|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
4201076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 61070
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$658.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,828.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$658.90
|
| Rate for Payer: United Healthcare Commercial |
$1,828.00
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 115351101
|
| Hospital Charge Code |
4409130
|
|
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
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 115351101
|
| Hospital Charge Code |
4409130
|
|
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
|
|
|
PYRIDOXINE HCL 100 MG INJ
|
Facility
|
OP
|
$56.39
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
4400671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna of NY Medicare |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.56
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: CDPHP Medicare |
$20.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.11
|
| Rate for Payer: EmblemHealth Medicaid |
$45.11
|
| Rate for Payer: EmblemHealth Medicare |
$19.17
|
| Rate for Payer: EmblemHealth Select Care |
$14.89
|
| Rate for Payer: Fidelis Medicare |
$22.56
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.56
|
| Rate for Payer: Humana Medicare |
$22.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$26.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.46
|
| Rate for Payer: United Healthcare Commercial |
$26.24
|
| Rate for Payer: United Healthcare Medicare |
$22.56
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
|
PYRIDOXINE HCL 100 MG INJ
|
Facility
|
IP
|
$56.39
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
4400671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna of NY Commercial |
$31.01
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.89
|
| Rate for Payer: EmblemHealth Select Care |
$14.89
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.01
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
|
PYROPHOSPHATE
|
Facility
|
OP
|
$409.94
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4211244
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$327.95 |
| Rate for Payer: Aetna of NY Medicare |
$188.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.98
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: CDPHP Medicare |
$151.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$327.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$327.95
|
| Rate for Payer: EmblemHealth Medicaid |
$327.95
|
| Rate for Payer: EmblemHealth Medicare |
$139.38
|
| Rate for Payer: EmblemHealth Select Care |
$295.16
|
| Rate for Payer: Fidelis Medicare |
$163.98
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.98
|
| Rate for Payer: Humana Medicare |
$163.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$188.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$230.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$172.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$172.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.49
|
| Rate for Payer: United Healthcare Commercial |
$172.21
|
| Rate for Payer: United Healthcare Medicare |
$163.98
|
| Rate for Payer: WellCare Medicare |
$225.47
|
|
|
PYROPHOSPHATE
|
Facility
|
IP
|
$409.94
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
4211244
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$266.46 |
| Rate for Payer: Cash Price |
$307.46
|
| Rate for Payer: Galaxy Health Commercial |
$266.46
|
|
|
QUANT BORDITELLA PERTUSSIS IGA IGM IGG
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
4301177
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
QUANT BORDITELLA PERTUSSIS IGA IGM IGG
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
4301177
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
QUETIAPINE FUMARATE 100MG TABS 10X10EA
|
Facility
|
OP
|
$21.12
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
4400693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$14.78
|
| Rate for Payer: Aetna of NY Medicare |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.45
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: CDPHP Medicare |
$7.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.90
|
| Rate for Payer: EmblemHealth Medicaid |
$16.90
|
| Rate for Payer: EmblemHealth Medicare |
$7.18
|
| Rate for Payer: EmblemHealth Select Care |
$15.21
|
| Rate for Payer: Fidelis Medicare |
$8.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.45
|
| Rate for Payer: Humana Medicare |
$8.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.17
|
| Rate for Payer: United Healthcare Medicare |
$8.45
|
| Rate for Payer: WellCare Medicare |
$11.62
|
|
|
QUETIAPINE FUMARATE 100MG TABS 10X10EA
|
Facility
|
IP
|
$21.12
|
|
|
Service Code
|
NDC 63739066510
|
| Hospital Charge Code |
4400693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Galaxy Health Commercial |
$13.73
|
| Rate for Payer: WellCare Medicare |
$11.62
|
|
|
QUETIAPINE FUMARATE 25MG TABS 10X10EA
|
Facility
|
OP
|
$14.42
|
|
|
Service Code
|
NDC 904663861
|
| Hospital Charge Code |
4400694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.77
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.77
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$5.77
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
QUETIAPINE FUMARATE 25MG TABS 10X10EA
|
Facility
|
IP
|
$14.42
|
|
|
Service Code
|
NDC 904663861
|
| Hospital Charge Code |
4400694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
QUICK STREP
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300680
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
QUICK STREP
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300680
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.40
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
QUINKE SPINAL NEEDLE 22G X 90MM (SQ2290)
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4473051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of NY Commercial |
$63.00
|
| Rate for Payer: Aetna of NY Medicare |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: CDPHP Medicare |
$33.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.00
|
| Rate for Payer: EmblemHealth Medicaid |
$72.00
|
| Rate for Payer: EmblemHealth Medicare |
$30.60
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.00
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.50
|
| Rate for Payer: United Healthcare Medicare |
$36.00
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
QUINKE SPINAL NEEDLE 22G X 90MM (SQ2290)
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4473051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
|
|
QUINKE SPINAL NEEDLE 25 G X 90MM (SQ2590)
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4473050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of NY Commercial |
$63.00
|
| Rate for Payer: Aetna of NY Medicare |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: CDPHP Medicare |
$33.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.00
|
| Rate for Payer: EmblemHealth Medicaid |
$72.00
|
| Rate for Payer: EmblemHealth Medicare |
$30.60
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$36.00
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.00
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.50
|
| Rate for Payer: United Healthcare Medicare |
$36.00
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
QUINKE SPINAL NEEDLE 25 G X 90MM (SQ2590)
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4473050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
|
|
RACEPINEPHRINE 0.0225 AMIH 30X.5ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 487590199
|
| Hospital Charge Code |
4400686
|
|
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
|
|
|
RACEPINEPHRINE 0.0225 AMIH 30X.5ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 487590199
|
| Hospital Charge Code |
4400686
|
|
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
|
|
|
RADIATION REDUCTION GLOVES 8.5
|
Facility
|
OP
|
$175.10
|
|
| Hospital Charge Code |
4479176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna of NY Commercial |
$122.57
|
| Rate for Payer: Aetna of NY Medicare |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.04
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: CDPHP Medicare |
$64.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.08
|
| Rate for Payer: EmblemHealth Medicaid |
$140.08
|
| Rate for Payer: EmblemHealth Medicare |
$59.53
|
| Rate for Payer: EmblemHealth Select Care |
$126.07
|
| Rate for Payer: Fidelis Medicare |
$70.04
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.04
|
| Rate for Payer: Humana Medicare |
$70.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$70.04
|
| Rate for Payer: WellCare Medicare |
$96.31
|
|
|
RADIATION REDUCTION GLOVES 8.5
|
Facility
|
IP
|
$175.10
|
|
| Hospital Charge Code |
4479176
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$113.81 |
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
|
|
RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 73525
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
|
