|
ATROPINE SULFATE 0.1MG/ML ANSY 10X10ML
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 00409163010
|
| Hospital Charge Code |
4400083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Galaxy Health Commercial |
$21.06
|
| Rate for Payer: WellCare Medicare |
$17.82
|
|
|
ATROPINE SULFATE 0.1MG/ML LSSY 10X10ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00409491134
|
| Hospital Charge Code |
4400084
|
|
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 0.1MG/ML LSSY 10X10ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00409491134
|
| Hospital Charge Code |
4400084
|
|
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
|
|
|
ATROPINE SULFATE INJECTION 0.01 MG
|
Facility
|
OP
|
$6.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
4409171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna of NY Commercial |
$3.54
|
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.22
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Commercial |
$5.18
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.15
|
| Rate for Payer: EmblemHealth Medicaid |
$5.15
|
| Rate for Payer: EmblemHealth Medicare |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Fidelis Medicare |
$2.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.38
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
ATROPINE SULFATE INJECTION 0.01 MG
|
Facility
|
IP
|
$6.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
4409171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna of NY Commercial |
$3.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.54
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
AUTOCLAVE CASES
|
Facility
|
IP
|
$1,014.00
|
|
| Hospital Charge Code |
4479218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$659.10 |
| Max. Negotiated Rate |
$659.10 |
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Galaxy Health Commercial |
$659.10
|
|
|
AUTOCLAVE CASES
|
Facility
|
OP
|
$1,014.00
|
|
| Hospital Charge Code |
4479218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$344.76 |
| Max. Negotiated Rate |
$816.27 |
| Rate for Payer: Aetna of NY Commercial |
$709.80
|
| Rate for Payer: Aetna of NY Medicare |
$466.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$760.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$760.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$375.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$507.00
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: CDPHP Commercial |
$816.27
|
| Rate for Payer: CDPHP Medicare |
$375.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$811.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$811.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$811.20
|
| Rate for Payer: EmblemHealth Medicaid |
$811.20
|
| Rate for Payer: EmblemHealth Medicare |
$344.76
|
| Rate for Payer: EmblemHealth Select Care |
$730.08
|
| Rate for Payer: Fidelis Medicare |
$386.44
|
| Rate for Payer: Galaxy Health Commercial |
$659.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$375.18
|
| Rate for Payer: Humana Medicare |
$375.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$709.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$466.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$760.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$570.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$393.94
|
| Rate for Payer: United Healthcare Medicare |
$375.18
|
| Rate for Payer: WellCare Medicare |
$557.70
|
|
|
AUTOMATED PLATELET COUNT
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
4301424
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$39.44 |
| Rate for Payer: Aetna of NY Commercial |
$31.85
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.50
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Commercial |
$39.44
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$29.40
|
| Rate for Payer: Fidelis Medicare |
$18.67
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.13
|
| Rate for Payer: Humana Medicare |
$18.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$36.75
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
AUTOMATED PLATELET COUNT
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
4301424
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
AUTOM URINE DIP W MICRO
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
4300802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
|
|
AUTOM URINE DIP W MICRO
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
4300802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.05
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$12.75
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
AUTOSUTURE ROYAL 35W SKIN STAPLER
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
4472212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
AUTOSUTURE ROYAL 35W SKIN STAPLER
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
4472212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna of NY Commercial |
$49.70
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.50
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
AVAMAX BONE CEMENT DELIVERY SYS VMX00CT
|
Facility
|
IP
|
$2,721.00
|
|
| Hospital Charge Code |
4479294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,768.65 |
| Max. Negotiated Rate |
$1,768.65 |
| Rate for Payer: Cash Price |
$2,040.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,768.65
|
|
|
AVAMAX BONE CEMENT DELIVERY SYS VMX00CT
|
Facility
|
OP
|
$2,721.00
|
|
| Hospital Charge Code |
4479294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$925.14 |
| Max. Negotiated Rate |
$2,190.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,904.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,251.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,040.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,040.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,006.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,360.50
|
| Rate for Payer: Cash Price |
$2,040.75
|
| Rate for Payer: CDPHP Commercial |
$2,190.40
|
| Rate for Payer: CDPHP Medicare |
$1,006.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,176.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,176.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,176.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,176.80
|
| Rate for Payer: EmblemHealth Medicare |
$925.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,959.12
|
| Rate for Payer: Fidelis Medicare |
$1,036.97
|
| Rate for Payer: Galaxy Health Commercial |
$1,768.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,006.77
|
| Rate for Payer: Humana Medicare |
$1,006.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,904.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,251.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,040.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,531.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,057.11
|
| Rate for Payer: United Healthcare Medicare |
$1,006.77
|
| Rate for Payer: WellCare Medicare |
$1,496.55
|
|
|
AVISTA MRI LEAD - 56CM/74CM
|
Facility
|
OP
|
$14,824.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4479094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.16 |
| Max. Negotiated Rate |
$11,933.32 |
| Rate for Payer: Aetna of NY Commercial |
$10,376.80
|
| Rate for Payer: Aetna of NY Medicare |
$6,819.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,670.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,670.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,484.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,412.00
|
| Rate for Payer: Cash Price |
$11,118.00
|
| Rate for Payer: CDPHP Commercial |
$11,933.32
|
| Rate for Payer: CDPHP Medicare |
$5,484.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,412.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,859.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,859.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11,859.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,040.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,412.00
|
| Rate for Payer: Fidelis Medicare |
$5,649.43
|
| Rate for Payer: Galaxy Health Commercial |
$9,635.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,484.88
|
| Rate for Payer: Humana Medicare |
$5,484.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,376.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,819.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,635.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,635.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,759.12
|
| Rate for Payer: United Healthcare Medicare |
$5,484.88
|
| Rate for Payer: WellCare Medicare |
$8,153.20
|
|
|
AVISTA MRI LEAD - 56CM/74CM
|
Facility
|
IP
|
$14,824.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4479094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,670.80 |
| Max. Negotiated Rate |
$10,376.80 |
| Rate for Payer: Aetna of NY Commercial |
$10,376.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,670.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,670.80
|
| Rate for Payer: Cash Price |
$11,118.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,412.00
|
| Rate for Payer: EmblemHealth Select Care |
$7,412.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,635.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,376.80
|
| Rate for Payer: Multiplan Commercial |
$6,670.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,635.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,635.60
|
| Rate for Payer: WellCare Medicare |
$8,153.20
|
|
|
AVULSION OF NAIL PLATE,SIMPLE, SINGLE
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4856671
|
|
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
|
|
|
AVULSION OF NAIL PLATE,SIMPLE, SINGLE
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4856671
|
|
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
|
|
|
AZACTAM 1 GRAM INJECTION
|
Facility
|
OP
|
$107.64
|
|
|
Service Code
|
NDC 00003256016
|
| Hospital Charge Code |
4409087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$86.65 |
| Rate for Payer: Aetna of NY Commercial |
$75.35
|
| Rate for Payer: Aetna of NY Medicare |
$49.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.82
|
| Rate for Payer: Cash Price |
$80.73
|
| Rate for Payer: CDPHP Commercial |
$86.65
|
| Rate for Payer: CDPHP Medicare |
$39.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.11
|
| Rate for Payer: EmblemHealth Medicaid |
$86.11
|
| Rate for Payer: EmblemHealth Medicare |
$36.60
|
| Rate for Payer: EmblemHealth Select Care |
$77.50
|
| Rate for Payer: Fidelis Medicare |
$41.02
|
| Rate for Payer: Galaxy Health Commercial |
$69.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.83
|
| Rate for Payer: Humana Medicare |
$39.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.73
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.82
|
| Rate for Payer: United Healthcare Medicare |
$39.83
|
| Rate for Payer: WellCare Medicare |
$59.20
|
|
|
AZACTAM 1 GRAM INJECTION
|
Facility
|
IP
|
$107.64
|
|
|
Service Code
|
NDC 00003256016
|
| Hospital Charge Code |
4409087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$69.97 |
| Rate for Payer: Cash Price |
$80.73
|
| Rate for Payer: Galaxy Health Commercial |
$69.97
|
|
|
AZACTAM (AZTREONAM) INJECTION 2 GRAMS
|
Facility
|
IP
|
$215.01
|
|
|
Service Code
|
NDC 00003257016
|
| Hospital Charge Code |
4409219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.26 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: Galaxy Health Commercial |
$139.76
|
| Rate for Payer: WellCare Medicare |
$118.26
|
|
|
AZACTAM (AZTREONAM) INJECTION 2 GRAMS
|
Facility
|
OP
|
$215.01
|
|
|
Service Code
|
NDC 00003257016
|
| Hospital Charge Code |
4409219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$173.08 |
| Rate for Payer: Aetna of NY Commercial |
$150.51
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$172.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.01
|
| Rate for Payer: EmblemHealth Medicaid |
$172.01
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: EmblemHealth Select Care |
$154.81
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.26
|
|
|
AZITHROMYCIN 100MG/5ML POSR 15 ML
|
Facility
|
OP
|
$104.64
|
|
|
Service Code
|
NDC 00093202723
|
| Hospital Charge Code |
4400087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna of NY Commercial |
$73.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.32
|
| Rate for Payer: Cash Price |
$78.48
|
| Rate for Payer: CDPHP Commercial |
$84.24
|
| Rate for Payer: CDPHP Medicare |
$38.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$83.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$83.71
|
| Rate for Payer: EmblemHealth Medicaid |
$83.71
|
| Rate for Payer: EmblemHealth Medicare |
$35.58
|
| Rate for Payer: EmblemHealth Select Care |
$75.34
|
| Rate for Payer: Fidelis Medicare |
$39.88
|
| Rate for Payer: Galaxy Health Commercial |
$68.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.72
|
| Rate for Payer: Humana Medicare |
$38.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$58.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.65
|
| Rate for Payer: United Healthcare Medicare |
$38.72
|
| Rate for Payer: WellCare Medicare |
$57.55
|
|
|
AZITHROMYCIN 100MG/5ML POSR 15 ML
|
Facility
|
IP
|
$104.64
|
|
|
Service Code
|
NDC 00093202723
|
| Hospital Charge Code |
4400087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.55 |
| Max. Negotiated Rate |
$68.02 |
| Rate for Payer: Cash Price |
$78.48
|
| Rate for Payer: Galaxy Health Commercial |
$68.02
|
| Rate for Payer: WellCare Medicare |
$57.55
|
|
