|
carBAMazepine ER 100 MG TABLET 100 mcg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
4401940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
carBAMazepine ER 100 MG TABLET 100 mcg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
4401940
|
|
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
|
|
|
carBAMazepine ER 400 MG TABLET 400 mg, 100 eaches
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 71930007412
|
| Hospital Charge Code |
4401935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
carBAMazepine ER 400 MG TABLET 400 mg, 100 eaches
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 71930007412
|
| Hospital Charge Code |
4401935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$8.40
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
CARBAMIDE PEROXIDE 0.065 DROP 15 ML
|
Facility
|
OP
|
$15.36
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
4400264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$12.36 |
| Rate for Payer: Aetna of NY Commercial |
$10.75
|
| Rate for Payer: Aetna of NY Medicare |
$7.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.68
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: CDPHP Commercial |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$5.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.29
|
| Rate for Payer: EmblemHealth Medicaid |
$12.29
|
| Rate for Payer: EmblemHealth Medicare |
$5.22
|
| Rate for Payer: EmblemHealth Select Care |
$11.06
|
| Rate for Payer: Fidelis Medicare |
$5.85
|
| Rate for Payer: Galaxy Health Commercial |
$9.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.68
|
| Rate for Payer: Humana Medicare |
$5.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.97
|
| Rate for Payer: United Healthcare Medicare |
$5.68
|
| Rate for Payer: WellCare Medicare |
$8.45
|
|
|
CARBAMIDE PEROXIDE 0.065 DROP 15 ML
|
Facility
|
IP
|
$15.36
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
4400264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Galaxy Health Commercial |
$9.98
|
| Rate for Payer: WellCare Medicare |
$8.45
|
|
|
CARBIDOPA/LEVODOPA 25-100MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
4400132
|
|
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
|
|
|
CARBIDOPA/LEVODOPA 25-100MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
4400132
|
|
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
|
|
|
CARBIDOPA-LEVODOPA 25-250 TAB 1 ea, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084009411
|
| Hospital Charge Code |
4401433
|
|
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
|
|
|
CARBIDOPA-LEVODOPA 25-250 TAB 1 ea, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084009411
|
| Hospital Charge Code |
4401433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CARBIDOPA-LEVO ER 25-100 TAB 1 ea, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
4401432
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CARBIDOPA-LEVO ER 25-100 TAB 1 ea, 1 each
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
4401432
|
|
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
|
|
|
CARBIDOPE/LEVODOPA EXTENDED RELEASE 25/1
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
4409221
|
|
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
|
|
|
CARBIDOPE/LEVODOPA EXTENDED RELEASE 25/1
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
4409221
|
|
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
|
|
|
CARBOGEN PER RX UNLSTD PULM PROCEDURE
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
4530007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
CARBOGEN PER RX UNLSTD PULM PROCEDURE
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
4530007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$312.90
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$223.50
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$312.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$290.55
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$312.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.83
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
CARBON DIOXIDE (CO2)
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4300151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
CARBON DIOXIDE (CO2)
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4300151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$11.40
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
CARBOXYHEMOGLOBIN; QUANTITATIVE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
4302010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
|
|
CARBOXYHEMOGLOBIN; QUANTITATIVE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
4302010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Aetna of NY Commercial |
$28.60
|
| Rate for Payer: Aetna of NY Medicare |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: CDPHP Commercial |
$35.42
|
| Rate for Payer: CDPHP Medicare |
$16.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.20
|
| Rate for Payer: EmblemHealth Medicaid |
$35.20
|
| Rate for Payer: EmblemHealth Medicare |
$14.96
|
| Rate for Payer: EmblemHealth Select Care |
$26.40
|
| Rate for Payer: Fidelis Medicare |
$16.77
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.28
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.09
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.11
|
| Rate for Payer: United Healthcare Commercial |
$33.00
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WellCare Medicare |
$24.20
|
|
|
CARBOXY HGB
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4301017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
CARBOXY HGB
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
4301017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$12.35
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$11.40
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
CARDENE IV SOLUTION 20 MG / 200 ML
|
Facility
|
IP
|
$352.26
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
4409163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.74 |
| Max. Negotiated Rate |
$228.97 |
| Rate for Payer: Cash Price |
$264.20
|
| Rate for Payer: Galaxy Health Commercial |
$228.97
|
| Rate for Payer: WellCare Medicare |
$193.74
|
|
|
CARDENE IV SOLUTION 20 MG / 200 ML
|
Facility
|
OP
|
$352.26
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
4409163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$283.57 |
| Rate for Payer: Aetna of NY Commercial |
$246.58
|
| Rate for Payer: Aetna of NY Medicare |
$162.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$264.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$264.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$130.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$176.13
|
| Rate for Payer: Cash Price |
$264.20
|
| Rate for Payer: CDPHP Commercial |
$283.57
|
| Rate for Payer: CDPHP Medicare |
$130.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$281.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$281.81
|
| Rate for Payer: EmblemHealth Medicaid |
$281.81
|
| Rate for Payer: EmblemHealth Medicare |
$119.77
|
| Rate for Payer: EmblemHealth Select Care |
$253.63
|
| Rate for Payer: Fidelis Medicare |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$228.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$130.34
|
| Rate for Payer: Humana Medicare |
$130.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$246.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$198.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$136.85
|
| Rate for Payer: United Healthcare Medicare |
$130.34
|
| Rate for Payer: WellCare Medicare |
$193.74
|
|
|
CARDIAC BLD POOL MUGA SCAN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4210009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
