|
4X5 AQUACEL AG DRESSING
|
Facility
|
IP
|
$70.04
|
|
| Hospital Charge Code |
4479235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.53 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
|
|
4X5 AQUACEL AG DRESSING
|
Facility
|
OP
|
$70.04
|
|
| Hospital Charge Code |
4479235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$56.03 |
| Rate for Payer: Aetna of NY Commercial |
$49.03
|
| Rate for Payer: Aetna of NY Medicare |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.02
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: CDPHP Medicare |
$25.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.03
|
| Rate for Payer: EmblemHealth Medicaid |
$56.03
|
| Rate for Payer: EmblemHealth Medicare |
$23.81
|
| Rate for Payer: EmblemHealth Select Care |
$50.43
|
| Rate for Payer: Fidelis Medicare |
$28.02
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.02
|
| Rate for Payer: Humana Medicare |
$28.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$28.02
|
| Rate for Payer: WellCare Medicare |
$38.52
|
|
|
5.0 BARRELL BURR#3759511
|
Facility
|
IP
|
$211.15
|
|
| Hospital Charge Code |
4479284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Cash Price |
$158.36
|
| Rate for Payer: Galaxy Health Commercial |
$137.25
|
|
|
5.0 BARRELL BURR#3759511
|
Facility
|
OP
|
$211.15
|
|
| Hospital Charge Code |
4479284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$168.92 |
| Rate for Payer: Aetna of NY Commercial |
$147.81
|
| Rate for Payer: Aetna of NY Medicare |
$97.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.46
|
| Rate for Payer: Cash Price |
$158.36
|
| Rate for Payer: CDPHP Medicare |
$78.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$168.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.92
|
| Rate for Payer: EmblemHealth Medicaid |
$168.92
|
| Rate for Payer: EmblemHealth Medicare |
$71.79
|
| Rate for Payer: EmblemHealth Select Care |
$152.03
|
| Rate for Payer: Fidelis Medicare |
$84.46
|
| Rate for Payer: Galaxy Health Commercial |
$137.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.46
|
| Rate for Payer: Humana Medicare |
$84.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$147.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$118.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.67
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WellCare Medicare |
$116.13
|
|
|
5-0 ETHILON FS-2
|
Facility
|
IP
|
$10.30
|
|
| Hospital Charge Code |
4478162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
|
|
5-0 ETHILON FS-2
|
Facility
|
OP
|
$10.30
|
|
| Hospital Charge Code |
4478162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.12
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
| Rate for Payer: WellCare Medicare |
$5.67
|
|
|
5-0 ETHILON PS-2
|
Facility
|
IP
|
$50.47
|
|
| Hospital Charge Code |
4478163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
|
|
5-0 ETHILON PS-2
|
Facility
|
OP
|
$50.47
|
|
| Hospital Charge Code |
4478163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$40.38 |
| Rate for Payer: Aetna of NY Commercial |
$35.33
|
| Rate for Payer: Aetna of NY Medicare |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.19
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: CDPHP Medicare |
$18.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.38
|
| Rate for Payer: EmblemHealth Medicaid |
$40.38
|
| Rate for Payer: EmblemHealth Medicare |
$17.16
|
| Rate for Payer: EmblemHealth Select Care |
$36.34
|
| Rate for Payer: Fidelis Medicare |
$20.19
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.19
|
| Rate for Payer: Humana Medicare |
$20.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.57
|
| Rate for Payer: United Healthcare Medicare |
$20.19
|
| Rate for Payer: WellCare Medicare |
$27.76
|
|
|
5.0FR TURBOJECT PICC SET#403806
|
Facility
|
IP
|
$693.19
|
|
| Hospital Charge Code |
4479278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$450.57 |
| Max. Negotiated Rate |
$450.57 |
| Rate for Payer: Cash Price |
$519.89
|
| Rate for Payer: Galaxy Health Commercial |
$450.57
|
|
|
5.0FR TURBOJECT PICC SET#403806
|
Facility
|
OP
|
$693.19
|
|
| Hospital Charge Code |
4479278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.98 |
| Max. Negotiated Rate |
$554.55 |
| Rate for Payer: Aetna of NY Commercial |
$485.23
|
| Rate for Payer: Aetna of NY Medicare |
$318.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$277.28
|
| Rate for Payer: Cash Price |
$519.89
|
| Rate for Payer: CDPHP Medicare |
$256.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$554.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$554.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$554.55
|
| Rate for Payer: EmblemHealth Medicaid |
$554.55
|
| Rate for Payer: EmblemHealth Medicare |
$235.68
|
| Rate for Payer: EmblemHealth Select Care |
$499.10
|
| Rate for Payer: Fidelis Medicare |
$277.28
|
| Rate for Payer: Galaxy Health Commercial |
$450.57
|
| Rate for Payer: Hamaspik Choice Medicare |
$277.28
|
| Rate for Payer: Humana Medicare |
$277.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$485.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$318.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$390.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$291.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$103.98
|
| Rate for Payer: United Healthcare Medicare |
$277.28
|
| Rate for Payer: WellCare Medicare |
$381.25
|
|
|
5-0 MONOSOF P-13
|
Facility
|
OP
|
$31.93
|
|
| Hospital Charge Code |
4478164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: Aetna of NY Commercial |
$22.35
|
| Rate for Payer: Aetna of NY Medicare |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.77
|
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: CDPHP Medicare |
$11.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.54
|
| Rate for Payer: EmblemHealth Medicaid |
$25.54
|
| Rate for Payer: EmblemHealth Medicare |
$10.86
|
| Rate for Payer: EmblemHealth Select Care |
$22.99
|
| Rate for Payer: Fidelis Medicare |
$12.77
|
| Rate for Payer: Galaxy Health Commercial |
$20.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.77
|
| Rate for Payer: Humana Medicare |
$12.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.79
|
| Rate for Payer: United Healthcare Medicare |
$12.77
|
| Rate for Payer: WellCare Medicare |
$17.56
|
|
|
5-0 MONOSOF P-13
|
Facility
|
IP
|
$31.93
|
|
| Hospital Charge Code |
4478164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: Galaxy Health Commercial |
$20.75
|
|
|
5-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
IP
|
$14.42
|
|
| Hospital Charge Code |
4471909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
|
|
5-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
OP
|
$14.42
|
|
| Hospital Charge Code |
4471909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna of NY Commercial |
$10.09
|
| Rate for Payer: Aetna of NY Medicare |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: CDPHP Medicare |
$5.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.54
|
| Rate for Payer: EmblemHealth Medicaid |
$11.54
|
| Rate for Payer: EmblemHealth Medicare |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$10.38
|
| Rate for Payer: Fidelis Medicare |
$5.77
|
| Rate for Payer: Galaxy Health Commercial |
$9.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.77
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$5.77
|
| Rate for Payer: WellCare Medicare |
$7.93
|
|
|
5-10 MM STYLET SATIN SLIP
|
Facility
|
IP
|
$24.72
|
|
| Hospital Charge Code |
4479141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
|
|
5-10 MM STYLET SATIN SLIP
|
Facility
|
OP
|
$24.72
|
|
| Hospital Charge Code |
4479141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.89
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.89
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.71
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
5.5CM FOR ADULT EPISTAXIS
|
Facility
|
OP
|
$100.94
|
|
| Hospital Charge Code |
4471073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna of NY Commercial |
$70.66
|
| Rate for Payer: Aetna of NY Medicare |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.38
|
| Rate for Payer: Cash Price |
$75.70
|
| Rate for Payer: CDPHP Medicare |
$37.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$80.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.75
|
| Rate for Payer: EmblemHealth Medicaid |
$80.75
|
| Rate for Payer: EmblemHealth Medicare |
$34.32
|
| Rate for Payer: EmblemHealth Select Care |
$72.68
|
| Rate for Payer: Fidelis Medicare |
$40.38
|
| Rate for Payer: Galaxy Health Commercial |
$65.61
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.38
|
| Rate for Payer: Humana Medicare |
$40.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.66
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$40.38
|
| Rate for Payer: WellCare Medicare |
$55.52
|
|
|
5.5CM FOR ADULT EPISTAXIS
|
Facility
|
IP
|
$100.94
|
|
| Hospital Charge Code |
4471073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$65.61 |
| Rate for Payer: Cash Price |
$75.70
|
| Rate for Payer: Galaxy Health Commercial |
$65.61
|
|
|
5.5 ET TUBE
|
Facility
|
OP
|
$23.69
|
|
| Hospital Charge Code |
4478224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna of NY Commercial |
$16.58
|
| Rate for Payer: Aetna of NY Medicare |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.48
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: CDPHP Medicare |
$8.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.95
|
| Rate for Payer: EmblemHealth Medicaid |
$18.95
|
| Rate for Payer: EmblemHealth Medicare |
$8.05
|
| Rate for Payer: EmblemHealth Select Care |
$17.06
|
| Rate for Payer: Fidelis Medicare |
$9.48
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.48
|
| Rate for Payer: Humana Medicare |
$9.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.55
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WellCare Medicare |
$13.03
|
|
|
5.5 ET TUBE
|
Facility
|
IP
|
$23.69
|
|
| Hospital Charge Code |
4478224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Galaxy Health Commercial |
$15.40
|
|
|
5.5 MM ROUND BUR ARTHROSCOPY B
|
Facility
|
IP
|
$186.43
|
|
| Hospital Charge Code |
4471242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: Galaxy Health Commercial |
$121.18
|
|
|
5.5 MM ROUND BUR ARTHROSCOPY B
|
Facility
|
OP
|
$186.43
|
|
| Hospital Charge Code |
4471242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$149.14 |
| Rate for Payer: Aetna of NY Commercial |
$130.50
|
| Rate for Payer: Aetna of NY Medicare |
$85.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.57
|
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: CDPHP Medicare |
$68.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$149.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.14
|
| Rate for Payer: EmblemHealth Medicaid |
$149.14
|
| Rate for Payer: EmblemHealth Medicare |
$63.39
|
| Rate for Payer: EmblemHealth Select Care |
$134.23
|
| Rate for Payer: Fidelis Medicare |
$74.57
|
| Rate for Payer: Galaxy Health Commercial |
$121.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.57
|
| Rate for Payer: Humana Medicare |
$74.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$130.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.96
|
| Rate for Payer: United Healthcare Medicare |
$74.57
|
| Rate for Payer: WellCare Medicare |
$102.54
|
|
|
5CC ALLOMATRIX PUTTY
|
Facility
|
OP
|
$3,388.70
|
|
| Hospital Charge Code |
4471637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.31 |
| Max. Negotiated Rate |
$2,710.96 |
| Rate for Payer: Aetna of NY Commercial |
$2,372.09
|
| Rate for Payer: Aetna of NY Medicare |
$1,558.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,355.48
|
| Rate for Payer: Cash Price |
$2,541.52
|
| Rate for Payer: CDPHP Medicare |
$1,253.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,694.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,710.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,710.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,710.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,152.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,694.35
|
| Rate for Payer: Fidelis Medicare |
$1,355.48
|
| Rate for Payer: Galaxy Health Commercial |
$2,202.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,355.48
|
| Rate for Payer: Humana Medicare |
$1,355.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,372.09
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,558.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,202.66
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,202.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,423.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$508.31
|
| Rate for Payer: United Healthcare Medicare |
$1,355.48
|
| Rate for Payer: WellCare Medicare |
$1,863.79
|
|
|
5CC ALLOMATRIX PUTTY
|
Facility
|
IP
|
$3,388.70
|
|
| Hospital Charge Code |
4471637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.91 |
| Max. Negotiated Rate |
$2,372.09 |
| Rate for Payer: Aetna of NY Commercial |
$2,372.09
|
| Rate for Payer: Cash Price |
$2,541.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,694.35
|
| Rate for Payer: EmblemHealth Select Care |
$1,694.35
|
| Rate for Payer: Galaxy Health Commercial |
$2,202.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,372.09
|
| Rate for Payer: Multiplan Commercial |
$1,524.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,202.66
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,202.66
|
| Rate for Payer: WellCare Medicare |
$1,863.79
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 409792609
|
| Hospital Charge Code |
4450036
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
|
