|
CULTURE STOOL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
4300244
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna of NY Commercial |
$18.20
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$16.80
|
| Rate for Payer: Fidelis Medicare |
$11.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
CULTURE STOOL
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
4300244
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
CULTURE THROAT (CULTURE AND SENSITIVITY)
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300246
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna of NY Commercial |
$16.90
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$15.60
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.40
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$19.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$19.50
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
CULTURE THROAT (CULTURE AND SENSITIVITY)
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300246
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
|
|
CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
4302011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
|
|
CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
4302011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of NY Commercial |
$39.00
|
| Rate for Payer: Aetna of NY Medicare |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: CDPHP Medicare |
$22.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.00
|
| Rate for Payer: EmblemHealth Medicaid |
$48.00
|
| Rate for Payer: EmblemHealth Medicare |
$20.40
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$39.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.00
|
| Rate for Payer: Humana Medicare |
$24.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$45.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Medicare |
$24.00
|
| Rate for Payer: WellCare Medicare |
$33.00
|
|
|
CULTURE URINE ROUTINE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
4300247
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$21.60
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.60
|
| Rate for Payer: Humana Medicare |
$21.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CULTURE URINE ROUTINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
4300247
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
CULTURE UROGENITAL
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300248
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
CULTURE UROGENITAL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300248
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
CULTURE VIRAL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
4300250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Galaxy Health Commercial |
$50.70
|
|
|
CULTURE VIRAL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
4300250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna of NY Commercial |
$50.70
|
| Rate for Payer: Aetna of NY Medicare |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.20
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: CDPHP Medicare |
$28.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$62.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$62.40
|
| Rate for Payer: EmblemHealth Medicaid |
$62.40
|
| Rate for Payer: EmblemHealth Medicare |
$26.52
|
| Rate for Payer: EmblemHealth Select Care |
$46.80
|
| Rate for Payer: Fidelis Medicare |
$31.20
|
| Rate for Payer: Galaxy Health Commercial |
$50.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.20
|
| Rate for Payer: Humana Medicare |
$31.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$58.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.70
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
| Rate for Payer: WellCare Medicare |
$42.90
|
|
|
CULTURE WOUND
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300249
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
CULTURE WOUND
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300249
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
CUTTERS/BURRS ULTIMATE SERIES
|
Facility
|
IP
|
$175.10
|
|
| Hospital Charge Code |
4471240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$113.81 |
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
|
|
CUTTERS/BURRS ULTIMATE SERIES
|
Facility
|
OP
|
$175.10
|
|
| Hospital Charge Code |
4471240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna of NY Commercial |
$122.57
|
| Rate for Payer: Aetna of NY Medicare |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.04
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: CDPHP Medicare |
$64.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.08
|
| Rate for Payer: EmblemHealth Medicaid |
$140.08
|
| Rate for Payer: EmblemHealth Medicare |
$59.53
|
| Rate for Payer: EmblemHealth Select Care |
$126.07
|
| Rate for Payer: Fidelis Medicare |
$70.04
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.04
|
| Rate for Payer: Humana Medicare |
$70.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$70.04
|
| Rate for Payer: WellCare Medicare |
$96.31
|
|
|
CVC/PICC DRESSING CHANGE KIT
|
Facility
|
OP
|
$70.04
|
|
| Hospital Charge Code |
4479204
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$56.03 |
| Rate for Payer: Aetna of NY Commercial |
$49.03
|
| Rate for Payer: Aetna of NY Medicare |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.02
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: CDPHP Medicare |
$25.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.03
|
| Rate for Payer: EmblemHealth Medicaid |
$56.03
|
| Rate for Payer: EmblemHealth Medicare |
$23.81
|
| Rate for Payer: EmblemHealth Select Care |
$50.43
|
| Rate for Payer: Fidelis Medicare |
$28.02
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.02
|
| Rate for Payer: Humana Medicare |
$28.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$28.02
|
| Rate for Payer: WellCare Medicare |
$38.52
|
|
|
CVC/PICC DRESSING CHANGE KIT
|
Facility
|
IP
|
$70.04
|
|
| Hospital Charge Code |
4479204
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.53 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
|
|
Cyanocobalamin 1000 MCG Tab
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
4400832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
Cyanocobalamin 1000 MCG Tab
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
4400832
|
|
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
|
|
|
CYCLOBENZAPRINE 5 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268019011
|
| Hospital Charge Code |
4401264
|
|
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
|
|
|
CYCLOBENZAPRINE 5 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268019011
|
| Hospital Charge Code |
4401264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CYCLOBENZAPRINE HCL 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904780961
|
| Hospital Charge Code |
4400202
|
|
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
|
|
|
CYCLOBENZAPRINE HCL 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904780961
|
| Hospital Charge Code |
4400202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CYCLOPENTOLATE 1 % OS
|
Facility
|
OP
|
$57.17
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
4409051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$45.74 |
| Rate for Payer: Aetna of NY Commercial |
$40.02
|
| Rate for Payer: Aetna of NY Medicare |
$26.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.87
|
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: CDPHP Medicare |
$21.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.74
|
| Rate for Payer: EmblemHealth Medicaid |
$45.74
|
| Rate for Payer: EmblemHealth Medicare |
$19.44
|
| Rate for Payer: EmblemHealth Select Care |
$41.16
|
| Rate for Payer: Fidelis Medicare |
$22.87
|
| Rate for Payer: Galaxy Health Commercial |
$37.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.87
|
| Rate for Payer: Humana Medicare |
$22.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$22.87
|
| Rate for Payer: WellCare Medicare |
$31.44
|
|
