|
CILASTATIN SODIUM; IMIPENEM, PER 250 MG
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
4400650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna of NY Commercial |
$25.49
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.18
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Commercial |
$37.31
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.08
|
| Rate for Payer: EmblemHealth Medicaid |
$37.08
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$7.56
|
| Rate for Payer: Fidelis Medicare |
$17.66
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.15
|
| Rate for Payer: Humana Medicare |
$17.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.56
|
| Rate for Payer: United Healthcare Commercial |
$11.80
|
| Rate for Payer: United Healthcare Medicare |
$17.15
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
CILASTATIN SODIUM; IMIPENEM, PER 250 MG
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
4400651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna of NY Commercial |
$41.25
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.50
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Commercial |
$60.38
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.56
|
| Rate for Payer: Fidelis Medicare |
$28.58
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.75
|
| Rate for Payer: Humana Medicare |
$27.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.56
|
| Rate for Payer: United Healthcare Commercial |
$11.80
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
CILASTATIN SODIUM; IMIPENEM, PER 250 MG
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
4400650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Aetna of NY Commercial |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.56
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.56
|
| Rate for Payer: EmblemHealth Select Care |
$7.56
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.49
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
CINACALCET HCL 30MG TABS 30 EA
|
Facility
|
OP
|
$85.49
|
|
|
Service Code
|
NDC 55513007330
|
| Hospital Charge Code |
4400691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$68.82 |
| Rate for Payer: Aetna of NY Commercial |
$59.84
|
| Rate for Payer: Aetna of NY Medicare |
$39.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$42.74
|
| Rate for Payer: Cash Price |
$64.12
|
| Rate for Payer: CDPHP Commercial |
$68.82
|
| Rate for Payer: CDPHP Medicare |
$31.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$68.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.39
|
| Rate for Payer: EmblemHealth Medicaid |
$68.39
|
| Rate for Payer: EmblemHealth Medicare |
$29.07
|
| Rate for Payer: EmblemHealth Select Care |
$61.55
|
| Rate for Payer: Fidelis Medicare |
$32.58
|
| Rate for Payer: Galaxy Health Commercial |
$55.57
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.63
|
| Rate for Payer: Humana Medicare |
$31.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$59.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.21
|
| Rate for Payer: United Healthcare Medicare |
$31.63
|
| Rate for Payer: WellCare Medicare |
$47.02
|
|
|
CINACALCET HCL 30MG TABS 30 EA
|
Facility
|
IP
|
$85.49
|
|
|
Service Code
|
NDC 55513007330
|
| Hospital Charge Code |
4400691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Cash Price |
$64.12
|
| Rate for Payer: Galaxy Health Commercial |
$55.57
|
| Rate for Payer: WellCare Medicare |
$47.02
|
|
|
CIPROFLOXACIN HCL 250MG TABS 10X10EA
|
Facility
|
OP
|
$16.74
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
4400161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna of NY Commercial |
$11.72
|
| Rate for Payer: Aetna of NY Medicare |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.37
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: CDPHP Commercial |
$13.48
|
| Rate for Payer: CDPHP Medicare |
$6.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.39
|
| Rate for Payer: EmblemHealth Medicaid |
$13.39
|
| Rate for Payer: EmblemHealth Medicare |
$5.69
|
| Rate for Payer: EmblemHealth Select Care |
$12.05
|
| Rate for Payer: Fidelis Medicare |
$6.38
|
| Rate for Payer: Galaxy Health Commercial |
$10.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.19
|
| Rate for Payer: Humana Medicare |
$6.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.56
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.50
|
| Rate for Payer: United Healthcare Medicare |
$6.19
|
| Rate for Payer: WellCare Medicare |
$9.21
|
|
|
CIPROFLOXACIN HCL 250MG TABS 10X10EA
|
Facility
|
IP
|
$16.74
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
4400161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Galaxy Health Commercial |
$10.88
|
| Rate for Payer: WellCare Medicare |
$9.21
|
|
|
CIPROFLOXACIN HCL 500MG TABS 10X10EA
|
Facility
|
IP
|
$15.71
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
4400160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Galaxy Health Commercial |
$10.21
|
| Rate for Payer: WellCare Medicare |
$8.64
|
|
|
CIPROFLOXACIN HCL 500MG TABS 10X10EA
|
Facility
|
OP
|
$15.71
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
4400160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna of NY Commercial |
$11.00
|
| Rate for Payer: Aetna of NY Medicare |
$7.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.86
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: CDPHP Commercial |
$12.65
|
| Rate for Payer: CDPHP Medicare |
$5.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.57
|
| Rate for Payer: EmblemHealth Medicaid |
$12.57
|
| Rate for Payer: EmblemHealth Medicare |
$5.34
|
| Rate for Payer: EmblemHealth Select Care |
$11.31
|
| Rate for Payer: Fidelis Medicare |
$5.99
|
| Rate for Payer: Galaxy Health Commercial |
$10.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.81
|
| Rate for Payer: Humana Medicare |
$5.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.10
|
| Rate for Payer: United Healthcare Medicare |
$5.81
|
| Rate for Payer: WellCare Medicare |
$8.64
|
|
|
CIPROFLOXACIN IV INJ 200 MG
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
4450002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.41
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: CDPHP Commercial |
$8.71
|
| Rate for Payer: CDPHP Medicare |
$4.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.66
|
| Rate for Payer: EmblemHealth Medicaid |
$8.66
|
| Rate for Payer: EmblemHealth Medicare |
$3.68
|
| Rate for Payer: EmblemHealth Select Care |
$1.86
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.86
|
| Rate for Payer: United Healthcare Commercial |
$3.23
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CIPROFLOXACIN IV INJ 200 MG
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
4450002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.86
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.86
|
| Rate for Payer: EmblemHealth Select Care |
$1.86
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CIPROFLOXACIN OS
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
4409050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$53.89
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.59
|
| Rate for Payer: EmblemHealth Medicaid |
$61.59
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$55.43
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.74
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.34
|
|
|
CIPROFLOXACIN OS
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
4409050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$50.04 |
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Galaxy Health Commercial |
$50.04
|
| Rate for Payer: WellCare Medicare |
$42.34
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
4002047
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
4002047
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$4,691.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,662.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,940.66
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
CISTERNOGRAPHY
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
4210010
|
|
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
|
|
|
CISTERNOGRAPHY
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
4210010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$75.75 |
| 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 |
$75.75
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
CITALOPRAM HYDROBROMIDE 10MG TABS 10X10E
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
4400164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of NY Commercial |
$5.23
|
| Rate for Payer: Aetna of NY Medicare |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.74
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: CDPHP Commercial |
$6.01
|
| Rate for Payer: CDPHP Medicare |
$2.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.98
|
| Rate for Payer: EmblemHealth Medicaid |
$5.98
|
| Rate for Payer: EmblemHealth Medicare |
$2.54
|
| Rate for Payer: EmblemHealth Select Care |
$5.38
|
| Rate for Payer: Fidelis Medicare |
$2.85
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.76
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
CITALOPRAM HYDROBROMIDE 10MG TABS 10X10E
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
4400164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
CITALOPRAM HYDROBROMIDE 40MG TABS 10X10E
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
NDC 00904608661
|
| Hospital Charge Code |
4400166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna of NY Commercial |
$7.57
|
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.41
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: CDPHP Commercial |
$8.71
|
| Rate for Payer: CDPHP Medicare |
$4.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.66
|
| Rate for Payer: EmblemHealth Medicaid |
$8.66
|
| Rate for Payer: EmblemHealth Medicare |
$3.68
|
| Rate for Payer: EmblemHealth Select Care |
$7.79
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CITALOPRAM HYDROBROMIDE 40MG TABS 10X10E
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
NDC 00904608661
|
| Hospital Charge Code |
4400166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$19.06
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
4409103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$15.34 |
| Rate for Payer: Aetna of NY Commercial |
$13.34
|
| Rate for Payer: Aetna of NY Medicare |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.53
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: CDPHP Commercial |
$15.34
|
| Rate for Payer: CDPHP Medicare |
$7.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.25
|
| Rate for Payer: EmblemHealth Medicaid |
$15.25
|
| Rate for Payer: EmblemHealth Medicare |
$6.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.72
|
| Rate for Payer: Fidelis Medicare |
$7.26
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.05
|
| Rate for Payer: Humana Medicare |
$7.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.40
|
| Rate for Payer: United Healthcare Medicare |
$7.05
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.06
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
4409103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
CLAVICLE STRAP ANY SIZE
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
4472169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
CLAVICLE STRAP ANY SIZE
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
4472169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
|
