|
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
|
|
|
5 % DEXTROSE + 0.45 % SODCHL 500 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 409792603
|
| 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 + 0.45 % SODCHL 500 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 409792603
|
| Hospital Charge Code |
4450037
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$15.66 |
| 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) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| 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 |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE/NORMAL SALINE 500 ML=1 UNIT
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
4450038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.28
|
| Rate for Payer: EmblemHealth Select Care |
$1.28
|
| 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/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 |
$1.28 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.28
|
| 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 |
$1.28
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
5% DEXTROSE &RINGERS INJ 500
|
Facility
|
OP
|
$4.12
|
|
| Hospital Charge Code |
4450121
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of NY Commercial |
$2.88
|
| Rate for Payer: Aetna of NY Medicare |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: CDPHP Medicare |
$1.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.30
|
| Rate for Payer: EmblemHealth Medicaid |
$3.30
|
| Rate for Payer: EmblemHealth Medicare |
$1.40
|
| Rate for Payer: EmblemHealth Select Care |
$2.97
|
| Rate for Payer: Fidelis Medicare |
$1.65
|
| Rate for Payer: Galaxy Health Commercial |
$2.68
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.65
|
| Rate for Payer: Humana Medicare |
$1.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.88
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$1.65
|
| Rate for Payer: WellCare Medicare |
$2.27
|
|
|
5% DEXTROSE &RINGERS INJ 500
|
Facility
|
IP
|
$4.12
|
|
| Hospital Charge Code |
4450121
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Galaxy Health Commercial |
$2.68
|
|
|
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 |
$1.87 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| Rate for Payer: EmblemHealth Select Care |
$1.87
|
| 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
|
$19.57
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| Rate for Payer: EmblemHealth Select Care |
$1.87
|
| 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 |
$1.87 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| 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 |
$1.87
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| 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 |
$1.87 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| Rate for Payer: EmblemHealth Select Care |
$1.87
|
| 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
|
$6.18
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
4450034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| 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 |
$1.87
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 |
$1.87 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| 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 |
$1.87
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| 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 |
4450032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| 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 |
$1.87
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| 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 |
4450032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.87
|
| Rate for Payer: EmblemHealth Select Care |
$1.87
|
| 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
|
$13.39
|
|
| Hospital Charge Code |
4479288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
5FR CATH KIT 10815
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4479288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
5" SCOTCHCAST PLUS CAST TAPE
|
Facility
|
OP
|
$27.81
|
|
| Hospital Charge Code |
4471832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna of NY Commercial |
$19.47
|
| Rate for Payer: Aetna of NY Medicare |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: CDPHP Medicare |
$10.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.25
|
| Rate for Payer: EmblemHealth Medicaid |
$22.25
|
| Rate for Payer: EmblemHealth Medicare |
$9.46
|
| Rate for Payer: EmblemHealth Select Care |
$20.02
|
| Rate for Payer: Fidelis Medicare |
$11.12
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.12
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: WellCare Medicare |
$15.30
|
|
|
5" SCOTCHCAST PLUS CAST TAPE
|
Facility
|
IP
|
$27.81
|
|
| Hospital Charge Code |
4471832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Galaxy Health Commercial |
$18.08
|
|
|
5X5CM SKIN GRAFT MATRISTEM
|
Facility
|
IP
|
$2,683.15
|
|
| Hospital Charge Code |
4472033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,744.05 |
| Max. Negotiated Rate |
$1,744.05 |
| Rate for Payer: Cash Price |
$2,012.36
|
| Rate for Payer: Galaxy Health Commercial |
$1,744.05
|
|
|
5X5CM SKIN GRAFT MATRISTEM
|
Facility
|
OP
|
$2,683.15
|
|
| Hospital Charge Code |
4472033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$402.47 |
| Max. Negotiated Rate |
$2,146.52 |
| Rate for Payer: Aetna of NY Commercial |
$1,878.20
|
| Rate for Payer: Aetna of NY Medicare |
$1,234.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,073.26
|
| Rate for Payer: Cash Price |
$2,012.36
|
| Rate for Payer: CDPHP Medicare |
$992.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,146.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,146.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,146.52
|
| Rate for Payer: EmblemHealth Medicaid |
$2,146.52
|
| Rate for Payer: EmblemHealth Medicare |
$912.27
|
| Rate for Payer: EmblemHealth Select Care |
$1,931.87
|
| Rate for Payer: Fidelis Medicare |
$1,073.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,744.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,073.26
|
| Rate for Payer: Humana Medicare |
$1,073.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,878.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,234.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,012.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,510.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,126.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$402.47
|
| Rate for Payer: United Healthcare Medicare |
$1,073.26
|
| Rate for Payer: WellCare Medicare |
$1,475.73
|
|
|
6.0 ALLOPURE GRAFT
|
Facility
|
OP
|
$8,498.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.78 |
| Max. Negotiated Rate |
$6,798.82 |
| Rate for Payer: Aetna of NY Commercial |
$5,948.97
|
| Rate for Payer: Aetna of NY Medicare |
$3,909.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,399.41
|
| Rate for Payer: Cash Price |
$6,373.90
|
| Rate for Payer: CDPHP Medicare |
$3,144.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,249.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,798.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6,798.82
|
| Rate for Payer: EmblemHealth Medicaid |
$6,798.82
|
| Rate for Payer: EmblemHealth Medicare |
$2,889.50
|
| Rate for Payer: EmblemHealth Select Care |
$4,249.27
|
| Rate for Payer: Fidelis Medicare |
$3,399.41
|
| Rate for Payer: Galaxy Health Commercial |
$5,524.04
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,399.41
|
| Rate for Payer: Humana Medicare |
$3,399.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,948.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,909.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,524.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,524.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,569.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,274.78
|
| Rate for Payer: United Healthcare Medicare |
$3,399.41
|
| Rate for Payer: WellCare Medicare |
$4,674.19
|
|
|
6.0 ALLOPURE GRAFT
|
Facility
|
IP
|
$8,498.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.34 |
| Max. Negotiated Rate |
$5,948.97 |
| Rate for Payer: Aetna of NY Commercial |
$5,948.97
|
| Rate for Payer: Cash Price |
$6,373.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,249.27
|
| Rate for Payer: EmblemHealth Select Care |
$4,249.27
|
| Rate for Payer: Galaxy Health Commercial |
$5,524.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,948.97
|
| Rate for Payer: Multiplan Commercial |
$3,824.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,524.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,524.04
|
| Rate for Payer: WellCare Medicare |
$4,674.19
|
|
|
6-0 MONOSOF P-13
|
Facility
|
IP
|
$42.23
|
|
| Hospital Charge Code |
4478165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
|
|
6-0 MONOSOF P-13
|
Facility
|
OP
|
$42.23
|
|
| Hospital Charge Code |
4478165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: Aetna of NY Commercial |
$29.56
|
| Rate for Payer: Aetna of NY Medicare |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: CDPHP Medicare |
$15.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.78
|
| Rate for Payer: EmblemHealth Medicaid |
$33.78
|
| Rate for Payer: EmblemHealth Medicare |
$14.36
|
| Rate for Payer: EmblemHealth Select Care |
$30.41
|
| Rate for Payer: Fidelis Medicare |
$16.89
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.89
|
| Rate for Payer: Humana Medicare |
$16.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$16.89
|
| Rate for Payer: WellCare Medicare |
$23.23
|
|
