|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650073
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna of NY Commercial |
$66.50
|
| Rate for Payer: Aetna of NY Medicare |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$47.50
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$31.52
|
| Rate for Payer: CDPHP Commercial |
$76.48
|
| Rate for Payer: CDPHP Essential Plan |
$70.92
|
| Rate for Payer: CDPHP Medicare |
$35.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$76.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.52
|
| Rate for Payer: EmblemHealth Medicaid |
$31.52
|
| Rate for Payer: EmblemHealth Medicare |
$32.30
|
| Rate for Payer: EmblemHealth Select Care |
$68.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$70.92
|
| Rate for Payer: Fidelis Medicare |
$36.20
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$46.33
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,152.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.15
|
| Rate for Payer: Humana Medicare |
$35.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$66.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,152.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$71.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.52
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$33.10
|
| Rate for Payer: WellCare Medicare |
$52.25
|
|
|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650073
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
|
|
SENNOSIDES 8.6MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
4400690
|
|
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
|
|
|
SENNOSIDES 8.6MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
4400690
|
|
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
|
|
|
SENSORCAINE MPF .0025 INJ 10 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 55150016710
|
| Hospital Charge Code |
4409191
|
|
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
|
|
|
SENSORCAINE MPF .0025 INJ 10 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 55150016710
|
| Hospital Charge Code |
4409191
|
|
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
|
|
|
SERFAS PROBE 90 ASD (SUCTION)
|
Facility
|
IP
|
$429.00
|
|
| Hospital Charge Code |
4471244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Galaxy Health Commercial |
$278.85
|
|
|
SERFAS PROBE 90 ASD (SUCTION)
|
Facility
|
OP
|
$429.00
|
|
| Hospital Charge Code |
4471244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$345.34 |
| Rate for Payer: Aetna of NY Commercial |
$300.30
|
| Rate for Payer: Aetna of NY Medicare |
$197.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$321.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$158.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$214.50
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: CDPHP Commercial |
$345.34
|
| Rate for Payer: CDPHP Medicare |
$158.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$343.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$343.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$343.20
|
| Rate for Payer: EmblemHealth Medicaid |
$343.20
|
| Rate for Payer: EmblemHealth Medicare |
$145.86
|
| Rate for Payer: EmblemHealth Select Care |
$308.88
|
| Rate for Payer: Fidelis Medicare |
$163.49
|
| Rate for Payer: Galaxy Health Commercial |
$278.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$158.73
|
| Rate for Payer: Humana Medicare |
$158.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$300.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$197.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$241.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$166.67
|
| Rate for Payer: United Healthcare Medicare |
$158.73
|
| Rate for Payer: WellCare Medicare |
$235.95
|
|
|
SERFAS PROBE NON-SUCTION
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
4471243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$85.33 |
| Rate for Payer: Aetna of NY Commercial |
$74.20
|
| Rate for Payer: Aetna of NY Medicare |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.00
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: CDPHP Commercial |
$85.33
|
| Rate for Payer: CDPHP Medicare |
$39.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.80
|
| Rate for Payer: EmblemHealth Medicaid |
$84.80
|
| Rate for Payer: EmblemHealth Medicare |
$36.04
|
| Rate for Payer: EmblemHealth Select Care |
$76.32
|
| Rate for Payer: Fidelis Medicare |
$40.40
|
| Rate for Payer: Galaxy Health Commercial |
$68.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.22
|
| Rate for Payer: Humana Medicare |
$39.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.18
|
| Rate for Payer: United Healthcare Medicare |
$39.22
|
| Rate for Payer: WellCare Medicare |
$58.30
|
|
|
SERFAS PROBE NON-SUCTION
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
4471243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Galaxy Health Commercial |
$68.90
|
|
|
SERTALINE 25 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
4401258
|
|
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
|
|
|
SERTALINE 25 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
4401258
|
|
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
|
|
|
SERTRALINE HCL 100MG TABS 100 EA
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 59762491004
|
| Hospital Charge Code |
4400695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Aetna of NY Medicare |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.25
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: CDPHP Commercial |
$6.84
|
| Rate for Payer: CDPHP Medicare |
$3.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.80
|
| Rate for Payer: EmblemHealth Medicaid |
$6.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.89
|
| Rate for Payer: EmblemHealth Select Care |
$6.12
|
| Rate for Payer: Fidelis Medicare |
$3.24
|
| Rate for Payer: Galaxy Health Commercial |
$5.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.14
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.30
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WellCare Medicare |
$4.68
|
|
|
SERTRALINE HCL 100MG TABS 100 EA
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 59762491004
|
| Hospital Charge Code |
4400695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Galaxy Health Commercial |
$5.52
|
| Rate for Payer: WellCare Medicare |
$4.68
|
|
|
SERTRALINE HCL 50MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
4400696
|
|
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
|
|
|
SERTRALINE HCL 50MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
4400696
|
|
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
|
|
|
SEVOFLURANE LIQD 250 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 10019065364
|
| Hospital Charge Code |
4400697
|
|
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
|
|
|
SEVOFLURANE LIQD 250 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 10019065364
|
| Hospital Charge Code |
4400697
|
|
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
|
|
|
SHAVE LES S/N/H/F/G; 0.5CM/<
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
4856654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SHAVE LES S/N/H/F/G; 0.5CM/<
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
4856695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SHAVE LES S/N/H/F/G; 0.5CM/<
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
4856654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$412.56
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SHAVE LES S/N/H/F/G; 0.5CM/<
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
4856695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SHAVE LES T/A/L; 0.5CM/<
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
4856691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
SHAVE LES T/A/L; 0.5CM/<
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
4856691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
SHAVE LES T/A/L; 0.6-1.0CM
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
4856692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
