|
SECONDARY IV TUBING
|
Facility
|
IP
|
$3.09
|
|
| Hospital Charge Code |
4471919
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
|
|
SECONDARY IV TUBING
|
Facility
|
OP
|
$3.09
|
|
| Hospital Charge Code |
4471919
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna of NY Commercial |
$2.16
|
| Rate for Payer: Aetna of NY Medicare |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: CDPHP Medicare |
$1.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.47
|
| Rate for Payer: EmblemHealth Medicaid |
$2.47
|
| Rate for Payer: EmblemHealth Medicare |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$2.22
|
| Rate for Payer: Fidelis Medicare |
$1.24
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.24
|
| Rate for Payer: Humana Medicare |
$1.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.16
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.46
|
| Rate for Payer: United Healthcare Medicare |
$1.24
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM<
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
4650112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM<
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
4650112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,59
|
| Hospital Charge Code |
4650397
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,59
|
| Hospital Charge Code |
4650397
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59 W KX)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,59,KX
|
| Hospital Charge Code |
4650449
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (MOD 59 W KX)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,59,KX
|
| Hospital Charge Code |
4650449
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (W/ KX)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,KX
|
| Hospital Charge Code |
4650345
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
SELECTIVE WOUND DEBRIDEMENT ADDTL 20CM< (W/ KX)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97597 GP,KX
|
| Hospital Charge Code |
4650345
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
SELF CARE TRAINING 15 MIN HOME MGMT
|
Facility
|
IP
|
$97.85
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650036
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: Galaxy Health Commercial |
$63.60
|
|
|
SELF CARE TRAINING 15 MIN HOME MGMT
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650036
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Aetna of NY Commercial |
$68.50
|
| Rate for Payer: Aetna of NY Medicare |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.14
|
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: CDPHP Medicare |
$36.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$78.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.52
|
| Rate for Payer: EmblemHealth Medicaid |
$31.52
|
| Rate for Payer: EmblemHealth Medicare |
$33.27
|
| Rate for Payer: EmblemHealth Select Care |
$70.45
|
| Rate for Payer: Fidelis Medicare |
$39.14
|
| Rate for Payer: Galaxy Health Commercial |
$63.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$30.89
|
| Rate for Payer: Hamaspik Choice Medicaid |
$31.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.14
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$73.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.68
|
| Rate for Payer: United Healthcare Commercial |
$73.39
|
| Rate for Payer: United Healthcare Medicare |
$39.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$33.10
|
| Rate for Payer: WellCare Medicare |
$53.82
|
|
|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
IP
|
$97.85
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650073
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: Galaxy Health Commercial |
$63.60
|
|
|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
4650073
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Aetna of NY Commercial |
$68.50
|
| Rate for Payer: Aetna of NY Medicare |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.14
|
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: Cash Price |
$73.39
|
| Rate for Payer: CDPHP Medicare |
$36.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$78.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.52
|
| Rate for Payer: EmblemHealth Medicaid |
$31.52
|
| Rate for Payer: EmblemHealth Medicare |
$33.27
|
| Rate for Payer: EmblemHealth Select Care |
$70.45
|
| Rate for Payer: Fidelis Medicare |
$39.14
|
| Rate for Payer: Galaxy Health Commercial |
$63.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$30.89
|
| Rate for Payer: Hamaspik Choice Medicaid |
$31.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.14
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$67.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$73.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.68
|
| Rate for Payer: United Healthcare Commercial |
$73.39
|
| Rate for Payer: United Healthcare Medicare |
$39.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$33.10
|
| Rate for Payer: WellCare Medicare |
$53.82
|
|
|
SENNOSIDES 8.6MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904652261
|
| Hospital Charge Code |
4400690
|
|
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
|
|
|
SENNOSIDES 8.6MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904652261
|
| Hospital Charge Code |
4400690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
SENSORCAINE MPF .0025 INJ 10 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 55150016710
|
| Hospital Charge Code |
4409191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
SENSORCAINE MPF .0025 INJ 10 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 55150016710
|
| Hospital Charge Code |
4409191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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
|
|
|
SERFAS PROBE 90 ASD (SUCTION)
|
Facility
|
OP
|
$441.87
|
|
| Hospital Charge Code |
4471244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$353.50 |
| Rate for Payer: Aetna of NY Commercial |
$309.31
|
| Rate for Payer: Aetna of NY Medicare |
$203.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$176.75
|
| Rate for Payer: Cash Price |
$331.40
|
| Rate for Payer: CDPHP Medicare |
$163.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$353.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$353.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$353.50
|
| Rate for Payer: EmblemHealth Medicaid |
$353.50
|
| Rate for Payer: EmblemHealth Medicare |
$150.24
|
| Rate for Payer: EmblemHealth Select Care |
$318.15
|
| Rate for Payer: Fidelis Medicare |
$176.75
|
| Rate for Payer: Galaxy Health Commercial |
$287.22
|
| Rate for Payer: Hamaspik Choice Medicare |
$176.75
|
| Rate for Payer: Humana Medicare |
$176.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$309.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$203.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$248.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$185.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$66.28
|
| Rate for Payer: United Healthcare Medicare |
$176.75
|
| Rate for Payer: WellCare Medicare |
$243.03
|
|
|
SERFAS PROBE 90 ASD (SUCTION)
|
Facility
|
IP
|
$441.87
|
|
| Hospital Charge Code |
4471244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$287.22 |
| Max. Negotiated Rate |
$287.22 |
| Rate for Payer: Cash Price |
$331.40
|
| Rate for Payer: Galaxy Health Commercial |
$287.22
|
|
|
SERFAS PROBE NON-SUCTION
|
Facility
|
OP
|
$109.18
|
|
| Hospital Charge Code |
4471243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Aetna of NY Commercial |
$76.43
|
| Rate for Payer: Aetna of NY Medicare |
$50.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.67
|
| Rate for Payer: Cash Price |
$81.89
|
| Rate for Payer: CDPHP Medicare |
$40.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$87.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$87.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$87.34
|
| Rate for Payer: EmblemHealth Medicaid |
$87.34
|
| Rate for Payer: EmblemHealth Medicare |
$37.12
|
| Rate for Payer: EmblemHealth Select Care |
$78.61
|
| Rate for Payer: Fidelis Medicare |
$43.67
|
| Rate for Payer: Galaxy Health Commercial |
$70.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.67
|
| Rate for Payer: Humana Medicare |
$43.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$61.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.38
|
| Rate for Payer: United Healthcare Medicare |
$43.67
|
| Rate for Payer: WellCare Medicare |
$60.05
|
|
|
SERFAS PROBE NON-SUCTION
|
Facility
|
IP
|
$109.18
|
|
| Hospital Charge Code |
4471243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.97 |
| Max. Negotiated Rate |
$70.97 |
| Rate for Payer: Cash Price |
$81.89
|
| Rate for Payer: Galaxy Health Commercial |
$70.97
|
|
|
SERTALINE 25 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
4401258
|
|
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
|
|
|
SERTALINE 25 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 60687023111
|
| Hospital Charge Code |
4401258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
SERTRALINE HCL 100MG TABS 100 EA
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 59762491004
|
| Hospital Charge Code |
4400695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Aetna of NY Medicare |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.40
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: CDPHP Medicare |
$3.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.80
|
| Rate for Payer: EmblemHealth Medicaid |
$6.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.89
|
| Rate for Payer: EmblemHealth Select Care |
$6.12
|
| Rate for Payer: Fidelis Medicare |
$3.40
|
| Rate for Payer: Galaxy Health Commercial |
$5.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.27
|
| Rate for Payer: United Healthcare Medicare |
$3.40
|
| Rate for Payer: WellCare Medicare |
$4.67
|
|
