CANALITH REPOSITIONING PROC (MOD 59)
|
Facility
|
IP
|
$130.00
|
|
Service Code
|
HCPCS 95992 GP,59
|
Hospital Charge Code |
4650391
|
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 (MOD 59 W KX)
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS 95992 GP,59,KX
|
Hospital Charge Code |
4650443
|
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 W KX)
|
Facility
|
IP
|
$130.00
|
|
Service Code
|
HCPCS 95992 GP,59,KX
|
Hospital Charge Code |
4650443
|
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 (W/ KX)
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS 95992 GP,KX
|
Hospital Charge Code |
4650339
|
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 (W/ KX)
|
Facility
|
IP
|
$130.00
|
|
Service Code
|
HCPCS 95992 GP,KX
|
Hospital Charge Code |
4650339
|
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
|
|
CANE
|
Facility
|
OP
|
$38.00
|
|
Hospital Charge Code |
4602606
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$12.92 |
Max. Negotiated Rate |
$30.59 |
Rate for Payer: Aetna of NY Commercial |
$26.60
|
Rate for Payer: Aetna of NY Medicare |
$17.48
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
Rate for Payer: Cash Price |
$28.50
|
Rate for Payer: CDPHP Commercial |
$30.59
|
Rate for Payer: CDPHP Medicare |
$14.06
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
Rate for Payer: EmblemHealth Medicaid |
$30.40
|
Rate for Payer: EmblemHealth Medicare |
$12.92
|
Rate for Payer: EmblemHealth Select Care |
$27.36
|
Rate for Payer: Fidelis Medicare |
$14.48
|
Rate for Payer: Galaxy Health Commercial |
$24.70
|
Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
Rate for Payer: Humana Medicare |
$14.06
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
Rate for Payer: United Healthcare Medicare |
$14.06
|
Rate for Payer: WellCare Medicare |
$20.90
|
|
CANE
|
Facility
|
IP
|
$38.00
|
|
Hospital Charge Code |
4479076
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$24.70 |
Max. Negotiated Rate |
$24.70 |
Rate for Payer: Cash Price |
$28.50
|
Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
CANE
|
Facility
|
OP
|
$38.00
|
|
Hospital Charge Code |
4479076
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$12.92 |
Max. Negotiated Rate |
$30.59 |
Rate for Payer: Aetna of NY Commercial |
$26.60
|
Rate for Payer: Aetna of NY Medicare |
$17.48
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
Rate for Payer: Cash Price |
$28.50
|
Rate for Payer: CDPHP Commercial |
$30.59
|
Rate for Payer: CDPHP Medicare |
$14.06
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
Rate for Payer: EmblemHealth Medicaid |
$30.40
|
Rate for Payer: EmblemHealth Medicare |
$12.92
|
Rate for Payer: EmblemHealth Select Care |
$27.36
|
Rate for Payer: Fidelis Medicare |
$14.48
|
Rate for Payer: Galaxy Health Commercial |
$24.70
|
Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
Rate for Payer: Humana Medicare |
$14.06
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
Rate for Payer: United Healthcare Medicare |
$14.06
|
Rate for Payer: WellCare Medicare |
$20.90
|
|
CANE
|
Facility
|
IP
|
$38.00
|
|
Hospital Charge Code |
4602606
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$24.70 |
Max. Negotiated Rate |
$24.70 |
Rate for Payer: Cash Price |
$28.50
|
Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
CANNULA 20GX100MMX10MM
|
Facility
|
OP
|
$795.00
|
|
Hospital Charge Code |
4479216
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$270.30 |
Max. Negotiated Rate |
$639.98 |
Rate for Payer: Aetna of NY Commercial |
$556.50
|
Rate for Payer: Aetna of NY Medicare |
$365.70
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$596.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$596.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$294.15
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$397.50
|
Rate for Payer: Cash Price |
$596.25
|
Rate for Payer: CDPHP Commercial |
$639.98
|
Rate for Payer: CDPHP Medicare |
$294.15
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$636.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$636.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$636.00
|
Rate for Payer: EmblemHealth Medicaid |
$636.00
|
Rate for Payer: EmblemHealth Medicare |
$270.30
|
Rate for Payer: EmblemHealth Select Care |
$572.40
|
Rate for Payer: Fidelis Medicare |
$302.97
|
Rate for Payer: Galaxy Health Commercial |
$516.75
|
Rate for Payer: Hamaspik Choice Medicare |
$294.15
|
Rate for Payer: Humana Medicare |
$294.15
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$556.50
|
Rate for Payer: Local 1199SEIU Medicare |
$365.70
|
Rate for Payer: MVP Health Care of NY Commercial |
$596.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$447.58
|
Rate for Payer: MVP Health Care of NY Medicare |
$308.86
|
Rate for Payer: United Healthcare Medicare |
$294.15
|
Rate for Payer: WellCare Medicare |
$437.25
|
|
CANNULA 20GX100MMX10MM
|
Facility
|
IP
|
$795.00
|
|
Hospital Charge Code |
4479216
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$516.75 |
Max. Negotiated Rate |
$516.75 |
Rate for Payer: Cash Price |
$596.25
|
Rate for Payer: Galaxy Health Commercial |
$516.75
|
|
CANNULA CURVED SHARP 10MMX100MM 20GA
|
Facility
|
OP
|
$79.00
|
|
Hospital Charge Code |
4479273
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$26.86 |
Max. Negotiated Rate |
$63.60 |
Rate for Payer: Aetna of NY Commercial |
$55.30
|
Rate for Payer: Aetna of NY Medicare |
$36.34
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
Rate for Payer: Cash Price |
$59.25
|
Rate for Payer: CDPHP Commercial |
$63.60
|
Rate for Payer: CDPHP Medicare |
$29.23
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.20
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
Rate for Payer: EmblemHealth Medicaid |
$63.20
|
Rate for Payer: EmblemHealth Medicare |
$26.86
|
Rate for Payer: EmblemHealth Select Care |
$56.88
|
Rate for Payer: Fidelis Medicare |
$30.11
|
Rate for Payer: Galaxy Health Commercial |
$51.35
|
Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
Rate for Payer: Humana Medicare |
$29.23
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.30
|
Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
Rate for Payer: MVP Health Care of NY Commercial |
$59.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.48
|
Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
Rate for Payer: United Healthcare Medicare |
$29.23
|
Rate for Payer: WellCare Medicare |
$43.45
|
|
CANNULA CURVED SHARP 10MMX100MM 20GA
|
Facility
|
IP
|
$79.00
|
|
Hospital Charge Code |
4479273
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$51.35 |
Max. Negotiated Rate |
$51.35 |
Rate for Payer: Cash Price |
$59.25
|
Rate for Payer: Galaxy Health Commercial |
$51.35
|
|
CAPSUREFIX NOVUS
|
Facility
|
OP
|
$2,407.00
|
|
Hospital Charge Code |
4471352
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$818.38 |
Max. Negotiated Rate |
$1,937.64 |
Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: CDPHP Commercial |
$1,937.64
|
Rate for Payer: CDPHP Medicare |
$890.59
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
Rate for Payer: EmblemHealth Medicare |
$818.38
|
Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
Rate for Payer: Fidelis Medicare |
$917.31
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
Rate for Payer: Humana Medicare |
$890.59
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
Rate for Payer: United Healthcare Medicare |
$890.59
|
Rate for Payer: WellCare Medicare |
$1,323.85
|
|
CAPSUREFIX NOVUS
|
Facility
|
IP
|
$2,407.00
|
|
Hospital Charge Code |
4471352
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,564.55 |
Max. Negotiated Rate |
$1,564.55 |
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
|
CAPSUREFIX NOVUS II
|
Facility
|
OP
|
$2,407.00
|
|
Hospital Charge Code |
4471351
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$818.38 |
Max. Negotiated Rate |
$1,937.64 |
Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: CDPHP Commercial |
$1,937.64
|
Rate for Payer: CDPHP Medicare |
$890.59
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
Rate for Payer: EmblemHealth Medicare |
$818.38
|
Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
Rate for Payer: Fidelis Medicare |
$917.31
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
Rate for Payer: Humana Medicare |
$890.59
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
Rate for Payer: United Healthcare Medicare |
$890.59
|
Rate for Payer: WellCare Medicare |
$1,323.85
|
|
CAPSUREFIX NOVUS II
|
Facility
|
IP
|
$2,407.00
|
|
Hospital Charge Code |
4471351
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,564.55 |
Max. Negotiated Rate |
$1,564.55 |
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
|
CAPSUREFIX NOVUS III
|
Facility
|
OP
|
$2,407.00
|
|
Hospital Charge Code |
4471350
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$818.38 |
Max. Negotiated Rate |
$1,937.64 |
Rate for Payer: Aetna of NY Commercial |
$1,684.90
|
Rate for Payer: Aetna of NY Medicare |
$1,107.22
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,805.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.59
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,203.50
|
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: CDPHP Commercial |
$1,937.64
|
Rate for Payer: CDPHP Medicare |
$890.59
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,925.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,925.60
|
Rate for Payer: EmblemHealth Medicaid |
$1,925.60
|
Rate for Payer: EmblemHealth Medicare |
$818.38
|
Rate for Payer: EmblemHealth Select Care |
$1,733.04
|
Rate for Payer: Fidelis Medicare |
$917.31
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
Rate for Payer: Hamaspik Choice Medicare |
$890.59
|
Rate for Payer: Humana Medicare |
$890.59
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,684.90
|
Rate for Payer: Local 1199SEIU Medicare |
$1,107.22
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,805.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,355.14
|
Rate for Payer: MVP Health Care of NY Medicare |
$935.12
|
Rate for Payer: United Healthcare Medicare |
$890.59
|
Rate for Payer: WellCare Medicare |
$1,323.85
|
|
CAPSUREFIX NOVUS III
|
Facility
|
IP
|
$2,407.00
|
|
Hospital Charge Code |
4471350
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,564.55 |
Max. Negotiated Rate |
$1,564.55 |
Rate for Payer: Cash Price |
$1,805.25
|
Rate for Payer: Galaxy Health Commercial |
$1,564.55
|
|
CAPTOPRIL 12.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
Service Code
|
NDC 51079086301
|
Hospital Charge Code |
4400128
|
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
|
|
CAPTOPRIL 12.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
Service Code
|
NDC 51079086301
|
Hospital Charge Code |
4400128
|
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
|
|
CAPTOPRIL RENAL
|
Facility
|
IP
|
$1,547.00
|
|
Service Code
|
HCPCS 78708
|
Hospital Charge Code |
4210034
|
Hospital Revenue Code
|
341
|
Min. Negotiated Rate |
$1,005.55 |
Max. Negotiated Rate |
$1,005.55 |
Rate for Payer: Cash Price |
$1,160.25
|
Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
|
CAPTOPRIL RENAL
|
Facility
|
OP
|
$1,547.00
|
|
Service Code
|
HCPCS 78708
|
Hospital Charge Code |
4210034
|
Hospital Revenue Code
|
341
|
Min. Negotiated Rate |
$101.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
Rate for Payer: Aetna of NY Medicare |
$711.62
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,160.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,160.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
Rate for Payer: Cash Price |
$1,160.25
|
Rate for Payer: Cash Price |
$1,160.25
|
Rate for Payer: CDPHP Commercial |
$1,245.34
|
Rate for Payer: CDPHP Medicare |
$572.39
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,082.90
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
Rate for Payer: EmblemHealth Medicare |
$525.98
|
Rate for Payer: EmblemHealth Select Care |
$1,005.55
|
Rate for Payer: Fidelis Medicare |
$589.56
|
Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
Rate for Payer: Humana Medicare |
$572.39
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
Rate for Payer: MVP Health Care of NY Commercial |
$1,160.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$870.96
|
Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.00
|
Rate for Payer: United Healthcare Commercial |
$1,500.00
|
Rate for Payer: United Healthcare Medicare |
$572.39
|
Rate for Payer: WellCare Medicare |
$850.85
|
|
CARBAMAZEPINE 200MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
Service Code
|
NDC 00904617261
|
Hospital Charge Code |
4400131
|
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
|
|
CARBAMAZEPINE 200MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
Service Code
|
NDC 00904617261
|
Hospital Charge Code |
4400131
|
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
|
|