|
PROPRANOLOL ER 160 MG CAPSULE 160 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51991082001
|
| Hospital Charge Code |
4401477
|
|
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
|
|
|
PROPRANOLOL ER 60 MG
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 68084050301
|
| Hospital Charge Code |
4409030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
PROPRANOLOL ER 60 MG
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 68084050301
|
| Hospital Charge Code |
4409030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
propranoloL ER 80 MG CAPSULE 80 mcg, 100 eaches
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
4401522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.80
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.80
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.80
|
| Rate for Payer: Humana Medicare |
$2.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Medicare |
$2.80
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
propranoloL ER 80 MG CAPSULE 80 mcg, 100 eaches
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
4401522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
PROPRANOLOL HCL 10MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904655061
|
| Hospital Charge Code |
4400662
|
|
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
|
|
|
PROPRANOLOL HCL 10MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904655061
|
| Hospital Charge Code |
4400662
|
|
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
|
|
|
PROPRANOLOL HCL INJ TO 1 MG
|
Facility
|
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
4400663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$24.72 |
| Rate for Payer: Aetna of NY Medicare |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.36
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: CDPHP Medicare |
$11.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.72
|
| Rate for Payer: EmblemHealth Medicaid |
$24.72
|
| Rate for Payer: EmblemHealth Medicare |
$10.51
|
| Rate for Payer: EmblemHealth Select Care |
$22.25
|
| Rate for Payer: Fidelis Medicare |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$20.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.36
|
| Rate for Payer: Humana Medicare |
$12.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$12.36
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
PROPRANOLOL HCL INJ TO 1 MG
|
Facility
|
IP
|
$30.90
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
4400663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of NY Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Galaxy Health Commercial |
$20.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.00
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
propylthiouraciL 50 MG TABLET 50 mg, 1 each
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
4401501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
propylthiouraciL 50 MG TABLET 50 mg, 1 each
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
4401501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.50
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
PROSTATE-SPECIFIC AG
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
4300659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
PROSTATE-SPECIFIC AG
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
4300659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$56.80 |
| Rate for Payer: Aetna of NY Commercial |
$46.15
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.40
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$42.60
|
| Rate for Payer: Fidelis Medicare |
$28.40
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.40
|
| Rate for Payer: Humana Medicare |
$28.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$53.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.65
|
| Rate for Payer: United Healthcare Commercial |
$53.25
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
PROSTEP CAM WALKER LARGE
|
Facility
|
IP
|
$77.25
|
|
| Hospital Charge Code |
4471609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$50.21 |
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
|
|
PROSTEP CAM WALKER LARGE
|
Facility
|
OP
|
$77.25
|
|
| Hospital Charge Code |
4471609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna of NY Commercial |
$54.08
|
| Rate for Payer: Aetna of NY Medicare |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.90
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: CDPHP Medicare |
$28.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.80
|
| Rate for Payer: EmblemHealth Medicaid |
$61.80
|
| Rate for Payer: EmblemHealth Medicare |
$26.27
|
| Rate for Payer: EmblemHealth Select Care |
$55.62
|
| Rate for Payer: Fidelis Medicare |
$30.90
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.90
|
| Rate for Payer: Humana Medicare |
$30.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$30.90
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
PROSTEP CAM WALKER MEDIUM
|
Facility
|
OP
|
$77.25
|
|
| Hospital Charge Code |
4471608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna of NY Commercial |
$54.08
|
| Rate for Payer: Aetna of NY Medicare |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.90
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: CDPHP Medicare |
$28.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.80
|
| Rate for Payer: EmblemHealth Medicaid |
$61.80
|
| Rate for Payer: EmblemHealth Medicare |
$26.27
|
| Rate for Payer: EmblemHealth Select Care |
$55.62
|
| Rate for Payer: Fidelis Medicare |
$30.90
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.90
|
| Rate for Payer: Humana Medicare |
$30.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$30.90
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
PROSTEP CAM WALKER MEDIUM
|
Facility
|
IP
|
$77.25
|
|
| Hospital Charge Code |
4471608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$50.21 |
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
|
|
PROSTEP CAM WALKER SMALL
|
Facility
|
IP
|
$77.25
|
|
| Hospital Charge Code |
4471607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$50.21 |
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
|
|
PROSTEP CAM WALKER SMALL
|
Facility
|
OP
|
$77.25
|
|
| Hospital Charge Code |
4471607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna of NY Commercial |
$54.08
|
| Rate for Payer: Aetna of NY Medicare |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.90
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: CDPHP Medicare |
$28.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.80
|
| Rate for Payer: EmblemHealth Medicaid |
$61.80
|
| Rate for Payer: EmblemHealth Medicare |
$26.27
|
| Rate for Payer: EmblemHealth Select Care |
$55.62
|
| Rate for Payer: Fidelis Medicare |
$30.90
|
| Rate for Payer: Galaxy Health Commercial |
$50.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.90
|
| Rate for Payer: Humana Medicare |
$30.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$30.90
|
| Rate for Payer: WellCare Medicare |
$42.49
|
|
|
PROTAMINE SULFATE INJ PER 10 MG
|
Facility
|
IP
|
$43.26
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
4408990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna of NY Commercial |
$23.79
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.67
|
| Rate for Payer: EmblemHealth Select Care |
$1.67
|
| Rate for Payer: Galaxy Health Commercial |
$28.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.79
|
| Rate for Payer: WellCare Medicare |
$23.79
|
|
|
PROTAMINE SULFATE INJ PER 10 MG
|
Facility
|
OP
|
$43.26
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
4408990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: Aetna of NY Medicare |
$19.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.30
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: CDPHP Medicare |
$16.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.61
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.61
|
| Rate for Payer: EmblemHealth Medicaid |
$34.61
|
| Rate for Payer: EmblemHealth Medicare |
$14.71
|
| Rate for Payer: EmblemHealth Select Care |
$1.67
|
| Rate for Payer: Fidelis Medicare |
$17.30
|
| Rate for Payer: Galaxy Health Commercial |
$28.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.30
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.49
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$17.30
|
| Rate for Payer: WellCare Medicare |
$23.79
|
|
|
PROTEIN C (PRO C-ACTIVITY)
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
4301082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
PROTEIN C (PRO C-ACTIVITY)
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
4301082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of NY Commercial |
$27.30
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$16.80
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
PROTEIN S ANTIGEN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
4300664
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
PROTEIN S ANTIGEN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
4300664
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of NY Commercial |
$22.75
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.00
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: EmblemHealth Select Care |
$21.00
|
| Rate for Payer: Fidelis Medicare |
$14.00
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.00
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$26.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$26.25
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
