IV PORT FLUSH KIT
|
Facility
|
IP
|
$64.00
|
|
Hospital Charge Code |
4451246
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$41.60 |
Max. Negotiated Rate |
$41.60 |
Rate for Payer: Cash Price |
$48.00
|
Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
IV PORT FLUSH (OMP ONLY)
|
Facility
|
OP
|
$175.00
|
|
Service Code
|
HCPCS 96523
|
Hospital Charge Code |
4451248
|
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
|
|
IV PORT FLUSH (OMP ONLY)
|
Facility
|
IP
|
$175.00
|
|
Service Code
|
HCPCS 96523
|
Hospital Charge Code |
4451248
|
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
|
|
IVP SINGLE DRUG OR SUBSTANCE
|
Facility
|
IP
|
$500.00
|
|
Service Code
|
HCPCS 96374
|
Hospital Charge Code |
4450107
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$325.00 |
Max. Negotiated Rate |
$325.00 |
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Galaxy Health Commercial |
$325.00
|
|
IVP SINGLE DRUG OR SUBSTANCE
|
Facility
|
OP
|
$500.00
|
|
Service Code
|
HCPCS 96374
|
Hospital Charge Code |
4450107
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$170.00 |
Max. Negotiated Rate |
$402.50 |
Rate for Payer: Aetna of NY Commercial |
$350.00
|
Rate for Payer: Aetna of NY Medicare |
$230.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.00
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$250.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: CDPHP Commercial |
$402.50
|
Rate for Payer: CDPHP Medicare |
$185.00
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$400.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$400.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$400.00
|
Rate for Payer: EmblemHealth Medicaid |
$400.00
|
Rate for Payer: EmblemHealth Medicare |
$170.00
|
Rate for Payer: EmblemHealth Select Care |
$360.00
|
Rate for Payer: Fidelis Medicare |
$190.55
|
Rate for Payer: Galaxy Health Commercial |
$325.00
|
Rate for Payer: Hamaspik Choice Medicare |
$185.00
|
Rate for Payer: Humana Medicare |
$185.00
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$350.00
|
Rate for Payer: Local 1199SEIU Medicare |
$230.00
|
Rate for Payer: MVP Health Care of NY Commercial |
$375.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$281.50
|
Rate for Payer: MVP Health Care of NY Medicare |
$194.25
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$375.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$204.22
|
Rate for Payer: United Healthcare Commercial |
$375.00
|
Rate for Payer: United Healthcare Medicare |
$185.00
|
Rate for Payer: WellCare Medicare |
$275.00
|
|
IV PUMP USAGE
|
Facility
|
IP
|
$20.00
|
|
Hospital Charge Code |
4451236
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.00 |
Max. Negotiated Rate |
$13.00 |
Rate for Payer: Cash Price |
$15.00
|
Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
IV PUMP USAGE
|
Facility
|
OP
|
$20.00
|
|
Hospital Charge Code |
4451236
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$6.80 |
Max. Negotiated Rate |
$16.10 |
Rate for Payer: Aetna of NY Commercial |
$14.00
|
Rate for Payer: Aetna of NY Medicare |
$9.20
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
Rate for Payer: Cash Price |
$15.00
|
Rate for Payer: CDPHP Commercial |
$16.10
|
Rate for Payer: CDPHP Medicare |
$7.40
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
Rate for Payer: EmblemHealth Medicaid |
$16.00
|
Rate for Payer: EmblemHealth Medicare |
$6.80
|
Rate for Payer: EmblemHealth Select Care |
$14.40
|
Rate for Payer: Fidelis Medicare |
$7.62
|
Rate for Payer: Galaxy Health Commercial |
$13.00
|
Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
Rate for Payer: Humana Medicare |
$7.40
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.00
|
Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
Rate for Payer: United Healthcare Medicare |
$7.40
|
Rate for Payer: WellCare Medicare |
$11.00
|
|
IV PUSH SEQ INJ SAME DRUG ADDITIONAL
|
Facility
|
OP
|
$136.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
4451234
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$45.26 |
Max. Negotiated Rate |
$400.55 |
Rate for Payer: Aetna of NY Commercial |
$95.20
|
Rate for Payer: Aetna of NY Medicare |
$62.56
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: CDPHP Commercial |
$109.48
|
Rate for Payer: CDPHP Medicare |
$50.32
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
Rate for Payer: EmblemHealth Medicaid |
$108.80
|
Rate for Payer: EmblemHealth Medicare |
$46.24
|
Rate for Payer: EmblemHealth Select Care |
$97.92
|
Rate for Payer: Fidelis Medicare |
$51.83
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
Rate for Payer: Humana Medicare |
$50.32
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.20
|
Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.57
|
Rate for Payer: MVP Health Care of NY Medicare |
$52.84
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.26
|
Rate for Payer: United Healthcare Commercial |
$102.00
|
Rate for Payer: United Healthcare Medicare |
$50.32
|
Rate for Payer: WellCare Medicare |
$74.80
|
|
IV PUSH SEQ INJ SAME DRUG ADDITIONAL
|
Facility
|
IP
|
$136.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
4451234
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$88.40 |
Max. Negotiated Rate |
$88.40 |
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
IV PUSH SUBSEQUENT
|
Facility
|
OP
|
$136.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
4451244
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$45.26 |
Max. Negotiated Rate |
$400.55 |
Rate for Payer: Aetna of NY Commercial |
$95.20
|
Rate for Payer: Aetna of NY Medicare |
$62.56
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: CDPHP Commercial |
$109.48
|
Rate for Payer: CDPHP Medicare |
$50.32
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
Rate for Payer: EmblemHealth Medicaid |
$108.80
|
Rate for Payer: EmblemHealth Medicare |
$46.24
|
Rate for Payer: EmblemHealth Select Care |
$97.92
|
Rate for Payer: Fidelis Medicare |
$51.83
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
Rate for Payer: Humana Medicare |
$50.32
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.20
|
Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.57
|
Rate for Payer: MVP Health Care of NY Medicare |
$52.84
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$45.26
|
Rate for Payer: United Healthcare Commercial |
$102.00
|
Rate for Payer: United Healthcare Medicare |
$50.32
|
Rate for Payer: WellCare Medicare |
$74.80
|
|
IV PUSH SUBSEQUENT
|
Facility
|
IP
|
$136.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
4451244
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$88.40 |
Max. Negotiated Rate |
$88.40 |
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
IV SALINE LOC
|
Facility
|
IP
|
$28.00
|
|
Hospital Charge Code |
4472144
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$18.20 |
Max. Negotiated Rate |
$18.20 |
Rate for Payer: Cash Price |
$21.00
|
Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
IV SALINE LOC
|
Facility
|
OP
|
$28.00
|
|
Hospital Charge Code |
4472144
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$9.52 |
Max. Negotiated Rate |
$22.54 |
Rate for Payer: Aetna of NY Commercial |
$19.60
|
Rate for Payer: Aetna of NY Medicare |
$12.88
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
Rate for Payer: Cash Price |
$21.00
|
Rate for Payer: CDPHP Commercial |
$22.54
|
Rate for Payer: CDPHP Medicare |
$10.36
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
Rate for Payer: EmblemHealth Medicaid |
$22.40
|
Rate for Payer: EmblemHealth Medicare |
$9.52
|
Rate for Payer: EmblemHealth Select Care |
$20.16
|
Rate for Payer: Fidelis Medicare |
$10.67
|
Rate for Payer: Galaxy Health Commercial |
$18.20
|
Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
Rate for Payer: Humana Medicare |
$10.36
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
Rate for Payer: United Healthcare Medicare |
$10.36
|
Rate for Payer: WellCare Medicare |
$15.40
|
|
IV SUPPLIES SOLUTIONING
|
Facility
|
OP
|
$47.00
|
|
Hospital Charge Code |
4472184
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$15.98 |
Max. Negotiated Rate |
$37.84 |
Rate for Payer: Aetna of NY Commercial |
$32.90
|
Rate for Payer: Aetna of NY Medicare |
$21.62
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.25
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.39
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.50
|
Rate for Payer: Cash Price |
$35.25
|
Rate for Payer: CDPHP Commercial |
$37.84
|
Rate for Payer: CDPHP Medicare |
$17.39
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
Rate for Payer: EmblemHealth Medicaid |
$37.60
|
Rate for Payer: EmblemHealth Medicare |
$15.98
|
Rate for Payer: EmblemHealth Select Care |
$33.84
|
Rate for Payer: Fidelis Medicare |
$17.91
|
Rate for Payer: Galaxy Health Commercial |
$30.55
|
Rate for Payer: Hamaspik Choice Medicare |
$17.39
|
Rate for Payer: Humana Medicare |
$17.39
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.90
|
Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
Rate for Payer: MVP Health Care of NY Medicare |
$18.26
|
Rate for Payer: United Healthcare Medicare |
$17.39
|
Rate for Payer: WellCare Medicare |
$25.85
|
|
IV SUPPLIES SOLUTIONING
|
Facility
|
IP
|
$47.00
|
|
Hospital Charge Code |
4472184
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$30.55 |
Max. Negotiated Rate |
$30.55 |
Rate for Payer: Cash Price |
$35.25
|
Rate for Payer: Galaxy Health Commercial |
$30.55
|
|
IV THERAPY EACH HOUR OVER 1.5 HOURS
|
Facility
|
IP
|
$136.00
|
|
Service Code
|
HCPCS 96366
|
Hospital Charge Code |
4450106
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$88.40 |
Max. Negotiated Rate |
$88.40 |
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
IV THERAPY EACH HOUR OVER 1.5 HOURS
|
Facility
|
OP
|
$136.00
|
|
Service Code
|
HCPCS 96366
|
Hospital Charge Code |
4450106
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$46.24 |
Max. Negotiated Rate |
$23,767.00 |
Rate for Payer: Aetna of NY Commercial |
$95.20
|
Rate for Payer: Aetna of NY Medicare |
$62.56
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$534.76
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$237.67
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: Cash Price |
$102.00
|
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$237.67
|
Rate for Payer: CDPHP Commercial |
$109.48
|
Rate for Payer: CDPHP Essential Plan |
$534.76
|
Rate for Payer: CDPHP Medicare |
$50.32
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$285.20
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$237.67
|
Rate for Payer: EmblemHealth Medicaid |
$237.67
|
Rate for Payer: EmblemHealth Medicare |
$46.24
|
Rate for Payer: EmblemHealth Select Care |
$97.92
|
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$534.76
|
Rate for Payer: Fidelis Medicare |
$51.83
|
Rate for Payer: Galaxy Health Commercial |
$88.40
|
Rate for Payer: Galaxy Health Workers Comp |
$349.37
|
Rate for Payer: Hamaspik Choice Medicaid |
$23,767.00
|
Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
Rate for Payer: Humana Medicare |
$50.32
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.20
|
Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23,767.00
|
Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$510.99
|
Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$510.99
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.57
|
Rate for Payer: MVP Health Care of NY Medicare |
$52.84
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.00
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$237.67
|
Rate for Payer: United Healthcare Commercial |
$102.00
|
Rate for Payer: United Healthcare Medicare |
$50.32
|
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$249.55
|
Rate for Payer: WellCare Medicare |
$74.80
|
|
IV THERAPY INITIAL
|
Facility
|
OP
|
$613.00
|
|
Service Code
|
HCPCS 96365
|
Hospital Charge Code |
4451242
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$35.35 |
Max. Negotiated Rate |
$493.46 |
Rate for Payer: Aetna of NY Commercial |
$429.10
|
Rate for Payer: Aetna of NY Medicare |
$281.98
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$226.81
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$306.50
|
Rate for Payer: Cash Price |
$459.75
|
Rate for Payer: Cash Price |
$459.75
|
Rate for Payer: Cash Price |
$459.75
|
Rate for Payer: CDPHP Commercial |
$493.46
|
Rate for Payer: CDPHP Medicare |
$226.81
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$490.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$490.40
|
Rate for Payer: EmblemHealth Medicaid |
$490.40
|
Rate for Payer: EmblemHealth Medicare |
$208.42
|
Rate for Payer: EmblemHealth Select Care |
$441.36
|
Rate for Payer: Fidelis Medicare |
$233.61
|
Rate for Payer: Galaxy Health Commercial |
$398.45
|
Rate for Payer: Hamaspik Choice Medicare |
$226.81
|
Rate for Payer: Humana Medicare |
$226.81
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$429.10
|
Rate for Payer: Local 1199SEIU Medicare |
$281.98
|
Rate for Payer: MVP Health Care of NY Commercial |
$459.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$345.12
|
Rate for Payer: MVP Health Care of NY Medicare |
$238.15
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$459.75
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
Rate for Payer: United Healthcare Commercial |
$459.75
|
Rate for Payer: United Healthcare Medicare |
$226.81
|
Rate for Payer: WellCare Medicare |
$337.15
|
|
IV THERAPY INITIAL
|
Facility
|
IP
|
$613.00
|
|
Service Code
|
HCPCS 96365
|
Hospital Charge Code |
4451242
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$398.45 |
Max. Negotiated Rate |
$398.45 |
Rate for Payer: Cash Price |
$459.75
|
Rate for Payer: Galaxy Health Commercial |
$398.45
|
|
JACKSON-PRATT WOUND DRAIN 10MM
|
Facility
|
IP
|
$42.00
|
|
Hospital Charge Code |
4472094
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$27.30 |
Max. Negotiated Rate |
$27.30 |
Rate for Payer: Cash Price |
$31.50
|
Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
JACKSON-PRATT WOUND DRAIN 10MM
|
Facility
|
OP
|
$42.00
|
|
Hospital Charge Code |
4472094
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.28 |
Max. Negotiated Rate |
$33.81 |
Rate for Payer: Aetna of NY Commercial |
$29.40
|
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: CDPHP Commercial |
$33.81
|
Rate for Payer: CDPHP Medicare |
$15.54
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
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: EmblemHealth Select Care |
$30.24
|
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 |
$29.40
|
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: United Healthcare Medicare |
$15.54
|
Rate for Payer: WellCare Medicare |
$23.10
|
|
Jantoven 1 MG TABLET 1 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
Service Code
|
NDC 00832121101
|
Hospital Charge Code |
4401422
|
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
|
|
Jantoven 1 MG TABLET 1 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
Service Code
|
NDC 00832121101
|
Hospital Charge Code |
4401422
|
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
|
|
Jantoven 2.5 MG TABLET 1 ea, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
Service Code
|
NDC 00832121301
|
Hospital Charge Code |
4401420
|
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
|
|
Jantoven 2.5 MG TABLET 1 ea, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
Service Code
|
NDC 00832121301
|
Hospital Charge Code |
4401420
|
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
|
|