|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (MOD 59 W KX)
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,59,KX
|
| Hospital Charge Code |
4670308
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$127.20
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.20
|
| Rate for Payer: Humana Medicare |
$127.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| 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 |
$133.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$127.20
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (W/ KX)
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,KX
|
| Hospital Charge Code |
4670270
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
|
|
TREATMENT SPEECH LANGUAGE VOICE AUD IND (W/ KX)
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 92507 GN,KX
|
| Hospital Charge Code |
4670270
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: CDPHP Medicare |
$117.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$254.40
|
| Rate for Payer: EmblemHealth Medicaid |
$254.40
|
| Rate for Payer: EmblemHealth Medicare |
$108.12
|
| Rate for Payer: EmblemHealth Select Care |
$228.96
|
| Rate for Payer: Fidelis Medicare |
$127.20
|
| Rate for Payer: Galaxy Health Commercial |
$206.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.20
|
| Rate for Payer: Humana Medicare |
$127.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$146.28
|
| 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 |
$133.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$127.20
|
| Rate for Payer: WellCare Medicare |
$174.90
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN
|
| Hospital Charge Code |
4670019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN
|
| Hospital Charge Code |
4670019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$275.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$137.60
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.59
|
| Rate for Payer: EmblemHealth Medicaid |
$107.59
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$137.60
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$105.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$137.60
|
| Rate for Payer: Humana Medicare |
$137.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$144.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$137.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.97
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59
|
| Hospital Charge Code |
4670285
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59
|
| Hospital Charge Code |
4670285
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$275.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$137.60
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.59
|
| Rate for Payer: EmblemHealth Medicaid |
$107.59
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$137.60
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$105.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$137.60
|
| Rate for Payer: Humana Medicare |
$137.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$144.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$137.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.97
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59 W KX)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59,KX
|
| Hospital Charge Code |
4670301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (MOD 59 W KX)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,59,KX
|
| Hospital Charge Code |
4670301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$275.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$137.60
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.59
|
| Rate for Payer: EmblemHealth Medicaid |
$107.59
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$137.60
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$105.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$137.60
|
| Rate for Payer: Humana Medicare |
$137.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$144.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$137.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.97
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (W/ KX)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,KX
|
| Hospital Charge Code |
4670263
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
TREAT OF SWALLOWING DYSFUCTION DYSPHAGIA (W/ KX)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 92526 GN,KX
|
| Hospital Charge Code |
4670263
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$275.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$137.60
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.59
|
| Rate for Payer: EmblemHealth Medicaid |
$107.59
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$137.60
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$105.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$137.60
|
| Rate for Payer: Humana Medicare |
$137.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$144.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$137.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.97
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
TRIAMCINOLONE ACET 40 MG/ML VL 40 mg, 1 mL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 70121104901
|
| Hospital Charge Code |
4401335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TRIAMCINOLONE ACET 40 MG/ML VL 40 mg, 1 mL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 70121104901
|
| Hospital Charge Code |
4401335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
IP
|
$31.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Aetna of NY Commercial |
$17.42
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.90
|
| Rate for Payer: EmblemHealth Select Care |
$0.90
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.42
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
OP
|
$31.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: Aetna of NY Medicare |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.67
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: CDPHP Medicare |
$11.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.34
|
| Rate for Payer: EmblemHealth Medicaid |
$25.34
|
| Rate for Payer: EmblemHealth Medicare |
$10.77
|
| Rate for Payer: EmblemHealth Select Care |
$0.90
|
| Rate for Payer: Fidelis Medicare |
$12.67
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.67
|
| Rate for Payer: Humana Medicare |
$12.67
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.75
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
OP
|
$32.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$25.75 |
| Rate for Payer: Aetna of NY Medicare |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: CDPHP Medicare |
$11.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.75
|
| Rate for Payer: EmblemHealth Medicaid |
$25.75
|
| Rate for Payer: EmblemHealth Medicare |
$10.94
|
| Rate for Payer: EmblemHealth Select Care |
$0.90
|
| Rate for Payer: Fidelis Medicare |
$12.88
|
| Rate for Payer: Galaxy Health Commercial |
$20.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.88
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.83
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Medicare |
$12.88
|
| Rate for Payer: WellCare Medicare |
$17.70
|
|
|
TRIAMCINOLONE ACET INJ NOS 10 MG
|
Facility
|
IP
|
$32.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4400398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of NY Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.90
|
| Rate for Payer: EmblemHealth Select Care |
$0.90
|
| Rate for Payer: Galaxy Health Commercial |
$20.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.70
|
| Rate for Payer: WellCare Medicare |
$17.70
|
|
|
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 |
$4.67 |
| Max. Negotiated Rate |
$24.93 |
| 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) Medicare |
$12.46
|
| Rate for Payer: Cash Price |
$23.37
|
| 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 |
$12.46
|
| Rate for Payer: Galaxy Health Commercial |
$20.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.46
|
| Rate for Payer: Humana Medicare |
$12.46
|
| 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 |
$13.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.67
|
| Rate for Payer: United Healthcare Medicare |
$12.46
|
| 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 |
$5.41 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Aetna of NY Commercial |
$25.23
|
| Rate for Payer: Aetna of NY Medicare |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.42
|
| Rate for Payer: Cash Price |
$27.04
|
| 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 |
$14.42
|
| Rate for Payer: Galaxy Health Commercial |
$23.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.42
|
| Rate for Payer: Humana Medicare |
$14.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.23
|
| 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 |
$15.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.41
|
| Rate for Payer: United Healthcare Medicare |
$14.42
|
| Rate for Payer: WellCare Medicare |
$19.83
|
|
|
TRIAMCINOLONE DENTAL PASTE
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
4408971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$199.20 |
| 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) Medicare |
$99.60
|
| Rate for Payer: Cash Price |
$186.75
|
| 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 |
$99.60
|
| Rate for Payer: Galaxy Health Commercial |
$161.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.60
|
| Rate for Payer: Humana Medicare |
$99.60
|
| 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 |
$104.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.35
|
| Rate for Payer: United Healthcare Medicare |
$99.60
|
| Rate for Payer: WellCare Medicare |
$136.95
|
|
|
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
|
|
|
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 |
$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
|
|
