|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59 W KX)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,59,KX
|
| Hospital Charge Code |
4690260
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59 W KX)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,59,KX
|
| Hospital Charge Code |
4690260
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (W/ KX)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,KX
|
| Hospital Charge Code |
4690194
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (W/ KX)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,KX
|
| Hospital Charge Code |
4690194
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
OVA AND PARASITES & GIARDIA AG
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
4300599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$17.55
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$16.20
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$20.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
OVA AND PARASITES & GIARDIA AG
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
4300599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
OVOSAPIAN FBROPTC AIRWAY #236075
|
Facility
|
IP
|
$23.69
|
|
| Hospital Charge Code |
4479279
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
|
|
OVOSAPIAN FBROPTC AIRWAY #236075
|
Facility
|
OP
|
$23.69
|
|
| Hospital Charge Code |
4479279
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna of NY Commercial |
$16.58
|
| Rate for Payer: Aetna of NY Medicare |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.48
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: CDPHP Medicare |
$8.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.95
|
| Rate for Payer: EmblemHealth Medicaid |
$18.95
|
| Rate for Payer: EmblemHealth Medicare |
$8.05
|
| Rate for Payer: EmblemHealth Select Care |
$17.06
|
| Rate for Payer: Fidelis Medicare |
$9.48
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.48
|
| Rate for Payer: Humana Medicare |
$9.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.55
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WellCare Medicare |
$13.03
|
|
|
OXACILLIN 2 GM VIAL 2 g, 1 each
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
4401524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna of NY Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| Rate for Payer: EmblemHealth Select Care |
$0.85
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.75
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
OXACILLIN 2 GM VIAL 2 g, 1 each
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
4401524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of NY Medicare |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.00
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: CDPHP Medicare |
$1.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4.00
|
| Rate for Payer: EmblemHealth Medicare |
$1.70
|
| Rate for Payer: EmblemHealth Select Care |
$0.85
|
| Rate for Payer: Fidelis Medicare |
$2.00
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.00
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$2.00
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
OXCARBAZEPINE 150 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
4408939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXCARBAZEPINE 150 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
4408939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYBUTYNIN 5 MG extended release
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 68084048001
|
| Hospital Charge Code |
4409211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Galaxy Health Commercial |
$8.42
|
| Rate for Payer: WellCare Medicare |
$7.12
|
|
|
OXYBUTYNIN 5 MG extended release
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 68084048001
|
| Hospital Charge Code |
4409211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna of NY Commercial |
$9.06
|
| Rate for Payer: Aetna of NY Medicare |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: CDPHP Medicare |
$4.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.36
|
| Rate for Payer: EmblemHealth Medicaid |
$10.36
|
| Rate for Payer: EmblemHealth Medicare |
$4.40
|
| Rate for Payer: EmblemHealth Select Care |
$9.32
|
| Rate for Payer: Fidelis Medicare |
$5.18
|
| Rate for Payer: Galaxy Health Commercial |
$8.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.71
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.94
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.12
|
|
|
OXYBUTYNIN CHLORIDE 5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904282161
|
| Hospital Charge Code |
4400598
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYBUTYNIN CHLORIDE 5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904282161
|
| Hospital Charge Code |
4400598
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYCODONE/ACETAMIN 5-325MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
4400601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYCODONE/ACETAMIN 5-325MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
4400601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYCODONE HCL 10MG TABS 2X10EA
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
4400602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.64
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.64
|
| Rate for Payer: Humana Medicare |
$4.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
OXYCODONE HCL 10MG TABS 2X10EA
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
4400602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
OXYCODONE HCL 20MG TABS 2X10EA
|
Facility
|
IP
|
$21.63
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
4400603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Galaxy Health Commercial |
$14.06
|
| Rate for Payer: WellCare Medicare |
$11.90
|
|
|
OXYCODONE HCL 20MG TABS 2X10EA
|
Facility
|
OP
|
$21.63
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
4400603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna of NY Commercial |
$15.14
|
| Rate for Payer: Aetna of NY Medicare |
$9.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.65
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: CDPHP Medicare |
$8.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.30
|
| Rate for Payer: EmblemHealth Medicaid |
$17.30
|
| Rate for Payer: EmblemHealth Medicare |
$7.35
|
| Rate for Payer: EmblemHealth Select Care |
$15.57
|
| Rate for Payer: Fidelis Medicare |
$8.65
|
| Rate for Payer: Galaxy Health Commercial |
$14.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.65
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.14
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.24
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: WellCare Medicare |
$11.90
|
|
|
OXYCODONE HCL 5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
4400600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYCODONE HCL 5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
4400600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYMETAZOLINE HCL 0.0005 SPIN 15 ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 904676130
|
| Hospital Charge Code |
4400548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$7.21 |
| 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) Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$6.76
|
| 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 |
$3.60
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.60
|
| Rate for Payer: Humana Medicare |
$3.60
|
| 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 |
$3.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
