|
BREVI CATHETER 19G X 14"
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
4473039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Galaxy Health Commercial |
$141.05
|
|
|
BRIDION INJECTION (Sugammadex) 200 mg/ 2 ml
|
Facility
|
OP
|
$359.07
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
4401281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.08 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Aetna of NY Commercial |
$197.49
|
| Rate for Payer: Aetna of NY Medicare |
$165.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$132.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$179.54
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: CDPHP Commercial |
$289.05
|
| Rate for Payer: CDPHP Medicare |
$132.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$287.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$287.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$287.26
|
| Rate for Payer: EmblemHealth Medicaid |
$287.26
|
| Rate for Payer: EmblemHealth Medicare |
$122.08
|
| Rate for Payer: EmblemHealth Select Care |
$258.53
|
| Rate for Payer: Fidelis Medicare |
$136.84
|
| Rate for Payer: Galaxy Health Commercial |
$233.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$132.86
|
| Rate for Payer: Humana Medicare |
$132.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$197.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.50
|
| Rate for Payer: United Healthcare Medicare |
$132.86
|
| Rate for Payer: WellCare Medicare |
$197.49
|
|
|
BRIDION INJECTION (Sugammadex) 200 mg/ 2 ml
|
Facility
|
IP
|
$359.07
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
4401281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.58 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna of NY Commercial |
$197.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.58
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Galaxy Health Commercial |
$233.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$197.49
|
| Rate for Payer: WellCare Medicare |
$197.49
|
|
|
Brilinta 60 MG TABLET 60 mg, 60 eaches
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
4401554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna of NY Commercial |
$18.20
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Commercial |
$20.93
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$18.72
|
| Rate for Payer: Fidelis Medicare |
$9.91
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.62
|
| Rate for Payer: Humana Medicare |
$9.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.10
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
Brilinta 60 MG TABLET 60 mg, 60 eaches
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
4401554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
Brilinta 90 MG TABLET 90 mg, 60 eaches
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
44001317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
Brilinta 90 MG TABLET 90 mg, 60 eaches
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
44001317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.50
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Commercial |
$16.90
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: EmblemHealth Select Care |
$15.12
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.16
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$97.95
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
4409101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Galaxy Health Commercial |
$63.67
|
| Rate for Payer: WellCare Medicare |
$53.87
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$97.95
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
4409101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of NY Commercial |
$68.56
|
| Rate for Payer: Aetna of NY Medicare |
$45.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$48.98
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: CDPHP Commercial |
$78.85
|
| Rate for Payer: CDPHP Medicare |
$36.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$78.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.36
|
| Rate for Payer: EmblemHealth Medicaid |
$78.36
|
| Rate for Payer: EmblemHealth Medicare |
$33.30
|
| Rate for Payer: EmblemHealth Select Care |
$70.52
|
| Rate for Payer: Fidelis Medicare |
$37.33
|
| Rate for Payer: Galaxy Health Commercial |
$63.67
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.24
|
| Rate for Payer: Humana Medicare |
$36.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.05
|
| Rate for Payer: United Healthcare Medicare |
$36.24
|
| Rate for Payer: WellCare Medicare |
$53.87
|
|
|
BS 30CM SPLITTER 2X8 KIT
|
Facility
|
OP
|
$6,468.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
4472219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.12 |
| Max. Negotiated Rate |
$5,206.74 |
| Rate for Payer: Aetna of NY Commercial |
$4,527.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,975.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,910.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,910.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,393.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,234.00
|
| Rate for Payer: Cash Price |
$4,851.00
|
| Rate for Payer: CDPHP Commercial |
$5,206.74
|
| Rate for Payer: CDPHP Medicare |
$2,393.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,234.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$5,174.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,199.12
|
| Rate for Payer: EmblemHealth Select Care |
$3,234.00
|
| Rate for Payer: Fidelis Medicare |
$2,464.95
|
| Rate for Payer: Galaxy Health Commercial |
$4,204.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,393.16
|
| Rate for Payer: Humana Medicare |
$2,393.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,527.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,975.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,204.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,204.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,512.82
|
| Rate for Payer: United Healthcare Medicare |
$2,393.16
|
| Rate for Payer: WellCare Medicare |
$3,557.40
|
|
|
BS 30CM SPLITTER 2X8 KIT
|
Facility
|
IP
|
$6,468.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
4472219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,910.60 |
| Max. Negotiated Rate |
$4,527.60 |
| Rate for Payer: Aetna of NY Commercial |
$4,527.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,910.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,910.60
|
| Rate for Payer: Cash Price |
$4,851.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,234.00
|
| Rate for Payer: EmblemHealth Select Care |
$3,234.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,204.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,527.60
|
| Rate for Payer: Multiplan Commercial |
$2,910.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,204.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,204.20
|
| Rate for Payer: WellCare Medicare |
$3,557.40
|
|
|
BUDESONIDE NEB SOL 0.25
|
Facility
|
OP
|
$29.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
4401244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna of NY Commercial |
$16.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.55
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: CDPHP Commercial |
$23.43
|
| Rate for Payer: CDPHP Medicare |
$10.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.28
|
| Rate for Payer: EmblemHealth Medicaid |
$23.28
|
| Rate for Payer: EmblemHealth Medicare |
$9.89
|
| Rate for Payer: EmblemHealth Select Care |
$1.20
|
| Rate for Payer: Fidelis Medicare |
$11.09
|
| Rate for Payer: Galaxy Health Commercial |
$18.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.77
|
| Rate for Payer: Humana Medicare |
$10.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Medicare |
$10.77
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
BUDESONIDE NEB SOL 0.25
|
Facility
|
IP
|
$29.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
4401244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna of NY Commercial |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.20
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.20
|
| Rate for Payer: EmblemHealth Select Care |
$1.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.00
|
| Rate for Payer: WellCare Medicare |
$16.00
|
|
|
BUDESONIDE NEB SOL 0.5
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
4401245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna of NY Commercial |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.20
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.20
|
| Rate for Payer: EmblemHealth Select Care |
$1.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.42
|
| Rate for Payer: WellCare Medicare |
$18.42
|
|
|
BUDESONIDE NEB SOL 0.5
|
Facility
|
OP
|
$33.50
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
4401245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna of NY Commercial |
$18.42
|
| Rate for Payer: Aetna of NY Medicare |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.75
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: CDPHP Commercial |
$26.97
|
| Rate for Payer: CDPHP Medicare |
$12.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.80
|
| Rate for Payer: EmblemHealth Medicaid |
$26.80
|
| Rate for Payer: EmblemHealth Medicare |
$11.39
|
| Rate for Payer: EmblemHealth Select Care |
$1.20
|
| Rate for Payer: Fidelis Medicare |
$12.77
|
| Rate for Payer: Galaxy Health Commercial |
$21.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$18.42
|
|
|
BUMETANIDE 0.25MG/ML SDV 10X2ML
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
BUMETANIDE 0.25MG/ML SDV 10X2ML
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
BUMETANIDE 1MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00093423301
|
| Hospital Charge Code |
4400115
|
|
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
|
|
|
BUMETANIDE 1MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00093423301
|
| Hospital Charge Code |
4400115
|
|
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
|
|
|
BUPIVACAINE-DEXTR 0.75% AMP 1 ea, 2 mL
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
4401309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
BUPIVACAINE-DEXTR 0.75% AMP 1 ea, 2 mL
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
4401309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
BUPIVACAINE/DEXTROSE 7.5MG/ML AMPS 10X2M
|
Facility
|
IP
|
$14.68
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Aetna of NY Commercial |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.61
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Galaxy Health Commercial |
$9.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.07
|
| Rate for Payer: WellCare Medicare |
$8.07
|
|
|
BUPIVACAINE/DEXTROSE 7.5MG/ML AMPS 10X2M
|
Facility
|
OP
|
$14.68
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna of NY Commercial |
$8.07
|
| Rate for Payer: Aetna of NY Medicare |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.34
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: CDPHP Commercial |
$11.82
|
| Rate for Payer: CDPHP Medicare |
$5.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.74
|
| Rate for Payer: EmblemHealth Medicaid |
$11.74
|
| Rate for Payer: EmblemHealth Medicare |
$4.99
|
| Rate for Payer: EmblemHealth Select Care |
$10.57
|
| Rate for Payer: Fidelis Medicare |
$5.59
|
| Rate for Payer: Galaxy Health Commercial |
$9.54
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.43
|
| Rate for Payer: Humana Medicare |
$5.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.70
|
| Rate for Payer: United Healthcare Medicare |
$5.43
|
| Rate for Payer: WellCare Medicare |
$8.07
|
|
|
BUPIVACAINE HCL 2.5MG/ML MDV 50 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| 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 |
$3.40
|
| 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
|
|
|
BUPIVACAINE HCL 2.5MG/ML MDV 50 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
