|
ENDOVIVE SAFETY PEG PUSH METH
|
Facility
|
IP
|
$681.86
|
|
| Hospital Charge Code |
4471978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$443.21 |
| Max. Negotiated Rate |
$443.21 |
| Rate for Payer: Cash Price |
$511.40
|
| Rate for Payer: Galaxy Health Commercial |
$443.21
|
|
|
ENDOVIVE SAFETY PEG PUSH METH
|
Facility
|
OP
|
$681.86
|
|
| Hospital Charge Code |
4471978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$545.49 |
| Rate for Payer: Aetna of NY Commercial |
$477.30
|
| Rate for Payer: Aetna of NY Medicare |
$313.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$272.74
|
| Rate for Payer: Cash Price |
$511.40
|
| Rate for Payer: CDPHP Medicare |
$252.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$545.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$545.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$545.49
|
| Rate for Payer: EmblemHealth Medicaid |
$545.49
|
| Rate for Payer: EmblemHealth Medicare |
$231.83
|
| Rate for Payer: EmblemHealth Select Care |
$490.94
|
| Rate for Payer: Fidelis Medicare |
$272.74
|
| Rate for Payer: Galaxy Health Commercial |
$443.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$272.74
|
| Rate for Payer: Humana Medicare |
$272.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$477.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$313.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$511.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$383.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$286.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.28
|
| Rate for Payer: United Healthcare Medicare |
$272.74
|
| Rate for Payer: WellCare Medicare |
$375.02
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4400472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENOXAPARIN SODIUM INJ, 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
4304884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
4304884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Medicare |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.00
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$42.00
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ENTRESTO 24 MG-26 MG TABLET 1 ea, 60 eaches
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
4401356
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$25.60 |
| 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) Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$24.00
|
| 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 |
$12.80
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.80
|
| Rate for Payer: Humana Medicare |
$12.80
|
| 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 |
$13.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.80
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 24 MG-26 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 78065920
|
| 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
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 78077720
|
| Hospital Charge Code |
4401357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$25.60 |
| 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) Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$24.00
|
| 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 |
$12.80
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.80
|
| Rate for Payer: Humana Medicare |
$12.80
|
| 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 |
$13.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.80
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 49 MG-51 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 78077720
|
| 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 97 MG-103 MG TABLET 1 ea, 60 eaches
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 78069620
|
| Hospital Charge Code |
4401358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$25.60 |
| 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) Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$24.00
|
| 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 |
$12.80
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.80
|
| Rate for Payer: Humana Medicare |
$12.80
|
| 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 |
$13.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.80
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 97 MG-103 MG TABLET 1 ea, 60 eaches
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 78069620
|
| 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
|
OP
|
$53.56
|
|
| Hospital Charge Code |
4479119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna of NY Commercial |
$37.49
|
| Rate for Payer: Aetna of NY Medicare |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: CDPHP Medicare |
$19.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.85
|
| Rate for Payer: EmblemHealth Medicaid |
$42.85
|
| Rate for Payer: EmblemHealth Medicare |
$18.21
|
| Rate for Payer: EmblemHealth Select Care |
$38.56
|
| Rate for Payer: Fidelis Medicare |
$21.42
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.42
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.17
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.03
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
| Rate for Payer: WellCare Medicare |
$29.46
|
|
|
ENT(WOODS LAMP)TRAY
|
Facility
|
IP
|
$53.56
|
|
| Hospital Charge Code |
4479119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
|
|
EON MINI CHARGING SYSTEM
|
Facility
|
IP
|
$5,634.10
|
|
| Hospital Charge Code |
4471308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,662.16 |
| Max. Negotiated Rate |
$3,662.16 |
| Rate for Payer: Cash Price |
$4,225.58
|
| Rate for Payer: Galaxy Health Commercial |
$3,662.16
|
|
|
EON MINI CHARGING SYSTEM
|
Facility
|
OP
|
$5,634.10
|
|
| Hospital Charge Code |
4471308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$845.12 |
| Max. Negotiated Rate |
$4,507.28 |
| Rate for Payer: Aetna of NY Commercial |
$3,943.87
|
| Rate for Payer: Aetna of NY Medicare |
$2,591.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,253.64
|
| Rate for Payer: Cash Price |
$4,225.58
|
| Rate for Payer: CDPHP Medicare |
$2,084.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,507.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,507.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,507.28
|
| Rate for Payer: EmblemHealth Medicaid |
$4,507.28
|
| Rate for Payer: EmblemHealth Medicare |
$1,915.59
|
| Rate for Payer: EmblemHealth Select Care |
$4,056.55
|
| Rate for Payer: Fidelis Medicare |
$2,253.64
|
| Rate for Payer: Galaxy Health Commercial |
$3,662.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,253.64
|
| Rate for Payer: Humana Medicare |
$2,253.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,943.87
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,591.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,225.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,172.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,366.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$845.12
|
| Rate for Payer: United Healthcare Medicare |
$2,253.64
|
| Rate for Payer: WellCare Medicare |
$3,098.76
|
|
|
EON MINI IPG
|
Facility
|
OP
|
$64,365.73
|
|
| Hospital Charge Code |
4471322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9,654.86 |
| Max. Negotiated Rate |
$51,492.58 |
| Rate for Payer: Aetna of NY Commercial |
$45,056.01
|
| Rate for Payer: Aetna of NY Medicare |
$29,608.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,746.29
|
| Rate for Payer: Cash Price |
$48,274.30
|
| Rate for Payer: CDPHP Medicare |
$23,815.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51,492.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51,492.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51,492.58
|
| Rate for Payer: EmblemHealth Medicaid |
$51,492.58
|
| Rate for Payer: EmblemHealth Medicare |
$21,884.35
|
| Rate for Payer: EmblemHealth Select Care |
$46,343.33
|
| Rate for Payer: Fidelis Medicare |
$25,746.29
|
| Rate for Payer: Galaxy Health Commercial |
$41,837.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,746.29
|
| Rate for Payer: Humana Medicare |
$25,746.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$45,056.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,608.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48,274.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36,237.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27,033.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,654.86
|
| Rate for Payer: United Healthcare Medicare |
$25,746.29
|
| Rate for Payer: WellCare Medicare |
$35,401.15
|
|
|
EON MINI IPG
|
Facility
|
IP
|
$64,365.73
|
|
| Hospital Charge Code |
4471322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41,837.72 |
| Max. Negotiated Rate |
$41,837.72 |
| Rate for Payer: Cash Price |
$48,274.30
|
| Rate for Payer: Galaxy Health Commercial |
$41,837.72
|
|
|
EON PROGRAMMER
|
Facility
|
OP
|
$4,433.12
|
|
| Hospital Charge Code |
4471324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$664.97 |
| Max. Negotiated Rate |
$3,546.50 |
| Rate for Payer: Aetna of NY Commercial |
$3,103.18
|
| Rate for Payer: Aetna of NY Medicare |
$2,039.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,773.25
|
| Rate for Payer: Cash Price |
$3,324.84
|
| Rate for Payer: CDPHP Medicare |
$1,640.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,546.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,546.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,546.50
|
| Rate for Payer: EmblemHealth Medicaid |
$3,546.50
|
| Rate for Payer: EmblemHealth Medicare |
$1,507.26
|
| Rate for Payer: EmblemHealth Select Care |
$3,191.85
|
| Rate for Payer: Fidelis Medicare |
$1,773.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,881.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,773.25
|
| Rate for Payer: Humana Medicare |
$1,773.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,103.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,324.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,495.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,861.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$664.97
|
| Rate for Payer: United Healthcare Medicare |
$1,773.25
|
| Rate for Payer: WellCare Medicare |
$2,438.22
|
|
|
EON PROGRAMMER
|
Facility
|
IP
|
$4,433.12
|
|
| Hospital Charge Code |
4471324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,881.53 |
| Max. Negotiated Rate |
$2,881.53 |
| Rate for Payer: Cash Price |
$3,324.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,881.53
|
|
|
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
|
|
