|
IRRIGATION/ TUR SET "Y" TYPE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4478211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
IRRIGATION/ TUR SET "Y" TYPE
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4478211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
IRRIG IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
4450116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$126.00
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$131.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Commercial |
$131.25
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
IRRIG IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
4450116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
4401287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
4401287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna of NY Commercial |
$63.00
|
| Rate for Payer: Aetna of NY Medicare |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$33.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$45.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: CDPHP Commercial |
$72.45
|
| Rate for Payer: CDPHP Medicare |
$33.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.00
|
| Rate for Payer: EmblemHealth Medicaid |
$72.00
|
| Rate for Payer: EmblemHealth Medicare |
$30.60
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$34.30
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$33.30
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.96
|
| Rate for Payer: United Healthcare Medicare |
$33.30
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
ISONIAZID 100 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00555006602
|
| Hospital Charge Code |
4409042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ISONIAZID 100 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00555006602
|
| Hospital Charge Code |
4409042
|
|
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
|
|
|
ISOSORBIDE DINITRATE 10 MG TAB 10 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4401435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ISOSORBIDE DINITRATE 10 MG TAB 10 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4401435
|
|
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
|
|
|
ISOSORBIDE MONONITRATE 30MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
4400394
|
|
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
|
|
|
ISOSORBIDE MONONITRATE 30MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
4400394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ISOVUE 200M 10ML
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
4471150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ISOVUE 200M 10ML
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
4471150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$20.30
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| 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 |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.30
|
| 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 |
$11.27
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ISOVUE 200M 20ML
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4471151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
ISOVUE 200M 20ML
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4471151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna of NY Commercial |
$63.00
|
| Rate for Payer: Aetna of NY Medicare |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$33.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$45.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: CDPHP Commercial |
$72.45
|
| Rate for Payer: CDPHP Medicare |
$33.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$72.00
|
| Rate for Payer: EmblemHealth Medicaid |
$72.00
|
| Rate for Payer: EmblemHealth Medicare |
$30.60
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$34.30
|
| Rate for Payer: Galaxy Health Commercial |
$58.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$33.30
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$41.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.96
|
| Rate for Payer: United Healthcare Medicare |
$33.30
|
| Rate for Payer: WellCare Medicare |
$49.50
|
|
|
ISOVUE 300 100ML
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4471129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$86.14 |
| Rate for Payer: Aetna of NY Commercial |
$74.90
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.50
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: EmblemHealth Select Care |
$77.04
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
ISOVUE 300 100ML
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4471129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
ISOVUE 300 50 ML
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
4471128
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ISOVUE 300 50 ML
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
4471128
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$20.30
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| 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 |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.30
|
| 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 |
$11.27
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
IV BLOOD TRANSFUSION KIT
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
4451247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Galaxy Health Commercial |
$52.65
|
|
|
IV BLOOD TRANSFUSION KIT
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
4451247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna of NY Commercial |
$56.70
|
| Rate for Payer: Aetna of NY Medicare |
$37.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.50
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: CDPHP Commercial |
$65.20
|
| Rate for Payer: CDPHP Medicare |
$29.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.80
|
| Rate for Payer: EmblemHealth Medicaid |
$64.80
|
| Rate for Payer: EmblemHealth Medicare |
$27.54
|
| Rate for Payer: EmblemHealth Select Care |
$58.32
|
| Rate for Payer: Fidelis Medicare |
$30.87
|
| Rate for Payer: Galaxy Health Commercial |
$52.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.97
|
| Rate for Payer: Humana Medicare |
$29.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.47
|
| Rate for Payer: United Healthcare Medicare |
$29.97
|
| Rate for Payer: WellCare Medicare |
$44.55
|
|
|
IV INFUSION KIT
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
4451245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
IV INFUSION KIT
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
4451245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
IV PORT FLUSH KIT
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4451246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna of NY Commercial |
$44.80
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.86
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
