|
CALAMINE/ZINC OXIDE OINT 113 GM
|
Facility
|
OP
|
$13.65
|
|
|
Service Code
|
NDC 64980032212
|
| Hospital Charge Code |
4400126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Aetna of NY Commercial |
$9.56
|
| Rate for Payer: Aetna of NY Medicare |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.82
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: CDPHP Commercial |
$10.99
|
| Rate for Payer: CDPHP Medicare |
$5.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.92
|
| Rate for Payer: EmblemHealth Medicaid |
$10.92
|
| Rate for Payer: EmblemHealth Medicare |
$4.64
|
| Rate for Payer: EmblemHealth Select Care |
$9.83
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.05
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.30
|
| Rate for Payer: United Healthcare Medicare |
$5.05
|
| Rate for Payer: WellCare Medicare |
$7.51
|
|
|
CALAMINE/ZINC OXIDE OINT 113 GM
|
Facility
|
IP
|
$13.65
|
|
|
Service Code
|
NDC 64980032212
|
| Hospital Charge Code |
4400126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Galaxy Health Commercial |
$8.87
|
| Rate for Payer: WellCare Medicare |
$7.51
|
|
|
CALCITONIN
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
4301152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Galaxy Health Commercial |
$172.90
|
|
|
CALCITONIN
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
4301152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$214.13 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$122.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$133.00
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: CDPHP Commercial |
$214.13
|
| Rate for Payer: CDPHP Medicare |
$98.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.80
|
| Rate for Payer: EmblemHealth Medicaid |
$212.80
|
| Rate for Payer: EmblemHealth Medicare |
$90.44
|
| Rate for Payer: EmblemHealth Select Care |
$159.60
|
| Rate for Payer: Fidelis Medicare |
$101.37
|
| Rate for Payer: Galaxy Health Commercial |
$172.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.42
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$199.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.79
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: United Healthcare Medicare |
$98.42
|
| Rate for Payer: WellCare Medicare |
$146.30
|
|
|
CALCITRATE ORAL
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904527260
|
| Hospital Charge Code |
4409233
|
|
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
|
|
|
CALCITRATE ORAL
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904527260
|
| Hospital Charge Code |
4409233
|
|
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
|
|
|
CALCITRIOL CAPSULE 0.25 MCG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
4409138
|
|
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
|
|
|
CALCITRIOL CAPSULE 0.25 MCG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
4409138
|
|
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
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
4409182
|
|
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
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
4409182
|
|
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
|
|
|
CALCIUM CARBONATE 500MG CHEW 150 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 37205021047
|
| Hospital Charge Code |
4400122
|
|
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
|
|
|
CALCIUM CARBONATE 500MG CHEW 150 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 37205021047
|
| Hospital Charge Code |
4400122
|
|
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
|
|
|
CALCIUM CHLORIDE 100MG/ML ANSY 10X10ML
|
Facility
|
IP
|
$33.48
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
4400123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: Galaxy Health Commercial |
$21.76
|
| Rate for Payer: WellCare Medicare |
$18.41
|
|
|
CALCIUM CHLORIDE 100MG/ML ANSY 10X10ML
|
Facility
|
OP
|
$33.48
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
4400123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of NY Commercial |
$23.44
|
| Rate for Payer: Aetna of NY Medicare |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.74
|
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: CDPHP Commercial |
$26.95
|
| Rate for Payer: CDPHP Medicare |
$12.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.78
|
| Rate for Payer: EmblemHealth Medicaid |
$26.78
|
| Rate for Payer: EmblemHealth Medicare |
$11.38
|
| Rate for Payer: EmblemHealth Select Care |
$24.11
|
| Rate for Payer: Fidelis Medicare |
$12.76
|
| Rate for Payer: Galaxy Health Commercial |
$21.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.39
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.01
|
| Rate for Payer: United Healthcare Medicare |
$12.39
|
| Rate for Payer: WellCare Medicare |
$18.41
|
|
|
CALCIUM GLUCONATE, PER 10 ML
|
Facility
|
IP
|
$20.09
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4408957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Aetna of NY Commercial |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.05
|
| Rate for Payer: Galaxy Health Commercial |
$13.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.05
|
| Rate for Payer: WellCare Medicare |
$11.05
|
|
|
CALCIUM GLUCONATE, PER 10 ML
|
Facility
|
OP
|
$20.09
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4408957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Aetna of NY Commercial |
$11.05
|
| Rate for Payer: Aetna of NY Medicare |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.04
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: CDPHP Commercial |
$16.17
|
| Rate for Payer: CDPHP Medicare |
$7.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.07
|
| Rate for Payer: EmblemHealth Medicaid |
$16.07
|
| Rate for Payer: EmblemHealth Medicare |
$6.83
|
| Rate for Payer: EmblemHealth Select Care |
$0.05
|
| Rate for Payer: Fidelis Medicare |
$7.66
|
| Rate for Payer: Galaxy Health Commercial |
$13.06
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.43
|
| Rate for Payer: Humana Medicare |
$7.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$7.43
|
| Rate for Payer: WellCare Medicare |
$11.05
|
|
|
CALCIUM SERUM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
4300141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
CALCIUM SERUM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
4300141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
4302025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
4302025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
CALDOLOR 800 MG/200 ML BAG 1 ea, 200 mL
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
NDC 66220028411
|
| Hospital Charge Code |
4401437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Galaxy Health Commercial |
$48.10
|
| Rate for Payer: WellCare Medicare |
$40.70
|
|
|
CALDOLOR 800 MG/200 ML BAG 1 ea, 200 mL
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
NDC 66220028411
|
| Hospital Charge Code |
4401437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Aetna of NY Commercial |
$51.80
|
| Rate for Payer: Aetna of NY Medicare |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$55.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$55.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.00
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: CDPHP Commercial |
$59.57
|
| Rate for Payer: CDPHP Medicare |
$27.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$59.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$59.20
|
| Rate for Payer: EmblemHealth Medicaid |
$59.20
|
| Rate for Payer: EmblemHealth Medicare |
$25.16
|
| Rate for Payer: EmblemHealth Select Care |
$53.28
|
| Rate for Payer: Fidelis Medicare |
$28.20
|
| Rate for Payer: Galaxy Health Commercial |
$48.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.38
|
| Rate for Payer: Humana Medicare |
$27.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.75
|
| Rate for Payer: United Healthcare Medicare |
$27.38
|
| Rate for Payer: WellCare Medicare |
$40.70
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP
|
| Hospital Charge Code |
4650076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP
|
| Hospital Charge Code |
4650076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
|
CANALITH REPOSITIONING PROC (MOD 59)
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 95992 GP,59
|
| Hospital Charge Code |
4650391
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: CDPHP Commercial |
$104.65
|
| Rate for Payer: CDPHP Medicare |
$48.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.00
|
| Rate for Payer: EmblemHealth Medicaid |
$104.00
|
| Rate for Payer: EmblemHealth Medicare |
$44.20
|
| Rate for Payer: EmblemHealth Select Care |
$93.60
|
| Rate for Payer: Fidelis Medicare |
$49.54
|
| Rate for Payer: Galaxy Health Commercial |
$84.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.10
|
| Rate for Payer: Humana Medicare |
$48.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$48.10
|
| Rate for Payer: WellCare Medicare |
$71.50
|
|
