|
5-0 ETHILON FS-2
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4478162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
5-0 ETHILON FS-2
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4478162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
5-0 ETHILON PS-2
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
4478163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
5-0 ETHILON PS-2
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
4478163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$39.44 |
| Rate for Payer: Aetna of NY Commercial |
$34.30
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.50
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Commercial |
$39.44
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$18.67
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.13
|
| Rate for Payer: Humana Medicare |
$18.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.04
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
5.0FR TURBOJECT PICC SET#403806
|
Facility
|
OP
|
$673.00
|
|
| Hospital Charge Code |
4479278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.82 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna of NY Commercial |
$471.10
|
| Rate for Payer: Aetna of NY Medicare |
$309.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$504.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$504.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$336.50
|
| Rate for Payer: Cash Price |
$504.75
|
| Rate for Payer: CDPHP Commercial |
$541.76
|
| Rate for Payer: CDPHP Medicare |
$249.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$538.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$538.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$538.40
|
| Rate for Payer: EmblemHealth Medicaid |
$538.40
|
| Rate for Payer: EmblemHealth Medicare |
$228.82
|
| Rate for Payer: EmblemHealth Select Care |
$484.56
|
| Rate for Payer: Fidelis Medicare |
$256.48
|
| Rate for Payer: Galaxy Health Commercial |
$437.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.01
|
| Rate for Payer: Humana Medicare |
$249.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$471.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$309.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$504.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$378.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$261.46
|
| Rate for Payer: United Healthcare Medicare |
$249.01
|
| Rate for Payer: WellCare Medicare |
$370.15
|
|
|
5.0FR TURBOJECT PICC SET#403806
|
Facility
|
IP
|
$673.00
|
|
| Hospital Charge Code |
4479278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$437.45 |
| Max. Negotiated Rate |
$437.45 |
| Rate for Payer: Cash Price |
$504.75
|
| Rate for Payer: Galaxy Health Commercial |
$437.45
|
|
|
5-0 MONOSOF P-13
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
4478164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
5-0 MONOSOF P-13
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
4478164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
5-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4471909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
5-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4471909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
5-10 MM STYLET SATIN SLIP
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
4479141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
5-10 MM STYLET SATIN SLIP
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
4479141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
5.5CM FOR ADULT EPISTAXIS
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
4471073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna of NY Commercial |
$68.60
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Commercial |
$78.89
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: EmblemHealth Select Care |
$70.56
|
| Rate for Payer: Fidelis Medicare |
$37.35
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.26
|
| Rate for Payer: Humana Medicare |
$36.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.07
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
5.5CM FOR ADULT EPISTAXIS
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
4471073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
|
|
5.5 ET TUBE
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
4478224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
5.5 ET TUBE
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
4478224
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
5.5 MM ROUND BUR ARTHROSCOPY B
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
4471242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
5.5 MM ROUND BUR ARTHROSCOPY B
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
4471242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$145.70 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$135.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$135.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$90.50
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Commercial |
$145.70
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$68.98
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.97
|
| Rate for Payer: Humana Medicare |
$66.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.32
|
| Rate for Payer: United Healthcare Medicare |
$66.97
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
5CC ALLOMATRIX PUTTY
|
Facility
|
IP
|
$3,290.00
|
|
| Hospital Charge Code |
4471637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,480.50 |
| Max. Negotiated Rate |
$2,303.00 |
| Rate for Payer: Aetna of NY Commercial |
$2,303.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,480.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,480.50
|
| Rate for Payer: Cash Price |
$2,467.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,645.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,645.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,138.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,303.00
|
| Rate for Payer: Multiplan Commercial |
$1,480.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,138.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,138.50
|
| Rate for Payer: WellCare Medicare |
$1,809.50
|
|
|
5CC ALLOMATRIX PUTTY
|
Facility
|
OP
|
$3,290.00
|
|
| Hospital Charge Code |
4471637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.60 |
| Max. Negotiated Rate |
$2,648.45 |
| Rate for Payer: Aetna of NY Commercial |
$2,303.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,513.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,480.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,480.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,217.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,645.00
|
| Rate for Payer: Cash Price |
$2,467.50
|
| Rate for Payer: CDPHP Commercial |
$2,648.45
|
| Rate for Payer: CDPHP Medicare |
$1,217.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,645.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,632.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,632.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,632.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,118.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,645.00
|
| Rate for Payer: Fidelis Medicare |
$1,253.82
|
| Rate for Payer: Galaxy Health Commercial |
$2,138.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,217.30
|
| Rate for Payer: Humana Medicare |
$1,217.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,303.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,513.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,138.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,138.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,278.16
|
| Rate for Payer: United Healthcare Medicare |
$1,217.30
|
| Rate for Payer: WellCare Medicare |
$1,809.50
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 00409792609
|
| 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
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 1000 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 00409792609
|
| Hospital Charge Code |
4450036
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of NY Commercial |
$13.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.78
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Commercial |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$14.09
|
| Rate for Payer: Fidelis Medicare |
$7.46
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.24
|
| Rate for Payer: Humana Medicare |
$7.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.60
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 500 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 00409792603
|
| Hospital Charge Code |
4450037
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of NY Commercial |
$13.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.78
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Commercial |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$14.09
|
| Rate for Payer: Fidelis Medicare |
$7.46
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.24
|
| Rate for Payer: Humana Medicare |
$7.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.60
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 500 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 00409792603
|
| Hospital Charge Code |
4450037
|
|
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
|
|
|
5% DEXTROSE/NORMAL SALINE 500 ML=1 UNIT
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
4450038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.78
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Commercial |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$1.13
|
| Rate for Payer: Fidelis Medicare |
$7.46
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.24
|
| Rate for Payer: Humana Medicare |
$7.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
