|
0 3.5 METRIC POLYSORB BRAIDED
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
4478151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
|
|
0 3.5 METRIC POLYSORB BRAIDED
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
4478151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$34.62 |
| Rate for Payer: Aetna of NY Commercial |
$30.10
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.50
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Commercial |
$34.62
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$30.96
|
| Rate for Payer: Fidelis Medicare |
$16.39
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.91
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
0.45 % SODIUM CHLORIDE 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 00409798509
|
| 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 00409798509
|
| Hospital Charge Code |
4450019
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.75 |
| 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) Blue Access/Small Group |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.78
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Commercial |
$15.75
|
| 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 |
$7.46
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.24
|
| Rate for Payer: Humana Medicare |
$7.24
|
| 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 |
$7.60
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
0.9 % SODIUM CHLORIDE 50 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00409798436
|
| Hospital Charge Code |
4450024
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
0.9 % SODIUM CHLORIDE 50 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00409798436
|
| 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 POLYSORB 3.5 12X18
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
4478146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna of NY Commercial |
$55.30
|
| Rate for Payer: Aetna of NY Medicare |
$36.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: CDPHP Commercial |
$63.60
|
| Rate for Payer: CDPHP Medicare |
$29.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
| Rate for Payer: EmblemHealth Medicaid |
$63.20
|
| Rate for Payer: EmblemHealth Medicare |
$26.86
|
| Rate for Payer: EmblemHealth Select Care |
$56.88
|
| Rate for Payer: Fidelis Medicare |
$30.11
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
0 POLYSORB 3.5 12X18
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
4478146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
|
|
0 TR CRON GS-22
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
4478157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
|
|
0 TR CRON GS-22
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
4478157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna of NY Commercial |
$53.20
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Commercial |
$61.18
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: EmblemHealth Select Care |
$54.72
|
| Rate for Payer: Fidelis Medicare |
$28.96
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.12
|
| Rate for Payer: Humana Medicare |
$28.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.53
|
| Rate for Payer: United Healthcare Medicare |
$28.12
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
100FT CORRUGATED TUBING
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
4478192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$34.62 |
| Rate for Payer: Aetna of NY Commercial |
$30.10
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.50
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Commercial |
$34.62
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$30.96
|
| Rate for Payer: Fidelis Medicare |
$16.39
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.91
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
100FT CORRUGATED TUBING
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
4478192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
|
|
10/2 FIRST FRACTURE KIT
|
Facility
|
OP
|
$14,312.00
|
|
| Hospital Charge Code |
4471967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,866.08 |
| Max. Negotiated Rate |
$11,521.16 |
| Rate for Payer: Aetna of NY Commercial |
$10,018.40
|
| Rate for Payer: Aetna of NY Medicare |
$6,583.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,440.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,440.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,295.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,156.00
|
| Rate for Payer: Cash Price |
$10,734.00
|
| Rate for Payer: CDPHP Commercial |
$11,521.16
|
| Rate for Payer: CDPHP Medicare |
$5,295.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,156.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,449.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,449.60
|
| Rate for Payer: EmblemHealth Medicaid |
$11,449.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,866.08
|
| Rate for Payer: EmblemHealth Select Care |
$7,156.00
|
| Rate for Payer: Fidelis Medicare |
$5,454.30
|
| Rate for Payer: Galaxy Health Commercial |
$9,302.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,295.44
|
| Rate for Payer: Humana Medicare |
$5,295.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,018.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,583.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,302.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,302.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,560.21
|
| Rate for Payer: United Healthcare Medicare |
$5,295.44
|
| Rate for Payer: WellCare Medicare |
$7,871.60
|
|
|
10/2 FIRST FRACTURE KIT
|
Facility
|
IP
|
$14,312.00
|
|
| Hospital Charge Code |
4471967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,440.40 |
| Max. Negotiated Rate |
$10,018.40 |
| Rate for Payer: Aetna of NY Commercial |
$10,018.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,440.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,440.40
|
| Rate for Payer: Cash Price |
$10,734.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,156.00
|
| Rate for Payer: EmblemHealth Select Care |
$7,156.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,302.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,018.40
|
| Rate for Payer: Multiplan Commercial |
$6,440.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,302.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,302.80
|
| Rate for Payer: WellCare Medicare |
$7,871.60
|
|
|
10CC SALINE FLUSH
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4471469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
10CC SALINE FLUSH
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4471469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
10CMX5M COMPRILAN
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
4471081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
10CMX5M COMPRILAN
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
4471081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
10FR 3CC FOLEY
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
4478206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
|
|
10FR 3CC FOLEY
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
4478206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
10FRX45" ENTERAL FEEDING TUBE
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
4478215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$39.20
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$40.32
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
10FRX45" ENTERAL FEEDING TUBE
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
4478215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
10MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 00409799309
|
| 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
|
|
|
10MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 00409799309
|
| Hospital Charge Code |
4450025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.25 |
| 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) Blue Access/Small Group |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Commercial |
$7.25
|
| 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 |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| 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 |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
1.2 MICRON FILTER EXTENTION SE
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4471902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
