|
ENTRESTO 24 MG-26 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
4401356
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 49 MG-51 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
4401357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 49 MG-51 MG TABLET 1 ea, 60 eaches
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
4401357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 97 MG-103 MG TABLET 1 ea, 60 eaches
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
4401358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 97 MG-103 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
4401358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENT(WOODS LAMP)TRAY
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
4479119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
ENT(WOODS LAMP)TRAY
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
4479119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
EON MINI CHARGING SYSTEM
|
Facility
|
OP
|
$5,470.00
|
|
| Hospital Charge Code |
4471308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,859.80 |
| Max. Negotiated Rate |
$4,403.35 |
| Rate for Payer: Aetna of NY Commercial |
$3,829.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,516.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,023.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,735.00
|
| Rate for Payer: Cash Price |
$4,102.50
|
| Rate for Payer: CDPHP Commercial |
$4,403.35
|
| Rate for Payer: CDPHP Medicare |
$2,023.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,376.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,376.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,859.80
|
| Rate for Payer: EmblemHealth Select Care |
$3,938.40
|
| Rate for Payer: Fidelis Medicare |
$2,084.62
|
| Rate for Payer: Galaxy Health Commercial |
$3,555.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,023.90
|
| Rate for Payer: Humana Medicare |
$2,023.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,829.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,516.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,102.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,079.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,125.10
|
| Rate for Payer: United Healthcare Medicare |
$2,023.90
|
| Rate for Payer: WellCare Medicare |
$3,008.50
|
|
|
EON MINI CHARGING SYSTEM
|
Facility
|
IP
|
$5,470.00
|
|
| Hospital Charge Code |
4471308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,555.50 |
| Max. Negotiated Rate |
$3,555.50 |
| Rate for Payer: Cash Price |
$4,102.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,555.50
|
|
|
EON MINI IPG
|
Facility
|
IP
|
$62,491.00
|
|
| Hospital Charge Code |
4471322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40,619.15 |
| Max. Negotiated Rate |
$40,619.15 |
| Rate for Payer: Cash Price |
$46,868.25
|
| Rate for Payer: Galaxy Health Commercial |
$40,619.15
|
|
|
EON MINI IPG
|
Facility
|
OP
|
$62,491.00
|
|
| Hospital Charge Code |
4471322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21,246.94 |
| Max. Negotiated Rate |
$50,305.26 |
| Rate for Payer: Aetna of NY Commercial |
$43,743.70
|
| Rate for Payer: Aetna of NY Medicare |
$28,745.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$46,868.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$46,868.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23,121.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31,245.50
|
| Rate for Payer: Cash Price |
$46,868.25
|
| Rate for Payer: CDPHP Commercial |
$50,305.26
|
| Rate for Payer: CDPHP Medicare |
$23,121.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49,992.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49,992.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$49,992.80
|
| Rate for Payer: EmblemHealth Medicaid |
$49,992.80
|
| Rate for Payer: EmblemHealth Medicare |
$21,246.94
|
| Rate for Payer: EmblemHealth Select Care |
$44,993.52
|
| Rate for Payer: Fidelis Medicare |
$23,815.32
|
| Rate for Payer: Galaxy Health Commercial |
$40,619.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$23,121.67
|
| Rate for Payer: Humana Medicare |
$23,121.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$43,743.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28,745.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46,868.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,182.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24,277.75
|
| Rate for Payer: United Healthcare Medicare |
$23,121.67
|
| Rate for Payer: WellCare Medicare |
$34,370.05
|
|
|
EON PROGRAMMER
|
Facility
|
IP
|
$4,304.00
|
|
| Hospital Charge Code |
4471324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,797.60 |
| Max. Negotiated Rate |
$2,797.60 |
| Rate for Payer: Cash Price |
$3,228.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,797.60
|
|
|
EON PROGRAMMER
|
Facility
|
OP
|
$4,304.00
|
|
| Hospital Charge Code |
4471324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,463.36 |
| Max. Negotiated Rate |
$3,464.72 |
| Rate for Payer: Aetna of NY Commercial |
$3,012.80
|
| Rate for Payer: Aetna of NY Medicare |
$1,979.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,228.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,228.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,592.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,152.00
|
| Rate for Payer: Cash Price |
$3,228.00
|
| Rate for Payer: CDPHP Commercial |
$3,464.72
|
| Rate for Payer: CDPHP Medicare |
$1,592.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,443.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,443.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,443.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,443.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,463.36
|
| Rate for Payer: EmblemHealth Select Care |
$3,098.88
|
| Rate for Payer: Fidelis Medicare |
$1,640.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,797.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,592.48
|
| Rate for Payer: Humana Medicare |
$1,592.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,012.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,979.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,228.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,423.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,672.10
|
| Rate for Payer: United Healthcare Medicare |
$1,592.48
|
| Rate for Payer: WellCare Medicare |
$2,367.20
|
|
|
EPHEDRINE SULFATE
|
Facility
|
IP
|
$127.46
|
|
|
Service Code
|
NDC 17478051500
|
| Hospital Charge Code |
4408983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: Cash Price |
$95.60
|
| Rate for Payer: Galaxy Health Commercial |
$82.85
|
| Rate for Payer: WellCare Medicare |
$70.10
|
|
|
EPHEDRINE SULFATE
|
Facility
|
OP
|
$127.46
|
|
|
Service Code
|
NDC 17478051500
|
| Hospital Charge Code |
4408983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$102.61 |
| Rate for Payer: Aetna of NY Commercial |
$89.22
|
| Rate for Payer: Aetna of NY Medicare |
$58.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$95.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$95.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$63.73
|
| Rate for Payer: Cash Price |
$95.60
|
| Rate for Payer: CDPHP Commercial |
$102.61
|
| Rate for Payer: CDPHP Medicare |
$47.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$101.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$101.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.97
|
| Rate for Payer: EmblemHealth Medicaid |
$101.97
|
| Rate for Payer: EmblemHealth Medicare |
$43.34
|
| Rate for Payer: EmblemHealth Select Care |
$91.77
|
| Rate for Payer: Fidelis Medicare |
$48.58
|
| Rate for Payer: Galaxy Health Commercial |
$82.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.16
|
| Rate for Payer: Humana Medicare |
$47.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.22
|
| Rate for Payer: Local 1199SEIU Medicare |
$58.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$71.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.52
|
| Rate for Payer: United Healthcare Medicare |
$47.16
|
| Rate for Payer: WellCare Medicare |
$70.10
|
|
|
EPIDIDYMECTOMY UNILATERAL
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54860
|
| Hospital Charge Code |
4002057
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
EPIDIDYMECTOMY UNILATERAL
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54860
|
| Hospital Charge Code |
4002057
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
EPIDURAL CATHETER HMS# 2000
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
4479082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna of NY Commercial |
$252.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$180.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: CDPHP Commercial |
$289.80
|
| Rate for Payer: CDPHP Medicare |
$133.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
| Rate for Payer: EmblemHealth Medicaid |
$288.00
|
| Rate for Payer: EmblemHealth Medicare |
$122.40
|
| Rate for Payer: EmblemHealth Select Care |
$259.20
|
| Rate for Payer: Fidelis Medicare |
$137.20
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$252.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$198.00
|
|
|
EPIDURAL CATHETER HMS# 2000
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
4479082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
|
|
EPIDURAL CATHETER SET
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
4479153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
EPIDURAL CATHETER SET
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
4479153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna of NY Commercial |
$160.30
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$114.50
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Commercial |
$184.34
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$183.20
|
| Rate for Payer: EmblemHealth Medicaid |
$183.20
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$87.27
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.73
|
| Rate for Payer: Humana Medicare |
$84.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$128.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.97
|
| Rate for Payer: United Healthcare Medicare |
$84.73
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EPISTAT NASAL CATH II
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
4471334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of NY Commercial |
$116.20
|
| Rate for Payer: Aetna of NY Medicare |
$76.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$83.00
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: CDPHP Commercial |
$133.63
|
| Rate for Payer: CDPHP Medicare |
$61.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$132.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.80
|
| Rate for Payer: EmblemHealth Medicaid |
$132.80
|
| Rate for Payer: EmblemHealth Medicare |
$56.44
|
| Rate for Payer: EmblemHealth Select Care |
$119.52
|
| Rate for Payer: Fidelis Medicare |
$63.26
|
| Rate for Payer: Galaxy Health Commercial |
$107.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.42
|
| Rate for Payer: Humana Medicare |
$61.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$76.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$93.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.49
|
| Rate for Payer: United Healthcare Medicare |
$61.42
|
| Rate for Payer: WellCare Medicare |
$91.30
|
|
|
EPISTAT NASAL CATH II
|
Facility
|
IP
|
$166.00
|
|
| Hospital Charge Code |
4471334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Galaxy Health Commercial |
$107.90
|
|
|
ER ABSORBABLE HEMOSTATE 4 X 8 INCHES
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4472203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$86.14 |
| Rate for Payer: Aetna of NY Commercial |
$74.90
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.50
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: EmblemHealth Select Care |
$77.04
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
ER ABSORBABLE HEMOSTATE 4 X 8 INCHES
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4472203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
|
