|
HYDRATION IV INFUSION INIT 31-60 MINS
|
Facility
OP
|
$613.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4450103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$493.46 |
| Rate for Payer: Aetna of NY Commercial |
$429.10
|
| Rate for Payer: Aetna of NY Medicare |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$226.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$306.50
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: CDPHP Commercial |
$493.46
|
| Rate for Payer: CDPHP Medicare |
$226.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$490.40
|
| Rate for Payer: EmblemHealth Medicaid |
$490.40
|
| Rate for Payer: EmblemHealth Medicare |
$208.42
|
| Rate for Payer: EmblemHealth Select Care |
$441.36
|
| Rate for Payer: Fidelis Medicare |
$233.61
|
| Rate for Payer: Galaxy Health Commercial |
$398.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$226.81
|
| Rate for Payer: Humana Medicare |
$226.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$429.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$281.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$345.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$238.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$459.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
| Rate for Payer: United Healthcare Medicare |
$226.81
|
| Rate for Payer: WellCare Medicare |
$337.15
|
|
|
HYDROCHLOROTHIAZIDE 12.5MG CAPS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400358
|
|
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
|
|
|
HYDROCHLOROTHIAZIDE 25MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400359
|
|
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
|
|
|
HYDROCODONE/APAP 5/325 TABLET
|
Facility
OP
|
$6.85
|
|
| Hospital Charge Code |
4409117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of NY Commercial |
$4.80
|
| Rate for Payer: Aetna of NY Medicare |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.42
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: CDPHP Commercial |
$5.51
|
| Rate for Payer: CDPHP Medicare |
$2.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.48
|
| Rate for Payer: EmblemHealth Medicaid |
$5.48
|
| Rate for Payer: EmblemHealth Medicare |
$2.33
|
| Rate for Payer: EmblemHealth Select Care |
$4.93
|
| Rate for Payer: Fidelis Medicare |
$2.61
|
| Rate for Payer: Galaxy Health Commercial |
$4.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.53
|
| Rate for Payer: Humana Medicare |
$2.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.66
|
| Rate for Payer: United Healthcare Medicare |
$2.53
|
| Rate for Payer: WellCare Medicare |
$3.77
|
|
|
HYDROCOLLOID 6X6IN
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
4471503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
HYDROCORTISONE 10MG TABS 100 EA
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
4400364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.72
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
HYDROCORTISONE 2.5% CRM 30 GM
|
Facility
OP
|
$31.67
|
|
| Hospital Charge Code |
4400363
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna of NY Commercial |
$22.17
|
| Rate for Payer: Aetna of NY Medicare |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.84
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: CDPHP Commercial |
$25.49
|
| Rate for Payer: CDPHP Medicare |
$11.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.34
|
| Rate for Payer: EmblemHealth Medicaid |
$25.34
|
| Rate for Payer: EmblemHealth Medicare |
$10.77
|
| Rate for Payer: EmblemHealth Select Care |
$22.80
|
| Rate for Payer: Fidelis Medicare |
$12.07
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.72
|
| Rate for Payer: Humana Medicare |
$11.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.30
|
| Rate for Payer: United Healthcare Medicare |
$11.72
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
HYDROCORTISONE ACETATE 25MG SUPP 12 EA
|
Facility
OP
|
$70.04
|
|
| Hospital Charge Code |
4400063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$56.38 |
| 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) Blue Access/Small Group |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.02
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: CDPHP Commercial |
$56.38
|
| 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 |
$26.69
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.91
|
| Rate for Payer: Humana Medicare |
$25.91
|
| 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 |
$27.21
|
| Rate for Payer: United Healthcare Medicare |
$25.91
|
| Rate for Payer: WellCare Medicare |
$38.52
|
|
|
HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
|
Facility
OP
|
$34.76
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
4400712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna of NY Commercial |
$19.12
|
| Rate for Payer: Aetna of NY Medicare |
$15.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.38
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: CDPHP Commercial |
$27.98
|
| Rate for Payer: CDPHP Medicare |
$12.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.81
|
| Rate for Payer: EmblemHealth Medicaid |
$27.81
|
| Rate for Payer: EmblemHealth Medicare |
$11.82
|
| Rate for Payer: EmblemHealth Select Care |
$18.46
|
| Rate for Payer: Fidelis Medicare |
$13.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.86
|
| Rate for Payer: Humana Medicare |
$12.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.46
|
| Rate for Payer: United Healthcare Commercial |
$28.89
|
| Rate for Payer: United Healthcare Medicare |
$12.86
|
| Rate for Payer: WellCare Medicare |
$19.12
|
|
|
HYDROmorphone 1 MG/ML CARPUJCT 1 mg, 1 mL
|
Facility
OP
|
$9.50
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4401934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.76
|
| Rate for Payer: Aetna of NY Commercial |
$5.22
|
| Rate for Payer: Aetna of NY Medicare |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.75
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: CDPHP Commercial |
$7.65
|
| Rate for Payer: CDPHP Medicare |
$3.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.23
|
| Rate for Payer: EmblemHealth Select Care |
$4.76
|
| Rate for Payer: Fidelis Medicare |
$3.62
|
| Rate for Payer: Galaxy Health Commercial |
$6.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.52
|
| Rate for Payer: Humana Medicare |
$3.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.22
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$3.52
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
HYDROMORPHONE HCL 2MG TABS 4X25EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400367
|
|
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
|
|
|
HYDROMORPHONE INJ, UP TO 4 MG
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4400368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.76
|
| 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: 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 |
$4.76
|
| 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 |
$4.76
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.76
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROXYCHLOROQUINE 200 MG TAB
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4409026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
HYDROXYIREA 500 MG CAPSULE
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409208
|
|
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
|
|
|
HYDROXYZINE HCL INJ TO 25 MG
|
Facility
OP
|
$16.48
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
4400372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna of NY Commercial |
$9.06
|
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.24
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Commercial |
$13.27
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$13.87
|
| Rate for Payer: Fidelis Medicare |
$6.28
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.10
|
| Rate for Payer: Humana Medicare |
$6.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$22.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.87
|
| Rate for Payer: United Healthcare Commercial |
$22.47
|
| Rate for Payer: United Healthcare Medicare |
$6.10
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
HYDROXYZINE PAMOATE 25MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400373
|
|
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
|
|
|
HYOSCYAMINE SULFATE 0.125MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400375
|
|
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
|
|
|
I131 IODIDE CAP RX PER 1 MCI THERA
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
4210077
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.50
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.15
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
IAAD IA SEVERE AQTRESPIRSYND CORONAVIRUS
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 87426
|
| Hospital Charge Code |
4302022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna of NY Commercial |
$105.30
|
| Rate for Payer: Aetna of NY Medicare |
$74.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$81.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: CDPHP Commercial |
$130.41
|
| Rate for Payer: CDPHP Medicare |
$59.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.60
|
| Rate for Payer: EmblemHealth Medicaid |
$129.60
|
| Rate for Payer: EmblemHealth Medicare |
$55.08
|
| Rate for Payer: Fidelis Medicare |
$61.74
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.94
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$121.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Medicare |
$59.94
|
| Rate for Payer: WellCare Medicare |
$89.10
|
|
|
IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
4302021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna of NY Commercial |
$105.30
|
| Rate for Payer: Aetna of NY Medicare |
$74.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$81.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: CDPHP Commercial |
$130.41
|
| Rate for Payer: CDPHP Medicare |
$59.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.60
|
| Rate for Payer: EmblemHealth Medicaid |
$129.60
|
| Rate for Payer: EmblemHealth Medicare |
$55.08
|
| Rate for Payer: Fidelis Medicare |
$61.74
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.94
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$121.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.79
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Medicare |
$59.94
|
| Rate for Payer: WellCare Medicare |
$89.10
|
|
|
IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 87637
|
| Hospital Charge Code |
4302028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.59 |
| Max. Negotiated Rate |
$355.81 |
| Rate for Payer: Aetna of NY Commercial |
$287.30
|
| Rate for Payer: Aetna of NY Medicare |
$203.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$221.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: CDPHP Commercial |
$355.81
|
| Rate for Payer: CDPHP Medicare |
$163.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$353.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$353.60
|
| Rate for Payer: EmblemHealth Medicaid |
$353.60
|
| Rate for Payer: EmblemHealth Medicare |
$150.28
|
| Rate for Payer: Fidelis Medicare |
$168.45
|
| Rate for Payer: Galaxy Health Commercial |
$287.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.54
|
| Rate for Payer: Humana Medicare |
$163.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$287.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$203.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$248.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$331.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$85.59
|
| Rate for Payer: United Healthcare Commercial |
$331.50
|
| Rate for Payer: United Healthcare Medicare |
$163.54
|
| Rate for Payer: WellCare Medicare |
$243.10
|
|
|
IBUPROFEN 200MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400378
|
|
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
|
|
|
IBUPROFEN 400MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400379
|
|
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
|
|
|
IBUPROFEN 600MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400380
|
|
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
|
|
|
IBUPROFEN 800MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400383
|
|
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
|
|
