
| Rate for Payer: Galaxy Health Commercial |
$111.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.26
|
| Rate for Payer: Humana Medicare |
$63.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$96.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.43
|
| Rate for Payer: United Healthcare Medicare |
$63.26
|
| Rate for Payer: WellCare Medicare |
$94.04
|
|
|
PREDNISOLONE ACETATE 0.01 DROP 5 ML
|
Facility
|
IP
|
$170.98
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
4400645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.04 |
| Max. Negotiated Rate |
$111.14 |
| Rate for Payer: Cash Price |
$128.24
|
| Rate for Payer: Galaxy Health Commercial |
$111.14
|
| Rate for Payer: WellCare Medicare |
$94.04
|
|
|
PREDNISOLONE ORAL PER 5 MG
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
4400644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of NY Commercial |
$4.11
|
| Rate for Payer: Aetna of NY Medicare |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.74
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: CDPHP Commercial |
$6.01
|
| Rate for Payer: CDPHP Medicare |
$2.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.98
|
| Rate for Payer: EmblemHealth Medicaid |
$5.98
|
| Rate for Payer: EmblemHealth Medicare |
$2.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.29
|
| Rate for Payer: Fidelis Medicare |
$2.85
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.76
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.41
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
PREDNISOLONE ORAL PER 5 MG
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
4400644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna of NY Commercial |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.29
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.29
|
| Rate for Payer: EmblemHealth Select Care |
$0.29
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.11
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4409109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400648
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of NY Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.33
|
| Rate for Payer: WellCare Medicare |
$0.33
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Aetna of NY Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: CDPHP Commercial |
$0.02
|
| Rate for Payer: CDPHP Medicare |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.02
|
| Rate for Payer: EmblemHealth Medicaid |
$0.02
|
| Rate for Payer: EmblemHealth Medicare |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Fidelis Medicare |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400648
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of NY Commercial |
$0.33
|
| Rate for Payer: Aetna of NY Medicare |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.30
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: CDPHP Commercial |
$0.48
|
| Rate for Payer: CDPHP Medicare |
$0.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.48
|
| Rate for Payer: EmblemHealth Medicaid |
$0.48
|
| Rate for Payer: EmblemHealth Medicare |
$0.20
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Fidelis Medicare |
$0.23
|
| Rate for Payer: Galaxy Health Commercial |
$0.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.22
|
| Rate for Payer: Humana Medicare |
$0.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WellCare Medicare |
$0.33
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Aetna of NY Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: CDPHP Commercial |
$0.02
|
| Rate for Payer: CDPHP Medicare |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.02
|
| Rate for Payer: EmblemHealth Medicaid |
$0.02
|
| Rate for Payer: EmblemHealth Medicare |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Fidelis Medicare |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4409109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Aetna of NY Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: CDPHP Commercial |
$0.02
|
| Rate for Payer: CDPHP Medicare |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.02
|
| Rate for Payer: EmblemHealth Medicaid |
$0.02
|
| Rate for Payer: EmblemHealth Medicare |
$0.01
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Fidelis Medicare |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.02
|
|
|
PREGABALIN 100 MG CAPSULE 100 mg, 1 each
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
4401423
|
|
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
|
|
|
PREGABALIN 100 MG CAPSULE 100 mg, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
4401423
|
|
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
|
|
|
PREGABALIN 25MG CAPS 90 EA
|
Facility
|
OP
|
$21.37
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
4400476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of NY Commercial |
$14.96
|
| Rate for Payer: Aetna of NY Medicare |
$9.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.68
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: CDPHP Commercial |
$17.20
|
| Rate for Payer: CDPHP Medicare |
$7.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.10
|
| Rate for Payer: EmblemHealth Medicaid |
$17.10
|
| Rate for Payer: EmblemHealth Medicare |
$7.27
|
| Rate for Payer: EmblemHealth Select Care |
$15.39
|
| Rate for Payer: Fidelis Medicare |
$8.14
|
| Rate for Payer: Galaxy Health Commercial |
$13.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.91
|
| Rate for Payer: Humana Medicare |
$7.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.30
|
| Rate for Payer: United Healthcare Medicare |
$7.91
|
| Rate for Payer: WellCare Medicare |
$11.75
|
|
|
PREGABALIN 25MG CAPS 90 EA
|
Facility
|
IP
|
$21.37
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
4400476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Galaxy Health Commercial |
$13.89
|
| Rate for Payer: WellCare Medicare |
$11.75
|
|
|
PREGABALIN 50MG CAPS 10X10EA
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
4400477
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of NY Commercial |
$16.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.72
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: CDPHP Commercial |
$18.86
|
| Rate for Payer: CDPHP Medicare |
$8.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.74
|
| Rate for Payer: EmblemHealth Medicaid |
$18.74
|
| Rate for Payer: EmblemHealth Medicare |
$7.97
|
| Rate for Payer: EmblemHealth Select Care |
$16.87
|
| Rate for Payer: Fidelis Medicare |
$8.93
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.67
|
| Rate for Payer: Humana Medicare |
$8.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.10
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
PREGABALIN 50MG CAPS 10X10EA
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
4400477
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
