|
ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
4002001
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
4002001
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| 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 |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
ASPIRIN 325 MG film coated
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
4401260
|
|
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
|
|
|
ASPIRIN 325 MG film coated
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
4401260
|
|
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
|
|
|
ASPIRIN 325MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739052301
|
| Hospital Charge Code |
4400075
|
|
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
|
|
|
ASPIRIN 325MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739052301
|
| Hospital Charge Code |
4400075
|
|
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
|
|
|
ASPIRIN 81MG CHEW 25X30EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
4400077
|
|
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
|
|
|
ASPIRIN 81MG CHEW 25X30EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
4400077
|
|
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
|
|
|
ASPIRIN 81MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739052201
|
| Hospital Charge Code |
4400078
|
|
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
|
|
|
ASPIRIN 81MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739052201
|
| Hospital Charge Code |
4400078
|
|
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
|
|
|
ASPIRIN SUPPOS 300MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
4408946
|
|
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
|
|
|
ASPIRIN SUPPOS 300MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
4408946
|
|
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
|
|
|
ASPIRIN SUPPOS 600MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00574703612
|
| Hospital Charge Code |
4408947
|
|
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
|
|
|
ASPIRIN SUPPOS 600MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00574703612
|
| Hospital Charge Code |
4408947
|
|
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
|
|
|
ASSAY OF LEAD
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
4302029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$34.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$15.15
|
| Rate for Payer: CDPHP Commercial |
$31.40
|
| Rate for Payer: CDPHP Essential Plan |
$34.09
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.15
|
| Rate for Payer: EmblemHealth Medicaid |
$15.15
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$34.09
|
| Rate for Payer: Fidelis Medicare |
$14.86
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$22.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,515.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.43
|
| Rate for Payer: Humana Medicare |
$14.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,515.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$32.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$32.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$15.91
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
ASSAY OF LEAD
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
4302029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
AST (SGOT)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
4300103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
AST (SGOT)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
4300103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ATORVASTATIN CALCIUM 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
4400452
|
|
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
|
|
|
ATORVASTATIN CALCIUM 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
4400452
|
|
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
|
|
|
ATORVASTATIN CALCIUM 40MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
4400453
|
|
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
|
|
|
ATORVASTATIN CALCIUM 40MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
4400453
|
|
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
|
|
|
ATROPINE SULFATE 0.01 DROP 5 ML
|
Facility
|
OP
|
$168.27
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
4400082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$135.46 |
| Rate for Payer: Aetna of NY Commercial |
$117.79
|
| Rate for Payer: Aetna of NY Medicare |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$126.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$126.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$84.14
|
| Rate for Payer: Cash Price |
$126.20
|
| Rate for Payer: CDPHP Commercial |
$135.46
|
| Rate for Payer: CDPHP Medicare |
$62.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$134.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$134.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.62
|
| Rate for Payer: EmblemHealth Medicaid |
$134.62
|
| Rate for Payer: EmblemHealth Medicare |
$57.21
|
| Rate for Payer: EmblemHealth Select Care |
$121.15
|
| Rate for Payer: Fidelis Medicare |
$64.13
|
| Rate for Payer: Galaxy Health Commercial |
$109.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.26
|
| Rate for Payer: Humana Medicare |
$62.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$117.79
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$94.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$65.37
|
| Rate for Payer: United Healthcare Medicare |
$62.26
|
| Rate for Payer: WellCare Medicare |
$92.55
|
|
|
ATROPINE SULFATE 0.01 DROP 5 ML
|
Facility
|
IP
|
$168.27
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
4400082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$109.38 |
| Rate for Payer: Cash Price |
$126.20
|
| Rate for Payer: Galaxy Health Commercial |
$109.38
|
| Rate for Payer: WellCare Medicare |
$92.55
|
|
|
ATROPINE SULFATE 0.1MG/ML ANSY 10X10ML
|
Facility
|
OP
|
$32.40
|
|
|
Service Code
|
NDC 00409163010
|
| Hospital Charge Code |
4400083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna of NY Commercial |
$22.68
|
| Rate for Payer: Aetna of NY Medicare |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.20
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: CDPHP Commercial |
$26.08
|
| Rate for Payer: CDPHP Medicare |
$11.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.92
|
| Rate for Payer: EmblemHealth Medicaid |
$25.92
|
| Rate for Payer: EmblemHealth Medicare |
$11.02
|
| Rate for Payer: EmblemHealth Select Care |
$23.33
|
| Rate for Payer: Fidelis Medicare |
$12.35
|
| Rate for Payer: Galaxy Health Commercial |
$21.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.99
|
| Rate for Payer: Humana Medicare |
$11.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.59
|
| Rate for Payer: United Healthcare Medicare |
$11.99
|
| Rate for Payer: WellCare Medicare |
$17.82
|
|
