|
DILTIAZEM HCL 180MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400238
|
|
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
|
|
|
DILTIAZEM HCL 30MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400231
|
|
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
|
|
|
DILTIAZEM HCL 5MG/ML SDV 10X10ML
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4400235
|
|
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
|
|
|
DILTIAZEM HCL 5MG/ML SDV 10X25ML
|
Facility
OP
|
$23.35
|
|
| Hospital Charge Code |
4400233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.34
|
| Rate for Payer: Aetna of NY Medicare |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.68
|
| Rate for Payer: Cash Price |
$17.51
|
| Rate for Payer: CDPHP Commercial |
$18.80
|
| Rate for Payer: CDPHP Medicare |
$8.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.68
|
| Rate for Payer: EmblemHealth Medicaid |
$18.68
|
| Rate for Payer: EmblemHealth Medicare |
$7.94
|
| Rate for Payer: EmblemHealth Select Care |
$16.81
|
| Rate for Payer: Fidelis Medicare |
$8.90
|
| Rate for Payer: Galaxy Health Commercial |
$15.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.64
|
| Rate for Payer: Humana Medicare |
$8.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.07
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WellCare Medicare |
$12.84
|
|
|
DILTIAZEM HCL 5MG/ML SDV 10X5ML
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
4400232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.48
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
DIPHENHYDRAMINE HCL 12.5MG/5ML LIQD 4 OZ
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400240
|
|
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
|
|
|
DIPHENHYDRAMINE HCL 25MG CAPS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400241
|
|
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
|
|
|
DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
4400242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| 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 |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| 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: 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 |
$0.82
|
| 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 |
$0.82
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
DIPHENOXYLATE/ATROPINE 2.5-0.025MG TABS
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400243
|
|
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
|
|
|
DIPHTH PERTUSSIS(ADACEL)TET VAC SYRN 10X
|
Facility
OP
|
$141.88
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
4400110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna of NY Commercial |
$78.03
|
| Rate for Payer: Aetna of NY Medicare |
$65.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$52.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$70.94
|
| Rate for Payer: Cash Price |
$106.41
|
| Rate for Payer: Cash Price |
$106.41
|
| Rate for Payer: CDPHP Commercial |
$114.21
|
| Rate for Payer: CDPHP Medicare |
$52.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$113.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.50
|
| Rate for Payer: EmblemHealth Medicaid |
$113.50
|
| Rate for Payer: EmblemHealth Medicare |
$48.24
|
| Rate for Payer: EmblemHealth Select Care |
$39.09
|
| Rate for Payer: Fidelis Medicare |
$54.07
|
| Rate for Payer: Galaxy Health Commercial |
$92.22
|
| Rate for Payer: Hamaspik Choice Medicare |
$52.50
|
| Rate for Payer: Humana Medicare |
$52.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$78.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$79.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$63.94
|
| Rate for Payer: United Healthcare Commercial |
$63.94
|
| Rate for Payer: United Healthcare Medicare |
$52.50
|
| Rate for Payer: WellCare Medicare |
$78.03
|
|
|
DIPYRIDAMOLE 25 MG TAB
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409110
|
|
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
|
|
|
DIRECT LDL
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
4300273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
DISP BIOPSY FORCEPS - SPIKED
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
4471833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
DISP DUAL-INCI FALOPE-RING BAND 8MM W T
|
Facility
OP
|
$923.00
|
|
| Hospital Charge Code |
4479084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$313.82 |
| Max. Negotiated Rate |
$743.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$341.51
|
| Rate for Payer: Aetna of NY Commercial |
$646.10
|
| Rate for Payer: Aetna of NY Medicare |
$424.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$692.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$692.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$461.50
|
| Rate for Payer: Cash Price |
$692.25
|
| Rate for Payer: CDPHP Commercial |
$743.02
|
| Rate for Payer: CDPHP Medicare |
$341.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$738.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$738.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$738.40
|
| Rate for Payer: EmblemHealth Medicaid |
$738.40
|
| Rate for Payer: EmblemHealth Medicare |
$313.82
|
| Rate for Payer: EmblemHealth Select Care |
$664.56
|
| Rate for Payer: Fidelis Medicare |
$351.76
|
| Rate for Payer: Galaxy Health Commercial |
$599.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$341.51
|
| Rate for Payer: Humana Medicare |
$341.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$646.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$424.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$692.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$519.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$358.59
|
| Rate for Payer: United Healthcare Medicare |
$341.51
|
| Rate for Payer: WellCare Medicare |
$507.65
|
|
|
DISP DUAL-INCI FALOPE-RING BAND W/O TRO
|
Facility
OP
|
$651.00
|
|
| Hospital Charge Code |
4479085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.34 |
| Max. Negotiated Rate |
$524.06 |
| Rate for Payer: Aetna of NY Commercial |
$455.70
|
| Rate for Payer: Aetna of NY Medicare |
$299.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$488.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$488.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$240.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$325.50
|
| Rate for Payer: Cash Price |
$488.25
|
| Rate for Payer: CDPHP Commercial |
$524.06
|
| Rate for Payer: CDPHP Medicare |
$240.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$520.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$520.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$520.80
|
| Rate for Payer: EmblemHealth Medicaid |
$520.80
|
| Rate for Payer: EmblemHealth Medicare |
$221.34
|
| Rate for Payer: EmblemHealth Select Care |
$468.72
|
| Rate for Payer: Fidelis Medicare |
$248.10
|
| Rate for Payer: Galaxy Health Commercial |
$423.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$240.87
|
| Rate for Payer: Humana Medicare |
$240.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$366.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$252.91
|
| Rate for Payer: United Healthcare Medicare |
$240.87
|
| Rate for Payer: WellCare Medicare |
$358.05
|
|
|
DISPERSIVE ELECTRODE: PMA-GP-BAY 4479209
|
Facility
OP
|
$347.00
|
|
| Hospital Charge Code |
4479209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$279.34 |
| Rate for Payer: Aetna of NY Commercial |
$242.90
|
| Rate for Payer: Aetna of NY Medicare |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$173.50
|
| Rate for Payer: Cash Price |
$260.25
|
| Rate for Payer: CDPHP Commercial |
$279.34
|
| Rate for Payer: CDPHP Medicare |
$128.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$277.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$277.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$277.60
|
| Rate for Payer: EmblemHealth Medicaid |
$277.60
|
| Rate for Payer: EmblemHealth Medicare |
$117.98
|
| Rate for Payer: EmblemHealth Select Care |
$249.84
|
| Rate for Payer: Fidelis Medicare |
$132.24
|
| Rate for Payer: Galaxy Health Commercial |
$225.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.39
|
| Rate for Payer: Humana Medicare |
$128.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$242.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$159.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$195.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.81
|
| Rate for Payer: United Healthcare Medicare |
$128.39
|
| Rate for Payer: WellCare Medicare |
$190.85
|
|
|
DISP HIGH FLOW INSULFLATOR
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
4471447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna of NY Commercial |
$37.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.50
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: CDPHP Commercial |
$42.66
|
| Rate for Payer: CDPHP Medicare |
$19.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.40
|
| Rate for Payer: EmblemHealth Medicaid |
$42.40
|
| Rate for Payer: EmblemHealth Medicare |
$18.02
|
| Rate for Payer: EmblemHealth Select Care |
$38.16
|
| Rate for Payer: Fidelis Medicare |
$20.20
|
| Rate for Payer: Galaxy Health Commercial |
$34.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.61
|
| Rate for Payer: Humana Medicare |
$19.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.59
|
| Rate for Payer: United Healthcare Medicare |
$19.61
|
| Rate for Payer: WellCare Medicare |
$29.15
|
|
|
DISPOSABLE GAIT BELTS
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4479203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
DISPOSIBLE SCLEROTHERAPY NEEDL
|
Facility
OP
|
$107.00
|
|
| Hospital Charge Code |
4471000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$86.14 |
| Rate for Payer: Aetna of NY Commercial |
$74.90
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.50
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: EmblemHealth Select Care |
$77.04
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
DIVALPROEX DR 250 MG TABLET
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
4401291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of NY Commercial |
$0.70
|
| Rate for Payer: Aetna of NY Medicare |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.50
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: CDPHP Commercial |
$0.81
|
| Rate for Payer: CDPHP Medicare |
$0.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.80
|
| Rate for Payer: EmblemHealth Medicaid |
$0.80
|
| Rate for Payer: EmblemHealth Medicare |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.72
|
| Rate for Payer: Fidelis Medicare |
$0.38
|
| Rate for Payer: Galaxy Health Commercial |
$0.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.39
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WellCare Medicare |
$0.55
|
|
|
DIVALPROEX SOD ER 250 MG TAB 250 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401365
|
|
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
|
|
|
DNA/RNA; MULTI ORG - AMP PR
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
4302007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$198.03 |
| Rate for Payer: Aetna of NY Commercial |
$159.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$184.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$184.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$123.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: CDPHP Commercial |
$198.03
|
| Rate for Payer: CDPHP Medicare |
$91.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$196.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$196.80
|
| Rate for Payer: EmblemHealth Medicaid |
$196.80
|
| Rate for Payer: EmblemHealth Medicare |
$83.64
|
| Rate for Payer: Fidelis Medicare |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$159.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.02
|
| Rate for Payer: Humana Medicare |
$91.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$159.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$138.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$95.57
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$184.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$184.50
|
| Rate for Payer: United Healthcare Medicare |
$91.02
|
| Rate for Payer: WellCare Medicare |
$135.30
|
|
|
DOBUTAMINE 5%DEXTROSE 250MG
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
4471209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.72
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
DOBUTAMINE HYDROCHLORIDE INJ, PER 250 MG
|
Facility
OP
|
$61.03
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
4450003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$49.13 |
| Rate for Payer: Aetna of NY Commercial |
$33.57
|
| Rate for Payer: Aetna of NY Medicare |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.52
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: CDPHP Commercial |
$49.13
|
| Rate for Payer: CDPHP Medicare |
$22.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.82
|
| Rate for Payer: EmblemHealth Medicaid |
$48.82
|
| Rate for Payer: EmblemHealth Medicare |
$20.75
|
| Rate for Payer: EmblemHealth Select Care |
$9.26
|
| Rate for Payer: Fidelis Medicare |
$23.26
|
| Rate for Payer: Galaxy Health Commercial |
$39.67
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.58
|
| Rate for Payer: Humana Medicare |
$22.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$22.58
|
| Rate for Payer: WellCare Medicare |
$33.57
|
|
|
DOBUTAMINE HYDROCHLORIDE INJ, PER 250 MG
|
Facility
OP
|
$17.25
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
4400248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna of NY Commercial |
$9.49
|
| Rate for Payer: Aetna of NY Medicare |
$7.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.62
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: CDPHP Commercial |
$13.89
|
| Rate for Payer: CDPHP Medicare |
$6.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.80
|
| Rate for Payer: EmblemHealth Medicaid |
$13.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.86
|
| Rate for Payer: EmblemHealth Select Care |
$9.26
|
| Rate for Payer: Fidelis Medicare |
$6.57
|
| Rate for Payer: Galaxy Health Commercial |
$11.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.38
|
| Rate for Payer: Humana Medicare |
$6.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$6.38
|
| Rate for Payer: WellCare Medicare |
$9.49
|
|
