|
TRIAMCINOLONE ACETONIDE 0.005 OINT 15 GM
|
Facility
|
IP
|
$31.16
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
4400772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Galaxy Health Commercial |
$20.25
|
| Rate for Payer: WellCare Medicare |
$17.14
|
|
|
TRIAMCINOLONE ACETONIDE 0.005 OINT 15 GM
|
Facility
|
OP
|
$31.16
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
4400772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: Aetna of NY Commercial |
$21.81
|
| Rate for Payer: Aetna of NY Medicare |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.58
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: CDPHP Commercial |
$25.08
|
| Rate for Payer: CDPHP Medicare |
$11.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.93
|
| Rate for Payer: EmblemHealth Medicaid |
$24.93
|
| Rate for Payer: EmblemHealth Medicare |
$10.59
|
| Rate for Payer: EmblemHealth Select Care |
$22.44
|
| Rate for Payer: Fidelis Medicare |
$11.88
|
| Rate for Payer: Galaxy Health Commercial |
$20.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare Medicare |
$11.53
|
| Rate for Payer: WellCare Medicare |
$17.14
|
|
|
TRIAMCINOLONE CR 0.1% 30 G
|
Facility
|
IP
|
$36.05
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
4408970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.83 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
| Rate for Payer: WellCare Medicare |
$19.83
|
|
|
TRIAMCINOLONE CR 0.1% 30 G
|
Facility
|
OP
|
$36.05
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
4408970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna of NY Commercial |
$25.24
|
| Rate for Payer: Aetna of NY Medicare |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.02
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: CDPHP Commercial |
$29.02
|
| Rate for Payer: CDPHP Medicare |
$13.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.84
|
| Rate for Payer: EmblemHealth Medicaid |
$28.84
|
| Rate for Payer: EmblemHealth Medicare |
$12.26
|
| Rate for Payer: EmblemHealth Select Care |
$25.96
|
| Rate for Payer: Fidelis Medicare |
$13.74
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.34
|
| Rate for Payer: Humana Medicare |
$13.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.24
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WellCare Medicare |
$19.83
|
|
|
TRIAMCINOLONE DENTAL PASTE
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
4408971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Galaxy Health Commercial |
$161.85
|
| Rate for Payer: WellCare Medicare |
$136.95
|
|
|
TRIAMCINOLONE DENTAL PASTE
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
4408971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.66 |
| Max. Negotiated Rate |
$200.44 |
| Rate for Payer: Aetna of NY Commercial |
$174.30
|
| Rate for Payer: Aetna of NY Medicare |
$114.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$186.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$186.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$124.50
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: CDPHP Commercial |
$200.44
|
| Rate for Payer: CDPHP Medicare |
$92.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$199.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$199.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$199.20
|
| Rate for Payer: EmblemHealth Medicaid |
$199.20
|
| Rate for Payer: EmblemHealth Medicare |
$84.66
|
| Rate for Payer: EmblemHealth Select Care |
$179.28
|
| Rate for Payer: Fidelis Medicare |
$94.89
|
| Rate for Payer: Galaxy Health Commercial |
$161.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.13
|
| Rate for Payer: Humana Medicare |
$92.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$174.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$114.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$140.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.74
|
| Rate for Payer: United Healthcare Medicare |
$92.13
|
| Rate for Payer: WellCare Medicare |
$136.95
|
|
|
TRIAMTERENE/HCTZ 37.5-25MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079093520
|
| Hospital Charge Code |
4400773
|
|
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
|
|
|
TRIAMTERENE/HCTZ 37.5-25MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079093520
|
| Hospital Charge Code |
4400773
|
|
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
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
4302006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Aetna of NY Commercial |
$79.30
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$61.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$73.20
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$91.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$91.50
|
| Rate for Payer: United Healthcare Medicare |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
4302006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
TRICOR 145 MG
|
Facility
|
IP
|
$15.97
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
4409040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$10.38 |
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Galaxy Health Commercial |
$10.38
|
| Rate for Payer: WellCare Medicare |
$8.78
|
|
|
TRICOR 145 MG
|
Facility
|
OP
|
$15.97
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
4409040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna of NY Commercial |
$11.18
|
| Rate for Payer: Aetna of NY Medicare |
$7.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: CDPHP Commercial |
$12.86
|
| Rate for Payer: CDPHP Medicare |
$5.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.78
|
| Rate for Payer: EmblemHealth Medicaid |
$12.78
|
| Rate for Payer: EmblemHealth Medicare |
$5.43
|
| Rate for Payer: EmblemHealth Select Care |
$11.50
|
| Rate for Payer: Fidelis Medicare |
$6.09
|
| Rate for Payer: Galaxy Health Commercial |
$10.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.91
|
| Rate for Payer: Humana Medicare |
$5.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.98
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.20
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WellCare Medicare |
$8.78
|
|
|
TRIGGER POINTS INJECTION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4850028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
TRIGGER POINTS INJECTION
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
4850028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| 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 |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: EmblemHealth Select Care |
$609.84
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
TRIGLYCERIDE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
4300796
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$19.80
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$24.75
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
TRIGLYCERIDE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
4300796
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
TRIHEXYPHENIDYL HCL 2MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 16571016010
|
| Hospital Charge Code |
4400774
|
|
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
|
|
|
TRIHEXYPHENIDYL HCL 2MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 16571016010
|
| Hospital Charge Code |
4400774
|
|
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
|
|
|
TRIM ND NAILS
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4856656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| 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 |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$126.00
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
TRIM ND NAILS
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4856656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
4856667
|
|
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
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
4856667
|
|
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
|
|
|
TRINTELLIX 10 MG TABLET 10 mg, 30 eaches
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
4401561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
TRINTELLIX 10 MG TABLET 10 mg, 30 eaches
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
4401561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
TRIPLE LUMEN TRAY
|
Facility
|
OP
|
$377.00
|
|
| Hospital Charge Code |
4471822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.18 |
| Max. Negotiated Rate |
$303.48 |
| Rate for Payer: Aetna of NY Commercial |
$263.90
|
| Rate for Payer: Aetna of NY Medicare |
$173.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$188.50
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: CDPHP Commercial |
$303.48
|
| Rate for Payer: CDPHP Medicare |
$139.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$188.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$301.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$301.60
|
| Rate for Payer: EmblemHealth Medicaid |
$301.60
|
| Rate for Payer: EmblemHealth Medicare |
$128.18
|
| Rate for Payer: EmblemHealth Select Care |
$188.50
|
| Rate for Payer: Fidelis Medicare |
$143.67
|
| Rate for Payer: Galaxy Health Commercial |
$245.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.49
|
| Rate for Payer: Humana Medicare |
$139.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$263.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.46
|
| Rate for Payer: United Healthcare Medicare |
$139.49
|
| Rate for Payer: WellCare Medicare |
$207.35
|
|
