|
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
|
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 81MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739052201
|
| Hospital Charge Code |
4400078
|
|
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
|
|
|
ASPIRIN SUPPOS 300MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
4408946
|
|
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
|
|
|
ASPIRIN SUPPOS 300MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 574703412
|
| 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 600MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 574703612
|
| 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 574703612
|
| Hospital Charge Code |
4408947
|
|
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
|
|
|
ASSAY OF LEAD
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
4302029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$32.57 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| 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 |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$14.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$15.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$15.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| 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 |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$15.91
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
ASSAY OF LEAD
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
4302029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
AST (SGOT)
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
4300103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Aetna of NY Commercial |
$10.40
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$9.60
|
| Rate for Payer: Fidelis Medicare |
$6.40
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.40
|
| Rate for Payer: Humana Medicare |
$6.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$12.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$6.40
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
AST (SGOT)
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
4300103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
ATORVASTATIN CALCIUM 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904629061
|
| Hospital Charge Code |
4400452
|
|
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
|
|
|
ATORVASTATIN CALCIUM 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904629061
|
| 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 40MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904629261
|
| Hospital Charge Code |
4400453
|
|
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
|
|
|
ATORVASTATIN CALCIUM 40MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904629261
|
| 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 65030355
|
| Hospital Charge Code |
4400082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$134.62 |
| 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) Medicare |
$67.31
|
| Rate for Payer: Cash Price |
$126.20
|
| 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 |
$67.31
|
| Rate for Payer: Galaxy Health Commercial |
$109.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.31
|
| Rate for Payer: Humana Medicare |
$67.31
|
| 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 |
$70.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.24
|
| Rate for Payer: United Healthcare Medicare |
$67.31
|
| Rate for Payer: WellCare Medicare |
$92.55
|
|
|
ATROPINE SULFATE 0.01 DROP 5 ML
|
Facility
|
IP
|
$168.27
|
|
|
Service Code
|
NDC 65030355
|
| 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 409163010
|
| Hospital Charge Code |
4400083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$25.92 |
| 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) Medicare |
$12.96
|
| Rate for Payer: Cash Price |
$24.30
|
| 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 |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$21.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.96
|
| Rate for Payer: Humana Medicare |
$12.96
|
| 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 |
$13.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.86
|
| Rate for Payer: United Healthcare Medicare |
$12.96
|
| Rate for Payer: WellCare Medicare |
$17.82
|
|
|
ATROPINE SULFATE 0.1MG/ML ANSY 10X10ML
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 409163010
|
| 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 409491134
|
| 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 409491134
|
| Hospital Charge Code |
4400084
|
|
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
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna of NY Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| 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
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.58
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| 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 |
$0.10
|
| Rate for Payer: Fidelis Medicare |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.58
|
| Rate for Payer: Humana Medicare |
$2.58
|
| 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 |
$2.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$2.58
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
AUTOCLAVE CASES
|
Facility
|
OP
|
$1,044.42
|
|
| Hospital Charge Code |
4479218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.66 |
| Max. Negotiated Rate |
$835.54 |
| Rate for Payer: Aetna of NY Commercial |
$731.09
|
| Rate for Payer: Aetna of NY Medicare |
$480.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$417.77
|
| Rate for Payer: Cash Price |
$783.32
|
| Rate for Payer: CDPHP Medicare |
$386.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$835.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$835.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$835.54
|
| Rate for Payer: EmblemHealth Medicaid |
$835.54
|
| Rate for Payer: EmblemHealth Medicare |
$355.10
|
| Rate for Payer: EmblemHealth Select Care |
$751.98
|
| Rate for Payer: Fidelis Medicare |
$417.77
|
| Rate for Payer: Galaxy Health Commercial |
$678.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$417.77
|
| Rate for Payer: Humana Medicare |
$417.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$731.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$480.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$783.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$588.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$438.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$156.66
|
| Rate for Payer: United Healthcare Medicare |
$417.77
|
| Rate for Payer: WellCare Medicare |
$574.43
|
|
|
AUTOCLAVE CASES
|
Facility
|
IP
|
$1,044.42
|
|
| Hospital Charge Code |
4479218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$678.87 |
| Max. Negotiated Rate |
$678.87 |
| Rate for Payer: Cash Price |
$783.32
|
| Rate for Payer: Galaxy Health Commercial |
$678.87
|
|
