|
AMMONIA PLASMA
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
4300046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$79.70 |
| Rate for Payer: Aetna of NY Commercial |
$64.35
|
| Rate for Payer: Aetna of NY Medicare |
$45.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.50
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: CDPHP Commercial |
$79.70
|
| Rate for Payer: CDPHP Medicare |
$36.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$79.20
|
| Rate for Payer: EmblemHealth Medicaid |
$79.20
|
| Rate for Payer: EmblemHealth Medicare |
$33.66
|
| Rate for Payer: Fidelis Medicare |
$37.73
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.63
|
| Rate for Payer: Humana Medicare |
$36.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$74.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$74.25
|
| Rate for Payer: United Healthcare Medicare |
$36.63
|
| Rate for Payer: WellCare Medicare |
$54.45
|
|
|
AMMONIUM LACTATE 0.12 CRM 140 GM
|
Facility
OP
|
$43.00
|
|
| Hospital Charge Code |
4400043
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
AMMONIUM LACTATE 0.12 LOTN 225 GM
|
Facility
OP
|
$56.39
|
|
| Hospital Charge Code |
4400044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna of NY Commercial |
$39.47
|
| Rate for Payer: Aetna of NY Medicare |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.20
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: CDPHP Commercial |
$45.39
|
| Rate for Payer: CDPHP Medicare |
$20.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.11
|
| Rate for Payer: EmblemHealth Medicaid |
$45.11
|
| Rate for Payer: EmblemHealth Medicare |
$19.17
|
| Rate for Payer: EmblemHealth Select Care |
$40.60
|
| Rate for Payer: Fidelis Medicare |
$21.49
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.86
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.91
|
| Rate for Payer: United Healthcare Medicare |
$20.86
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
|
AMOXICILLIN 250 MG CAP
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMOXICILLIN 400 MG/5 ML SUSP 400 mg, 100 mL
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
4401546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna of NY Commercial |
$21.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Commercial |
$24.15
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$11.43
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.10
|
| Rate for Payer: Humana Medicare |
$11.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.66
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
AMOXICILLIN/POT CLAVULANATE 400-57MG/5ML
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMOXICILLIN/POT CLAVULANATE 500-125MG TA
|
Facility
OP
|
$12.45
|
|
| Hospital Charge Code |
4400050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$10.02 |
| Rate for Payer: Aetna of NY Commercial |
$8.72
|
| Rate for Payer: Aetna of NY Medicare |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.22
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: CDPHP Commercial |
$10.02
|
| Rate for Payer: CDPHP Medicare |
$4.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.96
|
| Rate for Payer: EmblemHealth Medicaid |
$9.96
|
| Rate for Payer: EmblemHealth Medicare |
$4.23
|
| Rate for Payer: EmblemHealth Select Care |
$8.96
|
| Rate for Payer: Fidelis Medicare |
$4.74
|
| Rate for Payer: Galaxy Health Commercial |
$8.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.61
|
| Rate for Payer: Humana Medicare |
$4.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.84
|
| Rate for Payer: United Healthcare Medicare |
$4.61
|
| Rate for Payer: WellCare Medicare |
$6.85
|
|
|
AMOXICILLIN/POT CLAVULANATE 875-125MG TA
|
Facility
OP
|
$15.19
|
|
| Hospital Charge Code |
4400051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$12.23 |
| Rate for Payer: Aetna of NY Medicare |
$6.99
|
| Rate for Payer: Aetna of NY Commercial |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.60
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: CDPHP Commercial |
$12.23
|
| Rate for Payer: CDPHP Medicare |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.15
|
| Rate for Payer: EmblemHealth Medicaid |
$12.15
|
| Rate for Payer: EmblemHealth Medicare |
$5.16
|
| Rate for Payer: EmblemHealth Select Care |
$10.94
|
| Rate for Payer: Fidelis Medicare |
$5.79
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.62
|
| Rate for Payer: Humana Medicare |
$5.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.90
|
| Rate for Payer: United Healthcare Medicare |
$5.62
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
AMOXICILLIN TRIHYDRATE 250MG/5ML POSR 80
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMOXICILLIN TRIHYDRATE 400MG/5ML POSR 50
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMOXICILLIN TRIHYDRATE 500MG CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMOXICILLIN TRIHYDRATE 875MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400048
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
AMPICILLIN SODIUM INJ 500 MG
|
Facility
OP
|
$9.27
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
4400053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Aetna of NY Commercial |
$5.10
|
| Rate for Payer: Aetna of NY Medicare |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.64
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: CDPHP Commercial |
$7.46
|
| Rate for Payer: CDPHP Medicare |
$3.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.42
|
| Rate for Payer: EmblemHealth Medicaid |
$7.42
|
| Rate for Payer: EmblemHealth Medicare |
$3.15
|
| Rate for Payer: EmblemHealth Select Care |
$1.00
|
| Rate for Payer: Fidelis Medicare |
$3.53
|
| Rate for Payer: Galaxy Health Commercial |
$6.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.43
|
| Rate for Payer: Humana Medicare |
$3.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$3.43
|
| Rate for Payer: WellCare Medicare |
$5.10
|
|
|
AMPICILLIN SODIUM INJ 500 MG
|
Facility
OP
|
$12.30
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
4400054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of NY Commercial |
$6.76
|
| Rate for Payer: Aetna of NY Medicare |
$5.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.15
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: CDPHP Commercial |
$9.90
|
| Rate for Payer: CDPHP Medicare |
$4.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.84
|
| Rate for Payer: EmblemHealth Medicaid |
$9.84
|
| Rate for Payer: EmblemHealth Medicare |
$4.18
|
| Rate for Payer: EmblemHealth Select Care |
$1.00
|
| Rate for Payer: Fidelis Medicare |
$4.69
|
| Rate for Payer: Galaxy Health Commercial |
$8.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.55
|
| Rate for Payer: Humana Medicare |
$4.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$4.55
|
| Rate for Payer: WellCare Medicare |
$6.76
|
|
|
AMPICILLIN SODIUM PER 1.5 GM
|
Facility
OP
|
$11.07
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
4400056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of NY Commercial |
$6.09
|
| Rate for Payer: Aetna of NY Medicare |
$5.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.54
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: CDPHP Commercial |
$8.91
|
| Rate for Payer: CDPHP Medicare |
$4.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.86
|
| Rate for Payer: EmblemHealth Medicaid |
$8.86
|
| Rate for Payer: EmblemHealth Medicare |
$3.76
|
| Rate for Payer: EmblemHealth Select Care |
$2.12
|
| Rate for Payer: Fidelis Medicare |
$4.22
|
| Rate for Payer: Galaxy Health Commercial |
$7.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.10
|
| Rate for Payer: Humana Medicare |
$4.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare |
$4.10
|
| Rate for Payer: WellCare Medicare |
$6.09
|
|
|
AMPICILLIN SODIUM PER 1.5 GM
|
Facility
OP
|
$59.23
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
4400058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$47.68 |
| Rate for Payer: Aetna of NY Commercial |
$32.58
|
| Rate for Payer: Aetna of NY Medicare |
$27.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.62
|
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: CDPHP Commercial |
$47.68
|
| Rate for Payer: CDPHP Medicare |
$21.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.38
|
| Rate for Payer: EmblemHealth Medicaid |
$47.38
|
| Rate for Payer: EmblemHealth Medicare |
$20.14
|
| Rate for Payer: EmblemHealth Select Care |
$2.12
|
| Rate for Payer: Fidelis Medicare |
$22.57
|
| Rate for Payer: Galaxy Health Commercial |
$38.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.92
|
| Rate for Payer: Humana Medicare |
$21.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.42
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
| Rate for Payer: WellCare Medicare |
$32.58
|
|
|
AMYLASE SERUM
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
4300052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
ANASTROZOLE 1MG TABS 3X10EA
|
Facility
OP
|
$6.44
|
|
| Hospital Charge Code |
4400060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna of NY Commercial |
$4.51
|
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.22
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Commercial |
$5.18
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.15
|
| Rate for Payer: EmblemHealth Medicaid |
$5.15
|
| Rate for Payer: EmblemHealth Medicare |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$4.64
|
| Rate for Payer: Fidelis Medicare |
$2.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.38
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
ANCHOR (ICONIX 2.3MM)
|
Facility
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.98 |
| Max. Negotiated Rate |
$1,245.34 |
| Rate for Payer: Aetna of NY Commercial |
$1,082.90
|
| Rate for Payer: Aetna of NY Medicare |
$711.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$572.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$773.50
|
| Rate for Payer: Cash Price |
$1,160.25
|
| Rate for Payer: CDPHP Commercial |
$1,245.34
|
| Rate for Payer: CDPHP Medicare |
$572.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$773.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,237.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,237.60
|
| Rate for Payer: EmblemHealth Medicare |
$525.98
|
| Rate for Payer: EmblemHealth Select Care |
$773.50
|
| Rate for Payer: Fidelis Medicare |
$589.56
|
| Rate for Payer: Galaxy Health Commercial |
$1,005.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$572.39
|
| Rate for Payer: Humana Medicare |
$572.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,082.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$711.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,005.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,005.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$601.01
|
| Rate for Payer: United Healthcare Medicare |
$572.39
|
| Rate for Payer: WellCare Medicare |
$850.85
|
|
|
ANEST. BREATHING CIRCUIT
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
4478195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$5.60
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$5.76
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
ANESTHESIA 105 MINS
|
Facility
OP
|
$354.00
|
|
| Hospital Charge Code |
4120012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$284.97 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$130.98
|
| Rate for Payer: Aetna of NY Commercial |
$247.80
|
| Rate for Payer: Aetna of NY Medicare |
$162.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$265.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$177.00
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: CDPHP Commercial |
$284.97
|
| Rate for Payer: CDPHP Medicare |
$130.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$283.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$283.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$283.20
|
| Rate for Payer: EmblemHealth Medicaid |
$283.20
|
| Rate for Payer: EmblemHealth Medicare |
$120.36
|
| Rate for Payer: EmblemHealth Select Care |
$254.88
|
| Rate for Payer: Fidelis Medicare |
$134.91
|
| Rate for Payer: Galaxy Health Commercial |
$230.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$130.98
|
| Rate for Payer: Humana Medicare |
$130.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$247.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$199.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$137.53
|
| Rate for Payer: United Healthcare Medicare |
$130.98
|
| Rate for Payer: WellCare Medicare |
$194.70
|
|
|
ANESTHESIA 120 MIN
|
Facility
OP
|
$386.00
|
|
| Hospital Charge Code |
4120006
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$131.24 |
| Max. Negotiated Rate |
$310.73 |
| Rate for Payer: Aetna of NY Commercial |
$270.20
|
| Rate for Payer: Aetna of NY Medicare |
$177.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$289.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$289.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$142.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$193.00
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: CDPHP Commercial |
$310.73
|
| Rate for Payer: CDPHP Medicare |
$142.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$308.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$308.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$308.80
|
| Rate for Payer: EmblemHealth Medicaid |
$308.80
|
| Rate for Payer: EmblemHealth Medicare |
$131.24
|
| Rate for Payer: EmblemHealth Select Care |
$277.92
|
| Rate for Payer: Fidelis Medicare |
$147.10
|
| Rate for Payer: Galaxy Health Commercial |
$250.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$142.82
|
| Rate for Payer: Humana Medicare |
$142.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$270.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$177.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$149.96
|
| Rate for Payer: United Healthcare Medicare |
$142.82
|
| Rate for Payer: WellCare Medicare |
$212.30
|
|
|
ANESTHESIA 135 MINS
|
Facility
OP
|
$418.00
|
|
| Hospital Charge Code |
4120013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$336.49 |
| Rate for Payer: Aetna of NY Commercial |
$292.60
|
| Rate for Payer: Aetna of NY Medicare |
$192.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$313.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$313.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$154.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$209.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: CDPHP Commercial |
$336.49
|
| Rate for Payer: CDPHP Medicare |
$154.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$334.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$334.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$334.40
|
| Rate for Payer: EmblemHealth Medicaid |
$334.40
|
| Rate for Payer: EmblemHealth Medicare |
$142.12
|
| Rate for Payer: EmblemHealth Select Care |
$300.96
|
| Rate for Payer: Fidelis Medicare |
$159.30
|
| Rate for Payer: Galaxy Health Commercial |
$271.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$154.66
|
| Rate for Payer: Humana Medicare |
$154.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$292.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$192.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$235.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$162.39
|
| Rate for Payer: United Healthcare Medicare |
$154.66
|
| Rate for Payer: WellCare Medicare |
$229.90
|
|
|
ANESTHESIA 150 MIN
|
Facility
OP
|
$451.00
|
|
| Hospital Charge Code |
4120007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$153.34 |
| Max. Negotiated Rate |
$363.06 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
ANESTHESIA 15 MINS
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
4120002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$27.88 |
| Max. Negotiated Rate |
$66.01 |
| Rate for Payer: Aetna of NY Commercial |
$57.40
|
| Rate for Payer: Aetna of NY Medicare |
$37.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$41.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: CDPHP Commercial |
$66.01
|
| Rate for Payer: CDPHP Medicare |
$30.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.60
|
| Rate for Payer: EmblemHealth Medicaid |
$65.60
|
| Rate for Payer: EmblemHealth Medicare |
$27.88
|
| Rate for Payer: EmblemHealth Select Care |
$59.04
|
| Rate for Payer: Fidelis Medicare |
$31.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.34
|
| Rate for Payer: Humana Medicare |
$30.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$57.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$46.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.86
|
| Rate for Payer: United Healthcare Medicare |
$30.34
|
| Rate for Payer: WellCare Medicare |
$45.10
|
|
