|
XS LEFT COMFORTFORM WRIST
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
4471569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Aetna of NY Commercial |
$29.40
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Commercial |
$33.81
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$30.24
|
| Rate for Payer: Fidelis Medicare |
$16.01
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.54
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.32
|
| Rate for Payer: United Healthcare Medicare |
$15.54
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
XS RIGHT COMFORTFORM WRIST
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4471564
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
XS RIGHT COMFORTFORM WRIST
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4471564
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
XS SPECIALTY ARM SLING
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4471555
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
XS SPECIALTY ARM SLING
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4471555
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
XXL GOWN
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4479185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
XXL GOWN
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4479185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
XXL UNIVER KNEE WRAP CLOSED P
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
4471545
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
XXL UNIVER KNEE WRAP CLOSED P
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
4471545
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
XYLOCAINE 2% 10ML INJ
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
NDC 63323048617
|
| Hospital Charge Code |
4409205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of NY Commercial |
$7.75
|
| Rate for Payer: Aetna of NY Medicare |
$5.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.54
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: CDPHP Commercial |
$8.91
|
| Rate for Payer: CDPHP Medicare |
$4.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.86
|
| Rate for Payer: EmblemHealth Medicaid |
$8.86
|
| Rate for Payer: EmblemHealth Medicare |
$3.76
|
| Rate for Payer: EmblemHealth Select Care |
$7.97
|
| Rate for Payer: Fidelis Medicare |
$4.22
|
| Rate for Payer: Galaxy Health Commercial |
$7.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.10
|
| Rate for Payer: Humana Medicare |
$4.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.30
|
| Rate for Payer: United Healthcare Medicare |
$4.10
|
| Rate for Payer: WellCare Medicare |
$6.09
|
|
|
XYLOCAINE 2% 10ML INJ
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
NDC 63323048617
|
| Hospital Charge Code |
4409205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Galaxy Health Commercial |
$7.20
|
| Rate for Payer: WellCare Medicare |
$6.09
|
|
|
XYLOCAINE MPF .01 INJ 5ML
|
Facility
|
IP
|
$35.15
|
|
|
Service Code
|
NDC 63323049257
|
| Hospital Charge Code |
4409193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Galaxy Health Commercial |
$22.85
|
| Rate for Payer: WellCare Medicare |
$19.33
|
|
|
XYLOCAINE MPF .01 INJ 5ML
|
Facility
|
OP
|
$35.15
|
|
|
Service Code
|
NDC 63323049257
|
| Hospital Charge Code |
4409193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Aetna of NY Commercial |
$24.60
|
| Rate for Payer: Aetna of NY Medicare |
$16.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.58
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: CDPHP Commercial |
$28.30
|
| Rate for Payer: CDPHP Medicare |
$13.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.12
|
| Rate for Payer: EmblemHealth Medicaid |
$28.12
|
| Rate for Payer: EmblemHealth Medicare |
$11.95
|
| Rate for Payer: EmblemHealth Select Care |
$25.31
|
| Rate for Payer: Fidelis Medicare |
$13.40
|
| Rate for Payer: Galaxy Health Commercial |
$22.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.01
|
| Rate for Payer: Humana Medicare |
$13.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
| Rate for Payer: WellCare Medicare |
$19.33
|
|
|
ZENPEP DR 15,000 UNIT CAPSULE 15000 unit, 100 eaches
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 73562011101
|
| Hospital Charge Code |
4401574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$13.81 |
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Galaxy Health Commercial |
$13.81
|
| Rate for Payer: WellCare Medicare |
$11.68
|
|
|
ZENPEP DR 15,000 UNIT CAPSULE 15000 unit, 100 eaches
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 73562011101
|
| Hospital Charge Code |
4401574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.87
|
| Rate for Payer: Aetna of NY Medicare |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.62
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: CDPHP Commercial |
$17.10
|
| Rate for Payer: CDPHP Medicare |
$7.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.99
|
| Rate for Payer: EmblemHealth Medicaid |
$16.99
|
| Rate for Payer: EmblemHealth Medicare |
$7.22
|
| Rate for Payer: EmblemHealth Select Care |
$15.29
|
| Rate for Payer: Fidelis Medicare |
$8.09
|
| Rate for Payer: Galaxy Health Commercial |
$13.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.86
|
| Rate for Payer: Humana Medicare |
$7.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.87
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.93
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$7.86
|
| Rate for Payer: WellCare Medicare |
$11.68
|
|
|
ZIMMER BIOMET JUGGERKNOT SOFT ANCHOR 1.45MM
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.98 |
| Max. Negotiated Rate |
$1,849.08 |
| Rate for Payer: Aetna of NY Commercial |
$1,607.90
|
| Rate for Payer: Aetna of NY Medicare |
$1,056.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,033.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,033.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$849.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,148.50
|
| Rate for Payer: Cash Price |
$1,722.75
|
| Rate for Payer: CDPHP Commercial |
$1,849.08
|
| Rate for Payer: CDPHP Medicare |
$849.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,148.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,837.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,837.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,837.60
|
| Rate for Payer: EmblemHealth Medicare |
$780.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,148.50
|
| Rate for Payer: Fidelis Medicare |
$875.39
|
| Rate for Payer: Galaxy Health Commercial |
$1,493.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$849.89
|
| Rate for Payer: Humana Medicare |
$849.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,607.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,056.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,493.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,493.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$892.38
|
| Rate for Payer: United Healthcare Medicare |
$849.89
|
| Rate for Payer: WellCare Medicare |
$1,263.35
|
|
|
ZIMMER BIOMET JUGGERKNOT SOFT ANCHOR 1.45MM
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,033.65 |
| Max. Negotiated Rate |
$1,607.90 |
| Rate for Payer: Aetna of NY Commercial |
$1,607.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,033.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,033.65
|
| Rate for Payer: Cash Price |
$1,722.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,148.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,148.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,493.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,607.90
|
| Rate for Payer: Multiplan Commercial |
$1,033.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,493.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,493.05
|
| Rate for Payer: WellCare Medicare |
$1,263.35
|
|
|
ZINC SULFATE 220MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00731040106
|
| Hospital Charge Code |
4400822
|
|
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
|
|
|
ZINC SULFATE 220MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00731040106
|
| Hospital Charge Code |
4400822
|
|
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
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML 1 mg, 100 mL
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4401452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna of NY Commercial |
$93.06
|
| Rate for Payer: Aetna of NY Medicare |
$77.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$73.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$32.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$84.60
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$32.56
|
| Rate for Payer: CDPHP Commercial |
$136.21
|
| Rate for Payer: CDPHP Essential Plan |
$73.26
|
| Rate for Payer: CDPHP Medicare |
$62.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.56
|
| Rate for Payer: EmblemHealth Medicaid |
$32.56
|
| Rate for Payer: EmblemHealth Medicare |
$57.53
|
| Rate for Payer: EmblemHealth Select Care |
$6.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$73.26
|
| Rate for Payer: Fidelis Medicare |
$64.48
|
| Rate for Payer: Galaxy Health Commercial |
$109.98
|
| Rate for Payer: Galaxy Health Workers Comp |
$47.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,256.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.60
|
| Rate for Payer: Humana Medicare |
$62.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$93.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.73
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.56
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$62.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$34.19
|
| Rate for Payer: WellCare Medicare |
$93.06
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML 1 mg, 100 mL
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4401452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna of NY Commercial |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.94
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.94
|
| Rate for Payer: EmblemHealth Select Care |
$6.94
|
| Rate for Payer: Galaxy Health Commercial |
$109.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$93.06
|
| Rate for Payer: WellCare Medicare |
$93.06
|
|
|
ZOLEDRONIC ACID INJ, 1MG
|
Facility
|
IP
|
$3,071.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4409074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$1,996.62 |
| Rate for Payer: Aetna of NY Commercial |
$1,689.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.94
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.94
|
| Rate for Payer: EmblemHealth Select Care |
$6.94
|
| Rate for Payer: Galaxy Health Commercial |
$1,996.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,689.45
|
| Rate for Payer: WellCare Medicare |
$1,689.45
|
|
|
ZOLEDRONIC ACID INJ, 1MG
|
Facility
|
OP
|
$3,071.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4409074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,689.45
|
| Rate for Payer: Aetna of NY Medicare |
$1,412.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$73.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$32.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,136.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,535.86
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$32.56
|
| Rate for Payer: CDPHP Commercial |
$2,472.73
|
| Rate for Payer: CDPHP Essential Plan |
$73.26
|
| Rate for Payer: CDPHP Medicare |
$1,136.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.56
|
| Rate for Payer: EmblemHealth Medicaid |
$32.56
|
| Rate for Payer: EmblemHealth Medicare |
$1,044.38
|
| Rate for Payer: EmblemHealth Select Care |
$6.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$73.26
|
| Rate for Payer: Fidelis Medicare |
$1,170.63
|
| Rate for Payer: Galaxy Health Commercial |
$1,996.62
|
| Rate for Payer: Galaxy Health Workers Comp |
$47.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,256.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,136.54
|
| Rate for Payer: Humana Medicare |
$1,136.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,689.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,412.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,303.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,729.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,193.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.56
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$1,136.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$34.19
|
| Rate for Payer: WellCare Medicare |
$1,689.45
|
|
|
ZOLPIDEM TARTRATE 5MG TABS 10X10EA
|
Facility
|
IP
|
$14.16
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
4400824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Galaxy Health Commercial |
$9.20
|
| Rate for Payer: WellCare Medicare |
$7.79
|
|
|
ZOLPIDEM TARTRATE 5MG TABS 10X10EA
|
Facility
|
OP
|
$14.16
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
4400824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Aetna of NY Commercial |
$9.91
|
| Rate for Payer: Aetna of NY Medicare |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.08
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: CDPHP Commercial |
$11.40
|
| Rate for Payer: CDPHP Medicare |
$5.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.33
|
| Rate for Payer: EmblemHealth Medicaid |
$11.33
|
| Rate for Payer: EmblemHealth Medicare |
$4.81
|
| Rate for Payer: EmblemHealth Select Care |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$5.40
|
| Rate for Payer: Galaxy Health Commercial |
$9.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.24
|
| Rate for Payer: Humana Medicare |
$5.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.50
|
| Rate for Payer: United Healthcare Medicare |
$5.24
|
| Rate for Payer: WellCare Medicare |
$7.79
|
|
