|
VANCOMYCIN 1 GRAM/200 ML BAG 1 g, 200 mL
|
Facility
OP
|
$110.00
|
|
| Hospital Charge Code |
4401368
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$88.55 |
| Rate for Payer: Aetna of NY Commercial |
$77.00
|
| Rate for Payer: Aetna of NY Medicare |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$55.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: CDPHP Commercial |
$88.55
|
| Rate for Payer: CDPHP Medicare |
$40.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$88.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.00
|
| Rate for Payer: EmblemHealth Medicaid |
$88.00
|
| Rate for Payer: EmblemHealth Medicare |
$37.40
|
| Rate for Payer: EmblemHealth Select Care |
$79.20
|
| Rate for Payer: Fidelis Medicare |
$41.92
|
| Rate for Payer: Galaxy Health Commercial |
$71.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.70
|
| Rate for Payer: Humana Medicare |
$40.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$50.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$61.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.74
|
| Rate for Payer: United Healthcare Medicare |
$40.70
|
| Rate for Payer: WellCare Medicare |
$60.50
|
|
|
VANCOMYCIN 500 MG/100 ML BAG 500 mg, 100 mL
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$29.70
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
VANCOMYCIN 750 MG/150 ML BAG 5 mg, 150 mL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$24.75
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
VANCOMYCIN HCL 1.25 GRAM VIAL 1.25 g, 1 each
|
Facility
OP
|
$92.00
|
|
| Hospital Charge Code |
4401500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$74.06 |
| Rate for Payer: Aetna of NY Commercial |
$64.40
|
| Rate for Payer: Aetna of NY Medicare |
$42.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: CDPHP Commercial |
$74.06
|
| Rate for Payer: CDPHP Medicare |
$34.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$73.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.60
|
| Rate for Payer: EmblemHealth Medicaid |
$73.60
|
| Rate for Payer: EmblemHealth Medicare |
$31.28
|
| Rate for Payer: EmblemHealth Select Care |
$66.24
|
| Rate for Payer: Fidelis Medicare |
$35.06
|
| Rate for Payer: Galaxy Health Commercial |
$59.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.04
|
| Rate for Payer: Humana Medicare |
$34.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.74
|
| Rate for Payer: United Healthcare Medicare |
$34.04
|
| Rate for Payer: WellCare Medicare |
$50.60
|
|
|
VANCOMYCIN HCL 250MG CAPS 20 EA
|
Facility
OP
|
$178.45
|
|
| Hospital Charge Code |
4400788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna of NY Commercial |
$124.92
|
| Rate for Payer: Aetna of NY Medicare |
$82.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$133.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$133.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$89.22
|
| Rate for Payer: Cash Price |
$133.84
|
| Rate for Payer: CDPHP Commercial |
$143.65
|
| Rate for Payer: CDPHP Medicare |
$66.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$142.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.76
|
| Rate for Payer: EmblemHealth Medicaid |
$142.76
|
| Rate for Payer: EmblemHealth Medicare |
$60.67
|
| Rate for Payer: EmblemHealth Select Care |
$128.48
|
| Rate for Payer: Fidelis Medicare |
$68.01
|
| Rate for Payer: Galaxy Health Commercial |
$115.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.03
|
| Rate for Payer: Humana Medicare |
$66.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$124.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.33
|
| Rate for Payer: United Healthcare Medicare |
$66.03
|
| Rate for Payer: WellCare Medicare |
$98.15
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
OP
|
$29.75
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna of NY Commercial |
$16.36
|
| Rate for Payer: Aetna of NY Medicare |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.88
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: CDPHP Commercial |
$23.95
|
| Rate for Payer: CDPHP Medicare |
$11.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.80
|
| Rate for Payer: EmblemHealth Medicaid |
$23.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.12
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$11.34
|
| Rate for Payer: Galaxy Health Commercial |
$19.34
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.01
|
| Rate for Payer: Humana Medicare |
$11.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$11.01
|
| Rate for Payer: WellCare Medicare |
$16.36
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
OP
|
$29.87
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna of NY Commercial |
$16.43
|
| Rate for Payer: Aetna of NY Medicare |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.94
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: CDPHP Commercial |
$24.05
|
| Rate for Payer: CDPHP Medicare |
$11.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.90
|
| Rate for Payer: EmblemHealth Medicaid |
$23.90
|
| Rate for Payer: EmblemHealth Medicare |
$10.16
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$11.38
|
| Rate for Payer: Galaxy Health Commercial |
$19.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.05
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
| Rate for Payer: WellCare Medicare |
$16.43
|
|
|
VANCOMYCIN TROUGH
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4301020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4200050
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.18 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
4002062
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$161,026.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,623.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,610.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,610.26
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Essential Plan |
$3,623.08
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,932.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.26
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.26
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,623.08
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$161,026.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$161,026.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,462.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,462.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,610.26
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,690.77
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
4650078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59
|
| Hospital Charge Code |
4650393
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: WellCare Medicare |
$65.45
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59,KX
|
| Hospital Charge Code |
4650445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (W/ KX)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,KX
|
| Hospital Charge Code |
4650341
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPRESSIN 20U/ML MDV 25X1ML
|
Facility
OP
|
$137.25
|
|
| Hospital Charge Code |
4400792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$110.49 |
| Rate for Payer: Aetna of NY Commercial |
$96.08
|
| Rate for Payer: Aetna of NY Medicare |
$63.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.62
|
| Rate for Payer: Cash Price |
$102.94
|
| Rate for Payer: CDPHP Commercial |
$110.49
|
| Rate for Payer: CDPHP Medicare |
$50.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.80
|
| Rate for Payer: EmblemHealth Medicaid |
$109.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.66
|
| Rate for Payer: EmblemHealth Select Care |
$98.82
|
| Rate for Payer: Fidelis Medicare |
$52.31
|
| Rate for Payer: Galaxy Health Commercial |
$89.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.78
|
| Rate for Payer: Humana Medicare |
$50.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$96.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.32
|
| Rate for Payer: United Healthcare Medicare |
$50.78
|
| Rate for Payer: WellCare Medicare |
$75.49
|
|
|
VDRL CSF
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
4300823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Aetna of NY Commercial |
$27.30
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Commercial |
$33.81
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: Fidelis Medicare |
$16.01
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.54
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Medicare |
$15.54
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
VECURONIUM BR INJ 10 MG
|
Facility
OP
|
$32.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna of NY Commercial |
$17.98
|
| Rate for Payer: Aetna of NY Medicare |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.35
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: CDPHP Commercial |
$26.32
|
| Rate for Payer: CDPHP Medicare |
$12.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.16
|
| Rate for Payer: EmblemHealth Medicaid |
$26.16
|
| Rate for Payer: EmblemHealth Medicare |
$11.12
|
| Rate for Payer: EmblemHealth Select Care |
$23.54
|
| Rate for Payer: Fidelis Medicare |
$12.46
|
| Rate for Payer: Galaxy Health Commercial |
$21.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.10
|
| Rate for Payer: Humana Medicare |
$12.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.70
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
VENELEX OINTMENT 1 ea, 28.35 g
|
Facility
OP
|
$89.00
|
|
| Hospital Charge Code |
4401533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna of NY Commercial |
$62.30
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.50
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Commercial |
$71.64
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: EmblemHealth Select Care |
$64.08
|
| Rate for Payer: Fidelis Medicare |
$33.92
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.93
|
| Rate for Payer: Humana Medicare |
$32.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.58
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
VENIPUNCTURE
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
4300999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$16.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$7.15
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Essential Plan |
$16.09
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.15
|
| Rate for Payer: EmblemHealth Medicaid |
$7.15
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$16.09
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$715.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.15
|
| Rate for Payer: United Healthcare Commercial |
$6.75
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.51
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
VENLAFAXINE ER 150 MG CAPSULES
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
4409165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna of NY Commercial |
$12.80
|
| Rate for Payer: Aetna of NY Medicare |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.14
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: CDPHP Commercial |
$14.72
|
| Rate for Payer: CDPHP Medicare |
$6.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.62
|
| Rate for Payer: EmblemHealth Medicaid |
$14.62
|
| Rate for Payer: EmblemHealth Medicare |
$6.22
|
| Rate for Payer: EmblemHealth Select Care |
$13.16
|
| Rate for Payer: Fidelis Medicare |
$6.97
|
| Rate for Payer: Galaxy Health Commercial |
$11.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.76
|
| Rate for Payer: Humana Medicare |
$6.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.71
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.10
|
| Rate for Payer: United Healthcare Medicare |
$6.76
|
| Rate for Payer: WellCare Medicare |
$10.05
|
|
|
VENLAFAXINE HCL 37.5MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| 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: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| 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 |
$4.45
|
| 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 |
$4.33
|
| 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: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VENLAFAXINE HCL 50 MG TABLET 50 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VENLAFAXINE HCL ER 150 MG CAP 150 mg, 90 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VENLAFAXINE XR 37.5 MG CAP
|
Facility
OP
|
$11.59
|
|
| Hospital Charge Code |
4401265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.80
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Commercial |
$9.33
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.42
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
VENOFER INJECTION 100MG/5 ML
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
4409093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$0.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$0.27
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Essential Plan |
$0.61
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.27
|
| Rate for Payer: EmblemHealth Medicaid |
$0.27
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$0.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$0.61
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$0.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$27.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$27.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$0.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$0.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$0.28
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
