|
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
|
|
|
5% DEXTROSE &RINGERS INJ 500
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
4450121
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of NY Commercial |
$2.80
|
| Rate for Payer: Aetna of NY Medicare |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: CDPHP Commercial |
$3.22
|
| Rate for Payer: CDPHP Medicare |
$1.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3.20
|
| Rate for Payer: EmblemHealth Medicare |
$1.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.88
|
| Rate for Payer: Fidelis Medicare |
$1.52
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.55
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
5% DEXTROSE &RINGERS INJ 500
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
4450121
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| 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 |
$1.80
|
| 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 |
$1.80
|
| 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 |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| 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: 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 |
$1.80
|
| 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 |
$1.80
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.80
|
| Rate for Payer: EmblemHealth Select Care |
$1.80
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| 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 |
$1.80
|
| 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 |
$1.80
|
| 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 |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.80
|
| Rate for Payer: EmblemHealth Select Care |
$1.80
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.80
|
| Rate for Payer: EmblemHealth Select Care |
$1.80
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| 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 |
$1.80
|
| 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 |
$1.80
|
| 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 |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/WATER (500 ML = 1 UNIT)
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.80
|
| Rate for Payer: EmblemHealth Select Care |
$1.80
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5FR CATH KIT 10815
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4479288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
5FR CATH KIT 10815
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4479288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
5" SCOTCHCAST PLUS CAST TAPE
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4471832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
5" SCOTCHCAST PLUS CAST TAPE
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4471832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
5X5CM SKIN GRAFT MATRISTEM
|
Facility
|
OP
|
$2,605.00
|
|
| Hospital Charge Code |
4472033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$885.70 |
| Max. Negotiated Rate |
$2,097.02 |
| Rate for Payer: Aetna of NY Commercial |
$1,823.50
|
| Rate for Payer: Aetna of NY Medicare |
$1,198.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,953.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,953.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$963.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,302.50
|
| Rate for Payer: Cash Price |
$1,953.75
|
| Rate for Payer: CDPHP Commercial |
$2,097.02
|
| Rate for Payer: CDPHP Medicare |
$963.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,084.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,084.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,084.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,084.00
|
| Rate for Payer: EmblemHealth Medicare |
$885.70
|
| Rate for Payer: EmblemHealth Select Care |
$1,875.60
|
| Rate for Payer: Fidelis Medicare |
$992.77
|
| Rate for Payer: Galaxy Health Commercial |
$1,693.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$963.85
|
| Rate for Payer: Humana Medicare |
$963.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,823.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,198.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,953.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,466.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,012.04
|
| Rate for Payer: United Healthcare Medicare |
$963.85
|
| Rate for Payer: WellCare Medicare |
$1,432.75
|
|
|
5X5CM SKIN GRAFT MATRISTEM
|
Facility
|
IP
|
$2,605.00
|
|
| Hospital Charge Code |
4472033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,693.25 |
| Max. Negotiated Rate |
$1,693.25 |
| Rate for Payer: Cash Price |
$1,953.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,693.25
|
|
|
6.0 ALLOPURE GRAFT
|
Facility
|
IP
|
$8,251.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.95 |
| Max. Negotiated Rate |
$5,775.70 |
| Rate for Payer: Aetna of NY Commercial |
$5,775.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,712.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,712.95
|
| Rate for Payer: Cash Price |
$6,188.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,125.50
|
| Rate for Payer: EmblemHealth Select Care |
$4,125.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,363.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,775.70
|
| Rate for Payer: Multiplan Commercial |
$3,712.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,363.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,363.15
|
| Rate for Payer: WellCare Medicare |
$4,538.05
|
|
|
6.0 ALLOPURE GRAFT
|
Facility
|
OP
|
$8,251.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.34 |
| Max. Negotiated Rate |
$6,642.06 |
| Rate for Payer: Aetna of NY Commercial |
$5,775.70
|
| Rate for Payer: Aetna of NY Medicare |
$3,795.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,712.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,712.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,052.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,125.50
|
| Rate for Payer: Cash Price |
$6,188.25
|
| Rate for Payer: CDPHP Commercial |
$6,642.06
|
| Rate for Payer: CDPHP Medicare |
$3,052.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,125.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,600.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,600.80
|
| Rate for Payer: EmblemHealth Medicaid |
$6,600.80
|
| Rate for Payer: EmblemHealth Medicare |
$2,805.34
|
| Rate for Payer: EmblemHealth Select Care |
$4,125.50
|
| Rate for Payer: Fidelis Medicare |
$3,144.46
|
| Rate for Payer: Galaxy Health Commercial |
$5,363.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,052.87
|
| Rate for Payer: Humana Medicare |
$3,052.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,775.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,795.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,363.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,363.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,205.51
|
| Rate for Payer: United Healthcare Medicare |
$3,052.87
|
| Rate for Payer: WellCare Medicare |
$4,538.05
|
|
|
6-0 MONOSOF P-13
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
4478165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
6-0 MONOSOF P-13
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
4478165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.70
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$29.52
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
6-0 VICRYL UNDYED 18" PC-3 CON
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4471912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
6-0 VICRYL UNDYED 18" PC-3 CON
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4471911
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
6-0 VICRYL UNDYED 18" PC-3 CON
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4471912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
6-0 VICRYL UNDYED 18" PC-3 CON
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4471911
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
