|
ETHIBOND GREEN 30" CT-1 TAPER
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4472213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
ETHILON CT-1 GRN BRAIDED
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
4478159
|
|
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
|
|
|
ETHILON CT-1 GRN BRAIDED
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
4478159
|
|
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
|
|
|
ETHYL CHLORIDE AREX 103.5 ML
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
NDC 00386000111
|
| Hospital Charge Code |
4400279
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Galaxy Health Commercial |
$6.86
|
| Rate for Payer: WellCare Medicare |
$5.81
|
|
|
ETHYL CHLORIDE AREX 103.5 ML
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
NDC 00386000111
|
| Hospital Charge Code |
4400279
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna of NY Commercial |
$7.39
|
| Rate for Payer: Aetna of NY Medicare |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.28
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: CDPHP Commercial |
$8.50
|
| Rate for Payer: CDPHP Medicare |
$3.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.45
|
| Rate for Payer: EmblemHealth Medicaid |
$8.45
|
| Rate for Payer: EmblemHealth Medicare |
$3.59
|
| Rate for Payer: EmblemHealth Select Care |
$7.60
|
| Rate for Payer: Fidelis Medicare |
$4.02
|
| Rate for Payer: Galaxy Health Commercial |
$6.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.91
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.39
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.92
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.10
|
| Rate for Payer: United Healthcare Medicare |
$3.91
|
| Rate for Payer: WellCare Medicare |
$5.81
|
|
|
ETOMIDATE 2MG/ML SDV 10X10ML
|
Facility
|
OP
|
$36.31
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
4400035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna of NY Commercial |
$25.42
|
| Rate for Payer: Aetna of NY Medicare |
$16.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.16
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: CDPHP Commercial |
$29.23
|
| Rate for Payer: CDPHP Medicare |
$13.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.05
|
| Rate for Payer: EmblemHealth Medicaid |
$29.05
|
| Rate for Payer: EmblemHealth Medicare |
$12.35
|
| Rate for Payer: EmblemHealth Select Care |
$26.14
|
| Rate for Payer: Fidelis Medicare |
$13.84
|
| Rate for Payer: Galaxy Health Commercial |
$23.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.43
|
| Rate for Payer: Humana Medicare |
$13.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.23
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.11
|
| Rate for Payer: United Healthcare Medicare |
$13.43
|
| Rate for Payer: WellCare Medicare |
$19.97
|
|
|
ETOMIDATE 2MG/ML SDV 10X10ML
|
Facility
|
IP
|
$36.31
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
4400035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$23.60 |
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Galaxy Health Commercial |
$23.60
|
| Rate for Payer: WellCare Medicare |
$19.97
|
|
|
ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
NDC 00143950710
|
| Hospital Charge Code |
4401389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
NDC 00143950710
|
| Hospital Charge Code |
4401389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
4401528
|
|
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
|
|
|
ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
4401528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
ETOMIDATE INJ
|
Facility
|
OP
|
$28.84
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
4408985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna of NY Commercial |
$20.19
|
| Rate for Payer: Aetna of NY Medicare |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.42
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: CDPHP Commercial |
$23.22
|
| Rate for Payer: CDPHP Medicare |
$10.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.07
|
| Rate for Payer: EmblemHealth Medicaid |
$23.07
|
| Rate for Payer: EmblemHealth Medicare |
$9.81
|
| Rate for Payer: EmblemHealth Select Care |
$20.76
|
| Rate for Payer: Fidelis Medicare |
$10.99
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.67
|
| Rate for Payer: Humana Medicare |
$10.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.20
|
| Rate for Payer: United Healthcare Medicare |
$10.67
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
ETOMIDATE INJ
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
4408985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
EUFLEXXA 20 MG/2 ML SYRINGE 2 mL, 2 mL
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4401429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna of NY Commercial |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$115.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$115.57
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$115.57
|
| Rate for Payer: EmblemHealth Select Care |
$115.57
|
| Rate for Payer: Galaxy Health Commercial |
$795.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$673.20
|
| Rate for Payer: WellCare Medicare |
$673.20
|
|
|
EUFLEXXA 20 MG/2 ML SYRINGE 2 mL, 2 mL
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4401429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$985.32 |
| Rate for Payer: Aetna of NY Commercial |
$673.20
|
| Rate for Payer: Aetna of NY Medicare |
$563.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$115.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$115.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$452.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$612.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: CDPHP Commercial |
$985.32
|
| Rate for Payer: CDPHP Medicare |
$452.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$115.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$979.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$979.20
|
| Rate for Payer: EmblemHealth Medicaid |
$979.20
|
| Rate for Payer: EmblemHealth Medicare |
$416.16
|
| Rate for Payer: EmblemHealth Select Care |
$115.57
|
| Rate for Payer: Fidelis Medicare |
$466.47
|
| Rate for Payer: Galaxy Health Commercial |
$795.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$452.88
|
| Rate for Payer: Humana Medicare |
$452.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$673.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$475.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$216.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$115.57
|
| Rate for Payer: United Healthcare Commercial |
$216.84
|
| Rate for Payer: United Healthcare Medicare |
$452.88
|
| Rate for Payer: WellCare Medicare |
$673.20
|
|
|
EVAC SU HEMATOMA
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4856701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
EVAC SU HEMATOMA
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4856701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| 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 |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$263.52
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4600087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4600087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN
|
| Hospital Charge Code |
4670023
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$460.46 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$211.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: CDPHP Commercial |
$460.46
|
| Rate for Payer: CDPHP Medicare |
$211.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$457.60
|
| Rate for Payer: EmblemHealth Medicaid |
$457.60
|
| Rate for Payer: EmblemHealth Medicare |
$194.48
|
| Rate for Payer: EmblemHealth Select Care |
$411.84
|
| Rate for Payer: Fidelis Medicare |
$217.99
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$211.64
|
| Rate for Payer: Humana Medicare |
$211.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$211.64
|
| Rate for Payer: WellCare Medicare |
$314.60
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN
|
| Hospital Charge Code |
4670023
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$371.80 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59)
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,59
|
| Hospital Charge Code |
4670287
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$460.46 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$211.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: CDPHP Commercial |
$460.46
|
| Rate for Payer: CDPHP Medicare |
$211.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$457.60
|
| Rate for Payer: EmblemHealth Medicaid |
$457.60
|
| Rate for Payer: EmblemHealth Medicare |
$194.48
|
| Rate for Payer: EmblemHealth Select Care |
$411.84
|
| Rate for Payer: Fidelis Medicare |
$217.99
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$211.64
|
| Rate for Payer: Humana Medicare |
$211.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$211.64
|
| Rate for Payer: WellCare Medicare |
$314.60
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59)
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,59
|
| Hospital Charge Code |
4670287
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$371.80 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59 W KX)
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,59,KX
|
| Hospital Charge Code |
4670303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$371.80 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59 W KX)
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,59,KX
|
| Hospital Charge Code |
4670303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$460.46 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$211.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: CDPHP Commercial |
$460.46
|
| Rate for Payer: CDPHP Medicare |
$211.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$457.60
|
| Rate for Payer: EmblemHealth Medicaid |
$457.60
|
| Rate for Payer: EmblemHealth Medicare |
$194.48
|
| Rate for Payer: EmblemHealth Select Care |
$411.84
|
| Rate for Payer: Fidelis Medicare |
$217.99
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$211.64
|
| Rate for Payer: Humana Medicare |
$211.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$211.64
|
| Rate for Payer: WellCare Medicare |
$314.60
|
|
