|
0 3.5 METRIC POLYSORB BRAIDED
|
Facility
|
OP
|
$44.29
|
|
| Hospital Charge Code |
4478151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$35.43 |
| Rate for Payer: Aetna of NY Commercial |
$31.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.72
|
| Rate for Payer: Cash Price |
$33.22
|
| Rate for Payer: CDPHP Medicare |
$16.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.43
|
| Rate for Payer: EmblemHealth Medicaid |
$35.43
|
| Rate for Payer: EmblemHealth Medicare |
$15.06
|
| Rate for Payer: EmblemHealth Select Care |
$31.89
|
| Rate for Payer: Fidelis Medicare |
$17.72
|
| Rate for Payer: Galaxy Health Commercial |
$28.79
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.72
|
| Rate for Payer: Humana Medicare |
$17.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.64
|
| Rate for Payer: United Healthcare Medicare |
$17.72
|
| Rate for Payer: WellCare Medicare |
$24.36
|
|
|
0 3.5 METRIC POLYSORB BRAIDED
|
Facility
|
IP
|
$44.29
|
|
| Hospital Charge Code |
4478151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$28.79 |
| Rate for Payer: Cash Price |
$33.22
|
| Rate for Payer: Galaxy Health Commercial |
$28.79
|
|
|
0.45 % SODIUM CHLORIDE 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 409798509
|
| Hospital Charge Code |
4450019
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
|
|
0.45 % SODIUM CHLORIDE 1000 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 409798509
|
| Hospital Charge Code |
4450019
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Commercial |
$13.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$14.09
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
0.9 % SODIUM CHLORIDE 50 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 409798436
|
| Hospital Charge Code |
4450024
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
|
|
0.9 % SODIUM CHLORIDE 50 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 409798436
|
| Hospital Charge Code |
4450024
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
0 POLYSORB 3.5 12X18
|
Facility
|
OP
|
$81.37
|
|
| Hospital Charge Code |
4478146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna of NY Commercial |
$56.96
|
| Rate for Payer: Aetna of NY Medicare |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: CDPHP Medicare |
$30.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.10
|
| Rate for Payer: EmblemHealth Medicaid |
$65.10
|
| Rate for Payer: EmblemHealth Medicare |
$27.67
|
| Rate for Payer: EmblemHealth Select Care |
$58.59
|
| Rate for Payer: Fidelis Medicare |
$32.55
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.55
|
| Rate for Payer: Humana Medicare |
$32.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.21
|
| Rate for Payer: United Healthcare Medicare |
$32.55
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
0 POLYSORB 3.5 12X18
|
Facility
|
IP
|
$81.37
|
|
| Hospital Charge Code |
4478146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
|
|
0 TR CRON GS-22
|
Facility
|
OP
|
$78.28
|
|
| Hospital Charge Code |
4478157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$62.62 |
| Rate for Payer: Aetna of NY Commercial |
$54.80
|
| Rate for Payer: Aetna of NY Medicare |
$36.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$58.71
|
| Rate for Payer: CDPHP Medicare |
$28.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$62.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$62.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$62.62
|
| Rate for Payer: EmblemHealth Medicaid |
$62.62
|
| Rate for Payer: EmblemHealth Medicare |
$26.62
|
| Rate for Payer: EmblemHealth Select Care |
$56.36
|
| Rate for Payer: Fidelis Medicare |
$31.31
|
| Rate for Payer: Galaxy Health Commercial |
$50.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.31
|
| Rate for Payer: Humana Medicare |
$31.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$54.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.71
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.74
|
| Rate for Payer: United Healthcare Medicare |
$31.31
|
| Rate for Payer: WellCare Medicare |
$43.05
|
|
|
0 TR CRON GS-22
|
Facility
|
IP
|
$78.28
|
|
| Hospital Charge Code |
4478157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Cash Price |
$58.71
|
| Rate for Payer: Galaxy Health Commercial |
$50.88
|
|
|
100FT CORRUGATED TUBING
|
Facility
|
OP
|
$44.29
|
|
| Hospital Charge Code |
4478192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$35.43 |
| Rate for Payer: Aetna of NY Commercial |
$31.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.72
|
| Rate for Payer: Cash Price |
$33.22
|
| Rate for Payer: CDPHP Medicare |
$16.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.43
|
| Rate for Payer: EmblemHealth Medicaid |
$35.43
|
| Rate for Payer: EmblemHealth Medicare |
$15.06
|
| Rate for Payer: EmblemHealth Select Care |
$31.89
|
| Rate for Payer: Fidelis Medicare |
$17.72
|
| Rate for Payer: Galaxy Health Commercial |
$28.79
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.72
|
| Rate for Payer: Humana Medicare |
$17.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.64
|
| Rate for Payer: United Healthcare Medicare |
$17.72
|
| Rate for Payer: WellCare Medicare |
$24.36
|
|
|
100FT CORRUGATED TUBING
|
Facility
|
IP
|
$44.29
|
|
| Hospital Charge Code |
4478192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$28.79 |
| Rate for Payer: Cash Price |
$33.22
|
| Rate for Payer: Galaxy Health Commercial |
$28.79
|
|
|
10/2 FIRST FRACTURE KIT
|
Facility
|
IP
|
$14,741.36
|
|
| Hospital Charge Code |
4471967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,633.61 |
| Max. Negotiated Rate |
$10,318.95 |
| Rate for Payer: Aetna of NY Commercial |
$10,318.95
|
| Rate for Payer: Cash Price |
$11,056.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,370.68
|
| Rate for Payer: EmblemHealth Select Care |
$7,370.68
|
| Rate for Payer: Galaxy Health Commercial |
$9,581.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,318.95
|
| Rate for Payer: Multiplan Commercial |
$6,633.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,581.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,581.88
|
| Rate for Payer: WellCare Medicare |
$8,107.75
|
|
|
10/2 FIRST FRACTURE KIT
|
Facility
|
OP
|
$14,741.36
|
|
| Hospital Charge Code |
4471967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,211.20 |
| Max. Negotiated Rate |
$11,793.09 |
| Rate for Payer: Aetna of NY Commercial |
$10,318.95
|
| Rate for Payer: Aetna of NY Medicare |
$6,781.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,896.54
|
| Rate for Payer: Cash Price |
$11,056.02
|
| Rate for Payer: CDPHP Medicare |
$5,454.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,370.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,793.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,793.09
|
| Rate for Payer: EmblemHealth Medicaid |
$11,793.09
|
| Rate for Payer: EmblemHealth Medicare |
$5,012.06
|
| Rate for Payer: EmblemHealth Select Care |
$7,370.68
|
| Rate for Payer: Fidelis Medicare |
$5,896.54
|
| Rate for Payer: Galaxy Health Commercial |
$9,581.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,896.54
|
| Rate for Payer: Humana Medicare |
$5,896.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,318.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,781.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,581.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,581.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,191.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,211.20
|
| Rate for Payer: United Healthcare Medicare |
$5,896.54
|
| Rate for Payer: WellCare Medicare |
$8,107.75
|
|
|
10CC SALINE FLUSH
|
Facility
|
OP
|
$6.18
|
|
| Hospital Charge Code |
4471469
|
|
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
|
|
|
10CC SALINE FLUSH
|
Facility
|
IP
|
$6.18
|
|
| Hospital Charge Code |
4471469
|
|
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
|
|
|
10CMX5M COMPRILAN
|
Facility
|
IP
|
$23.69
|
|
| Hospital Charge Code |
4471081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
|
|
10CMX5M COMPRILAN
|
Facility
|
OP
|
$23.69
|
|
| Hospital Charge Code |
4471081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna of NY Commercial |
$16.58
|
| Rate for Payer: Aetna of NY Medicare |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.48
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: CDPHP Medicare |
$8.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.95
|
| Rate for Payer: EmblemHealth Medicaid |
$18.95
|
| Rate for Payer: EmblemHealth Medicare |
$8.05
|
| Rate for Payer: EmblemHealth Select Care |
$17.06
|
| Rate for Payer: Fidelis Medicare |
$9.48
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.48
|
| Rate for Payer: Humana Medicare |
$9.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.55
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WellCare Medicare |
$13.03
|
|
|
10FR 3CC FOLEY
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4478206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
10FR 3CC FOLEY
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4478206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
10FRX45" ENTERAL FEEDING TUBE
|
Facility
|
OP
|
$57.68
|
|
| Hospital Charge Code |
4478215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$46.14 |
| Rate for Payer: Aetna of NY Commercial |
$40.38
|
| Rate for Payer: Aetna of NY Medicare |
$26.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.07
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: CDPHP Medicare |
$21.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.14
|
| Rate for Payer: EmblemHealth Medicaid |
$46.14
|
| Rate for Payer: EmblemHealth Medicare |
$19.61
|
| Rate for Payer: EmblemHealth Select Care |
$41.53
|
| Rate for Payer: Fidelis Medicare |
$23.07
|
| Rate for Payer: Galaxy Health Commercial |
$37.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.07
|
| Rate for Payer: Humana Medicare |
$23.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.65
|
| Rate for Payer: United Healthcare Medicare |
$23.07
|
| Rate for Payer: WellCare Medicare |
$31.72
|
|
|
10FRX45" ENTERAL FEEDING TUBE
|
Facility
|
IP
|
$57.68
|
|
| Hospital Charge Code |
4478215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$37.49 |
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$37.49
|
|
|
10MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 409799309
|
| Hospital Charge Code |
4450025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna of NY Commercial |
$6.31
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.60
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.60
|
| Rate for Payer: Humana Medicare |
$3.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
10MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 409799309
|
| Hospital Charge Code |
4450025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
|
|
1.2 MICRON FILTER EXTENTION SE
|
Facility
|
OP
|
$38.11
|
|
| Hospital Charge Code |
4471902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: Aetna of NY Commercial |
$26.68
|
| Rate for Payer: Aetna of NY Medicare |
$17.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.24
|
| Rate for Payer: Cash Price |
$28.58
|
| Rate for Payer: CDPHP Medicare |
$14.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.49
|
| Rate for Payer: EmblemHealth Medicaid |
$30.49
|
| Rate for Payer: EmblemHealth Medicare |
$12.96
|
| Rate for Payer: EmblemHealth Select Care |
$27.44
|
| Rate for Payer: Fidelis Medicare |
$15.24
|
| Rate for Payer: Galaxy Health Commercial |
$24.77
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.24
|
| Rate for Payer: Humana Medicare |
$15.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare |
$15.24
|
| Rate for Payer: WellCare Medicare |
$20.96
|
|
