|
T3 FREE
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
4300755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
T3 FREE
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
4300755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna of NY Commercial |
$148.85
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$114.50
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Commercial |
$184.34
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$137.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$183.20
|
| Rate for Payer: EmblemHealth Medicaid |
$183.20
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$137.40
|
| Rate for Payer: Fidelis Medicare |
$87.27
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.73
|
| Rate for Payer: Humana Medicare |
$84.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$148.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$128.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.97
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$171.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$171.75
|
| Rate for Payer: United Healthcare Medicare |
$84.73
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
T3 UPTAKE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
4300754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
T3 UPTAKE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
4300754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$22.20
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
T4 (THYROXINE)
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
4300756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$22.80
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.76
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
T4 (THYROXINE)
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
4300756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
tacrolimus 0.5 MG CAPSULE 0.5 mg, 100 eaches
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna of NY Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.85
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
tacrolimus 0.5 MG CAPSULE 0.5 mg, 100 eaches
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$3.85
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| 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 |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.85
|
| 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 |
$2.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
tacrolimus 1 MG CAPSULE (IR) 1 mg, 100 eaches
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$26.40
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
tacrolimus 1 MG CAPSULE (IR) 1 mg, 100 eaches
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
4401482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.40
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
TACROLIMUS-BLOOD
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
4300760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
|
|
TACROLIMUS-BLOOD
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
4300760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna of NY Commercial |
$120.90
|
| Rate for Payer: Aetna of NY Medicare |
$85.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: CDPHP Commercial |
$149.73
|
| Rate for Payer: CDPHP Medicare |
$68.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$111.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.80
|
| Rate for Payer: EmblemHealth Medicaid |
$148.80
|
| Rate for Payer: EmblemHealth Medicare |
$63.24
|
| Rate for Payer: EmblemHealth Select Care |
$111.60
|
| Rate for Payer: Fidelis Medicare |
$70.88
|
| Rate for Payer: Galaxy Health Commercial |
$120.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.82
|
| Rate for Payer: Humana Medicare |
$68.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$139.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
| Rate for Payer: United Healthcare Medicare |
$68.82
|
| Rate for Payer: WellCare Medicare |
$102.30
|
|
|
TAMIFLU 30 MG CAPSULE 30 mg, 10 eaches
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
4401311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
TAMIFLU 30 MG CAPSULE 30 mg, 10 eaches
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
4401311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
TAMOXIFEN 20 MG TABLET 20 mg, 30 eaches
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4401418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
TAMOXIFEN 20 MG TABLET 20 mg, 30 eaches
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4401418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
TAMSULOSIN HCL 0.4MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
4400746
|
|
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
|
|
|
TAMSULOSIN HCL 0.4MG CAPS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
4400746
|
|
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
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
4853026
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
4853026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$2,521.93 |
| 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 |
$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 |
$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: Cash Price |
$71.25
|
| Rate for Payer: CDPHP Commercial |
$76.48
|
| 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 |
$76.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$76.00
|
| Rate for Payer: EmblemHealth Medicaid |
$76.00
|
| Rate for Payer: EmblemHealth Medicare |
$32.30
|
| Rate for Payer: EmblemHealth Select Care |
$68.40
|
| Rate for Payer: Fidelis Medicare |
$36.20
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
| 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 Commercial |
$71.25
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
| Rate for Payer: WellCare Medicare |
$52.25
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
4853025
|
|
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
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
4853025
|
|
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
|
|
|
TARGET CATH ACCESSORIES KI
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
4472107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
|
|
TARGET CATH ACCESSORIES KI
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
4472107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna of NY Commercial |
$65.10
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.50
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Commercial |
$74.86
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: EmblemHealth Select Care |
$66.96
|
| Rate for Payer: Fidelis Medicare |
$35.44
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.41
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.13
|
| Rate for Payer: United Healthcare Medicare |
$34.41
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
TB TEST CELL IMMUN MEASURE
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
4304879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: Aetna of NY Commercial |
$210.60
|
| Rate for Payer: Aetna of NY Medicare |
$149.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$119.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$162.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$70.47
|
| Rate for Payer: CDPHP Commercial |
$260.82
|
| Rate for Payer: CDPHP Essential Plan |
$158.56
|
| Rate for Payer: CDPHP Medicare |
$119.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$194.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$70.47
|
| Rate for Payer: EmblemHealth Medicaid |
$70.47
|
| Rate for Payer: EmblemHealth Medicare |
$110.16
|
| Rate for Payer: EmblemHealth Select Care |
$194.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$158.56
|
| Rate for Payer: Fidelis Medicare |
$123.48
|
| Rate for Payer: Galaxy Health Commercial |
$210.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$103.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7,047.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$119.88
|
| Rate for Payer: Humana Medicare |
$119.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$210.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$149.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7,047.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$151.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$182.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$125.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$243.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.47
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Medicare |
$119.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$73.99
|
| Rate for Payer: WellCare Medicare |
$178.20
|
|
