|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4409109
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$0.00
|
| 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
|
$6.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4400648
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PREDNISONE IR OR DR ORAL 1MG
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
4409109
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of NY Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: CDPHP Medicare |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.00
|
| 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 |
$0.00
|
| 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 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 |
$0.00
|
| 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
|
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 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 |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| 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 |
$3.21 |
| Max. Negotiated Rate |
$17.10 |
| 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) Medicare |
$8.55
|
| Rate for Payer: Cash Price |
$16.03
|
| 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 |
$8.55
|
| Rate for Payer: Galaxy Health Commercial |
$13.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.55
|
| Rate for Payer: Humana Medicare |
$8.55
|
| 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 |
$8.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$8.55
|
| 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 71101341
|
| Hospital Charge Code |
4400477
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$18.74 |
| 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) Medicare |
$9.37
|
| Rate for Payer: Cash Price |
$17.57
|
| 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 |
$9.37
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.37
|
| Rate for Payer: Humana Medicare |
$9.37
|
| 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 |
$9.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.51
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
PREGABALIN 50MG CAPS 10X10EA
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 71101341
|
| 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
|
|
|
PREG TEST SERUM QUAL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
4300648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
PREG TEST SERUM QUAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
4300648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
PREG TEST/URINE QUAL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
4300649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
PREG TEST/URINE QUAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
4300649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
PRESERVISION AREDS 2 SOFTGEL 1 ea, 60 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 24208069760
|
| Hospital Charge Code |
4401458
|
|
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
|
|
|
PRESERVISION AREDS 2 SOFTGEL 1 ea, 60 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 24208069760
|
| Hospital Charge Code |
4401458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
PREVACID SOLUTAB 15 MG
|
Facility
|
OP
|
$49.70
|
|
|
Service Code
|
NDC 64764054311
|
| Hospital Charge Code |
4401270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$39.76 |
| Rate for Payer: Aetna of NY Commercial |
$34.79
|
| Rate for Payer: Aetna of NY Medicare |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.88
|
| Rate for Payer: Cash Price |
$37.28
|
| Rate for Payer: CDPHP Medicare |
$18.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.76
|
| Rate for Payer: EmblemHealth Medicaid |
$39.76
|
| Rate for Payer: EmblemHealth Medicare |
$16.90
|
| Rate for Payer: EmblemHealth Select Care |
$35.78
|
| Rate for Payer: Fidelis Medicare |
$19.88
|
| Rate for Payer: Galaxy Health Commercial |
$32.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.88
|
| Rate for Payer: Humana Medicare |
$19.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.79
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.46
|
| Rate for Payer: United Healthcare Medicare |
$19.88
|
| Rate for Payer: WellCare Medicare |
$27.34
|
|
|
PREVACID SOLUTAB 15 MG
|
Facility
|
IP
|
$49.70
|
|
|
Service Code
|
NDC 64764054311
|
| Hospital Charge Code |
4401270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$37.28
|
| Rate for Payer: Galaxy Health Commercial |
$32.30
|
| Rate for Payer: WellCare Medicare |
$27.34
|
|
|
PRIMARY IV TUBING
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
4471895
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.96 |
| Rate for Payer: Aetna of NY Commercial |
$28.84
|
| Rate for Payer: Aetna of NY Medicare |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: CDPHP Medicare |
$15.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.96
|
| Rate for Payer: EmblemHealth Medicaid |
$32.96
|
| Rate for Payer: EmblemHealth Medicare |
$14.01
|
| Rate for Payer: EmblemHealth Select Care |
$29.66
|
| Rate for Payer: Fidelis Medicare |
$16.48
|
| Rate for Payer: Galaxy Health Commercial |
$26.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.18
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$22.66
|
|
|
PRIMARY IV TUBING
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
4471895
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Galaxy Health Commercial |
$26.78
|
|
|
PRIMIDONE 50MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
4400652
|
|
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
|
|
|
PRIMIDONE 50MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
4400652
|
|
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
|
|
|
PRISM DRESSING 5562028
|
Facility
|
IP
|
$48.41
|
|
| Hospital Charge Code |
4479315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$31.47 |
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Galaxy Health Commercial |
$31.47
|
|
|
PRISM DRESSING 5562028
|
Facility
|
OP
|
$48.41
|
|
| Hospital Charge Code |
4479315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna of NY Commercial |
$33.89
|
| Rate for Payer: Aetna of NY Medicare |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.36
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: CDPHP Medicare |
$17.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.73
|
| Rate for Payer: EmblemHealth Medicaid |
$38.73
|
| Rate for Payer: EmblemHealth Medicare |
$16.46
|
| Rate for Payer: EmblemHealth Select Care |
$34.86
|
| Rate for Payer: Fidelis Medicare |
$19.36
|
| Rate for Payer: Galaxy Health Commercial |
$31.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.36
|
| Rate for Payer: Humana Medicare |
$19.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.26
|
| Rate for Payer: United Healthcare Medicare |
$19.36
|
| Rate for Payer: WellCare Medicare |
$26.63
|
|
|
PROBE KIT GENICULAR SYSTEM
|
Facility
|
IP
|
$3,131.20
|
|
| Hospital Charge Code |
4479223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,035.28 |
| Max. Negotiated Rate |
$2,035.28 |
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
|
|
PROBE KIT GENICULAR SYSTEM
|
Facility
|
OP
|
$3,131.20
|
|
| Hospital Charge Code |
4479223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$469.68 |
| Max. Negotiated Rate |
$2,504.96 |
| Rate for Payer: Aetna of NY Commercial |
$2,191.84
|
| Rate for Payer: Aetna of NY Medicare |
$1,440.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,252.48
|
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: CDPHP Medicare |
$1,158.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,064.61
|
| Rate for Payer: EmblemHealth Select Care |
$2,254.46
|
| Rate for Payer: Fidelis Medicare |
$1,252.48
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,252.48
|
| Rate for Payer: Humana Medicare |
$1,252.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,191.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,440.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,348.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,762.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,315.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$469.68
|
| Rate for Payer: United Healthcare Medicare |
$1,252.48
|
| Rate for Payer: WellCare Medicare |
$1,722.16
|
|
