|
HERCULES 3 STAGE #431928
|
Facility
|
IP
|
$355.35
|
|
| Hospital Charge Code |
4479314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.98 |
| Max. Negotiated Rate |
$230.98 |
| Rate for Payer: Cash Price |
$266.51
|
| Rate for Payer: Galaxy Health Commercial |
$230.98
|
|
|
HERCULES 3 STAGE BALLOON 18-19-20
|
Facility
|
OP
|
$647.87
|
|
| Hospital Charge Code |
4473038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$518.30 |
| Rate for Payer: Aetna of NY Commercial |
$453.51
|
| Rate for Payer: Aetna of NY Medicare |
$298.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.15
|
| Rate for Payer: Cash Price |
$485.90
|
| Rate for Payer: CDPHP Medicare |
$239.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$518.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$518.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$518.30
|
| Rate for Payer: EmblemHealth Medicaid |
$518.30
|
| Rate for Payer: EmblemHealth Medicare |
$220.28
|
| Rate for Payer: EmblemHealth Select Care |
$466.47
|
| Rate for Payer: Fidelis Medicare |
$259.15
|
| Rate for Payer: Galaxy Health Commercial |
$421.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.15
|
| Rate for Payer: Humana Medicare |
$259.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$453.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$298.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$364.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$97.18
|
| Rate for Payer: United Healthcare Medicare |
$259.15
|
| Rate for Payer: WellCare Medicare |
$356.33
|
|
|
HERCULES 3 STAGE BALLOON 18-19-20
|
Facility
|
IP
|
$647.87
|
|
| Hospital Charge Code |
4473038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.12 |
| Max. Negotiated Rate |
$421.12 |
| Rate for Payer: Cash Price |
$485.90
|
| Rate for Payer: Galaxy Health Commercial |
$421.12
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$725.12
|
|
| Hospital Charge Code |
4471894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.33 |
| Max. Negotiated Rate |
$471.33 |
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$725.12
|
|
| Hospital Charge Code |
4471890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.33 |
| Max. Negotiated Rate |
$471.33 |
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$725.12
|
|
| Hospital Charge Code |
4471891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$580.10 |
| Rate for Payer: Aetna of NY Commercial |
$507.58
|
| Rate for Payer: Aetna of NY Medicare |
$333.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.05
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: CDPHP Medicare |
$268.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.10
|
| Rate for Payer: EmblemHealth Medicaid |
$580.10
|
| Rate for Payer: EmblemHealth Medicare |
$246.54
|
| Rate for Payer: EmblemHealth Select Care |
$522.09
|
| Rate for Payer: Fidelis Medicare |
$290.05
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.05
|
| Rate for Payer: Humana Medicare |
$290.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$507.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.77
|
| Rate for Payer: United Healthcare Medicare |
$290.05
|
| Rate for Payer: WellCare Medicare |
$398.82
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$725.12
|
|
| Hospital Charge Code |
4471892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.33 |
| Max. Negotiated Rate |
$471.33 |
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$725.12
|
|
| Hospital Charge Code |
4471890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$580.10 |
| Rate for Payer: Aetna of NY Commercial |
$507.58
|
| Rate for Payer: Aetna of NY Medicare |
$333.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.05
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: CDPHP Medicare |
$268.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.10
|
| Rate for Payer: EmblemHealth Medicaid |
$580.10
|
| Rate for Payer: EmblemHealth Medicare |
$246.54
|
| Rate for Payer: EmblemHealth Select Care |
$522.09
|
| Rate for Payer: Fidelis Medicare |
$290.05
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.05
|
| Rate for Payer: Humana Medicare |
$290.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$507.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.77
|
| Rate for Payer: United Healthcare Medicare |
$290.05
|
| Rate for Payer: WellCare Medicare |
$398.82
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
IP
|
$725.12
|
|
| Hospital Charge Code |
4471891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.33 |
| Max. Negotiated Rate |
$471.33 |
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$725.12
|
|
| Hospital Charge Code |
4471894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$580.10 |
| Rate for Payer: Aetna of NY Commercial |
$507.58
|
| Rate for Payer: Aetna of NY Medicare |
$333.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.05
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: CDPHP Medicare |
$268.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.10
|
| Rate for Payer: EmblemHealth Medicaid |
$580.10
|
| Rate for Payer: EmblemHealth Medicare |
$246.54
|
| Rate for Payer: EmblemHealth Select Care |
$522.09
|
| Rate for Payer: Fidelis Medicare |
$290.05
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.05
|
| Rate for Payer: Humana Medicare |
$290.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$507.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.77
|
| Rate for Payer: United Healthcare Medicare |
$290.05
|
| Rate for Payer: WellCare Medicare |
$398.82
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
|
OP
|
$725.12
|
|
| Hospital Charge Code |
4471892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$580.10 |
| Rate for Payer: Aetna of NY Commercial |
$507.58
|
| Rate for Payer: Aetna of NY Medicare |
$333.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$290.05
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: CDPHP Medicare |
$268.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$580.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.10
|
| Rate for Payer: EmblemHealth Medicaid |
$580.10
|
| Rate for Payer: EmblemHealth Medicare |
$246.54
|
| Rate for Payer: EmblemHealth Select Care |
$522.09
|
| Rate for Payer: Fidelis Medicare |
$290.05
|
| Rate for Payer: Galaxy Health Commercial |
$471.33
|
| Rate for Payer: Hamaspik Choice Medicare |
$290.05
|
| Rate for Payer: Humana Medicare |
$290.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$507.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$333.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$408.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$304.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.77
|
| Rate for Payer: United Healthcare Medicare |
$290.05
|
| Rate for Payer: WellCare Medicare |
$398.82
|
|
|
HETEROPHILE ABS QUAL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
4300440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.60
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.60
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.60
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
HETEROPHILE ABS QUAL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
4300440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
HFO W/JOINT(S) CF
|
Facility
|
IP
|
$917.73
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
4690265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.98 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Cash Price |
$688.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.87
|
| Rate for Payer: EmblemHealth Select Care |
$458.87
|
| Rate for Payer: Galaxy Health Commercial |
$596.52
|
| Rate for Payer: Multiplan Commercial |
$412.98
|
| Rate for Payer: WellCare Medicare |
$504.75
|
|
|
HFO W/JOINT(S) CF
|
Facility
|
OP
|
$917.73
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
4690265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$734.18 |
| Rate for Payer: Aetna of NY Commercial |
$642.41
|
| Rate for Payer: Aetna of NY Medicare |
$422.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$367.09
|
| Rate for Payer: Cash Price |
$688.30
|
| Rate for Payer: CDPHP Medicare |
$339.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$458.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$734.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$734.18
|
| Rate for Payer: EmblemHealth Medicaid |
$734.18
|
| Rate for Payer: EmblemHealth Medicare |
$312.03
|
| Rate for Payer: EmblemHealth Select Care |
$458.87
|
| Rate for Payer: Fidelis Medicare |
$367.09
|
| Rate for Payer: Galaxy Health Commercial |
$596.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$367.09
|
| Rate for Payer: Humana Medicare |
$367.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$642.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$422.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$688.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$516.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$385.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$137.66
|
| Rate for Payer: United Healthcare Medicare |
$367.09
|
| Rate for Payer: WellCare Medicare |
$504.75
|
|
|
HFO W/O JOINTS CF
|
Facility
|
OP
|
$777.65
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
4690165
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.65 |
| Max. Negotiated Rate |
$622.12 |
| Rate for Payer: Aetna of NY Commercial |
$544.36
|
| Rate for Payer: Aetna of NY Medicare |
$357.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$311.06
|
| Rate for Payer: Cash Price |
$583.24
|
| Rate for Payer: CDPHP Medicare |
$287.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$388.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$622.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$622.12
|
| Rate for Payer: EmblemHealth Medicaid |
$622.12
|
| Rate for Payer: EmblemHealth Medicare |
$264.40
|
| Rate for Payer: EmblemHealth Select Care |
$388.82
|
| Rate for Payer: Fidelis Medicare |
$311.06
|
| Rate for Payer: Galaxy Health Commercial |
$505.47
|
| Rate for Payer: Hamaspik Choice Medicare |
$311.06
|
| Rate for Payer: Humana Medicare |
$311.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$544.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$357.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.24
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$437.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$326.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.65
|
| Rate for Payer: United Healthcare Medicare |
$311.06
|
| Rate for Payer: WellCare Medicare |
$427.71
|
|
|
HFO W/O JOINTS CF
|
Facility
|
IP
|
$777.65
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
4690165
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.94 |
| Max. Negotiated Rate |
$505.47 |
| Rate for Payer: Cash Price |
$583.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$388.82
|
| Rate for Payer: EmblemHealth Select Care |
$388.82
|
| Rate for Payer: Galaxy Health Commercial |
$505.47
|
| Rate for Payer: Multiplan Commercial |
$349.94
|
| Rate for Payer: WellCare Medicare |
$427.71
|
|
|
HIGH FLOW SHEATH KIT 125 MM (AR-3210-0051)
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
4473047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
|
|
HIGH FLOW SHEATH KIT 125 MM (AR-3210-0051)
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
4473047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of NY Commercial |
$241.50
|
| Rate for Payer: Aetna of NY Medicare |
$158.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$138.00
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: CDPHP Medicare |
$127.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$276.00
|
| Rate for Payer: EmblemHealth Medicare |
$117.30
|
| Rate for Payer: EmblemHealth Select Care |
$248.40
|
| Rate for Payer: Fidelis Medicare |
$138.00
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$138.00
|
| Rate for Payer: Humana Medicare |
$138.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$241.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$144.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.75
|
| Rate for Payer: United Healthcare Medicare |
$138.00
|
| Rate for Payer: WellCare Medicare |
$189.75
|
|
|
HIV-1 AG W/HIV-1 & HIV-2 AB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
4305529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$99.20 |
| Rate for Payer: Aetna of NY Commercial |
$80.60
|
| Rate for Payer: Aetna of NY Medicare |
$57.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: CDPHP Medicare |
$45.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$99.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$99.20
|
| Rate for Payer: EmblemHealth Medicaid |
$99.20
|
| Rate for Payer: EmblemHealth Medicare |
$42.16
|
| Rate for Payer: EmblemHealth Select Care |
$74.40
|
| Rate for Payer: Fidelis Medicare |
$49.60
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.60
|
| Rate for Payer: Humana Medicare |
$49.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$80.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$69.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$93.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.60
|
| Rate for Payer: United Healthcare Commercial |
$93.00
|
| Rate for Payer: United Healthcare Medicare |
$49.60
|
| Rate for Payer: WellCare Medicare |
$68.20
|
|
|
HIV-1 AG W/HIV-1 & HIV-2 AB
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
4305529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Galaxy Health Commercial |
$80.60
|
|
|
HIV1 RNA QUANT BY PCR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
4301179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
|
|
HIV1 RNA QUANT BY PCR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
4301179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna of NY Commercial |
$214.50
|
| Rate for Payer: Aetna of NY Medicare |
$151.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$132.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: CDPHP Medicare |
$122.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$198.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$264.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$264.00
|
| Rate for Payer: EmblemHealth Medicaid |
$264.00
|
| Rate for Payer: EmblemHealth Medicare |
$112.20
|
| Rate for Payer: EmblemHealth Select Care |
$198.00
|
| Rate for Payer: Fidelis Medicare |
$132.00
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$132.00
|
| Rate for Payer: Humana Medicare |
$132.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$214.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$151.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$185.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$138.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$247.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WellCare Medicare |
$181.50
|
|
|
HOLTER MONITOR - ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
4150500
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
HOLTER MONITOR - ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
4150500
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$265.20
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$285.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$265.20
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$265.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
