|
VITAMIN B 1 (THIAMINE) 100 MG TAB
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409023
|
|
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
|
|
|
VITAMIN B6
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
4301199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$175.49 |
| Rate for Payer: Aetna of NY Commercial |
$141.70
|
| Rate for Payer: Aetna of NY Medicare |
$100.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$163.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$163.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$109.00
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: CDPHP Commercial |
$175.49
|
| Rate for Payer: CDPHP Medicare |
$80.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$174.40
|
| Rate for Payer: EmblemHealth Medicare |
$74.12
|
| Rate for Payer: Fidelis Medicare |
$83.08
|
| Rate for Payer: Galaxy Health Commercial |
$141.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.66
|
| Rate for Payer: Humana Medicare |
$80.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$100.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$122.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$163.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.10
|
| Rate for Payer: United Healthcare Commercial |
$163.50
|
| Rate for Payer: United Healthcare Medicare |
$80.66
|
| Rate for Payer: WellCare Medicare |
$119.90
|
|
|
VITAMIN B 6 (PYRIDOXINE) 100 MG TAB
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409024
|
|
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
|
|
|
VITAMIN D 1000U TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400805
|
|
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
|
|
|
VITAMIN D 25 HYDROXY
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
4301198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$160.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Commercial |
$257.60
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: Fidelis Medicare |
$121.95
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$240.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$240.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
VITAMIN D3 50,000 UNITS CAP
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409034
|
|
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
|
|
|
VITAMIN D 400U TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400807
|
|
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
|
|
|
VITAMIN E 400U CAPS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400808
|
|
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
|
|
|
VIVITROL
|
Facility
OP
|
$4,560.00
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
4401915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3,670.80 |
| Rate for Payer: Aetna of NY Commercial |
$2,508.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,687.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,280.00
|
| Rate for Payer: Cash Price |
$3,420.00
|
| Rate for Payer: Cash Price |
$3,420.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3.21
|
| Rate for Payer: CDPHP Commercial |
$3,670.80
|
| Rate for Payer: CDPHP Essential Plan |
$7.22
|
| Rate for Payer: CDPHP Medicare |
$1,687.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.21
|
| Rate for Payer: EmblemHealth Medicaid |
$3.21
|
| Rate for Payer: EmblemHealth Medicare |
$1,550.40
|
| Rate for Payer: EmblemHealth Select Care |
$3.97
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7.22
|
| Rate for Payer: Fidelis Medicare |
$1,737.82
|
| Rate for Payer: Galaxy Health Commercial |
$2,964.00
|
| Rate for Payer: Galaxy Health Workers Comp |
$3.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$321.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,687.20
|
| Rate for Payer: Humana Medicare |
$1,687.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,508.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,097.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$321.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,420.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,567.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,771.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$6.50
|
| Rate for Payer: United Healthcare Medicare |
$1,687.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3.37
|
| Rate for Payer: WellCare Medicare |
$2,508.00
|
|
|
V ZOSTER IGM TITER
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
4300815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$32.50
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$37.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$37.50
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
WARFARIN SODIUM 2.5MG TABS 100 EA
|
Facility
OP
|
$7.47
|
|
| Hospital Charge Code |
4400189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of NY Commercial |
$5.23
|
| Rate for Payer: Aetna of NY Medicare |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.74
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: CDPHP Commercial |
$6.01
|
| Rate for Payer: CDPHP Medicare |
$2.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.98
|
| Rate for Payer: EmblemHealth Medicaid |
$5.98
|
| Rate for Payer: EmblemHealth Medicare |
$2.54
|
| Rate for Payer: EmblemHealth Select Care |
$5.38
|
| Rate for Payer: Fidelis Medicare |
$2.85
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.76
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
WARFARIN SODIUM 2MG TABS 100 EA
|
Facility
OP
|
$7.21
|
|
| Hospital Charge Code |
4400190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.60
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Commercial |
$5.80
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.75
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.80
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
WARFARIN SODIUM 3MG TABS 100 EA
|
Facility
OP
|
$7.47
|
|
| Hospital Charge Code |
4400191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of NY Commercial |
$5.23
|
| Rate for Payer: Aetna of NY Medicare |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.74
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: CDPHP Commercial |
$6.01
|
| Rate for Payer: CDPHP Medicare |
$2.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.98
|
| Rate for Payer: EmblemHealth Medicaid |
$5.98
|
| Rate for Payer: EmblemHealth Medicare |
$2.54
|
| Rate for Payer: EmblemHealth Select Care |
$5.38
|
| Rate for Payer: Fidelis Medicare |
$2.85
|
| Rate for Payer: Galaxy Health Commercial |
$4.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.76
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.23
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WellCare Medicare |
$4.11
|
|
|
WARFARIN SODIUM 5MG TABS 100 EA
|
Facility
OP
|
$7.73
|
|
| Hospital Charge Code |
4400193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$5.41
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
WARFARIN SODIUM 6MG TABS 100 EA
|
Facility
OP
|
$10.04
|
|
| Hospital Charge Code |
4400194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of NY Commercial |
$7.03
|
| Rate for Payer: Aetna of NY Medicare |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.02
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: CDPHP Commercial |
$8.08
|
| Rate for Payer: CDPHP Medicare |
$3.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.03
|
| Rate for Payer: EmblemHealth Medicaid |
$8.03
|
| Rate for Payer: EmblemHealth Medicare |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$7.23
|
| Rate for Payer: Fidelis Medicare |
$3.83
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.90
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
WAYNE PNEUMOTHORAX
|
Facility
OP
|
$587.00
|
|
| Hospital Charge Code |
4479109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$472.54 |
| Rate for Payer: Aetna of NY Commercial |
$410.90
|
| Rate for Payer: Aetna of NY Medicare |
$270.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$440.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$440.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$217.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$293.50
|
| Rate for Payer: Cash Price |
$440.25
|
| Rate for Payer: CDPHP Commercial |
$472.54
|
| Rate for Payer: CDPHP Medicare |
$217.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$469.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$469.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$469.60
|
| Rate for Payer: EmblemHealth Medicaid |
$469.60
|
| Rate for Payer: EmblemHealth Medicare |
$199.58
|
| Rate for Payer: EmblemHealth Select Care |
$422.64
|
| Rate for Payer: Fidelis Medicare |
$223.71
|
| Rate for Payer: Galaxy Health Commercial |
$381.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$217.19
|
| Rate for Payer: Humana Medicare |
$217.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$410.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$270.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$330.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$228.05
|
| Rate for Payer: United Healthcare Medicare |
$217.19
|
| Rate for Payer: WellCare Medicare |
$322.85
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4856705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4609572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
WEDGING OF CAST NOT CLUBFOOT CAST
|
Facility
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
4850164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| 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) Medicare |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
WEST NILE VIRUS AB IGM
|
Facility
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
4301197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna of NY Commercial |
$176.80
|
| Rate for Payer: Aetna of NY Medicare |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$136.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: CDPHP Commercial |
$218.96
|
| Rate for Payer: CDPHP Medicare |
$100.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$217.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.60
|
| Rate for Payer: EmblemHealth Medicaid |
$217.60
|
| Rate for Payer: EmblemHealth Medicare |
$92.48
|
| Rate for Payer: Fidelis Medicare |
$103.66
|
| Rate for Payer: Galaxy Health Commercial |
$176.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.64
|
| Rate for Payer: Humana Medicare |
$100.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$176.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$125.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$153.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$204.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$204.00
|
| Rate for Payer: United Healthcare Medicare |
$100.64
|
| Rate for Payer: WellCare Medicare |
$149.60
|
|
|
WET SKIN PREP TRAY
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4471379
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4650042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59
|
| Hospital Charge Code |
4650379
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59,KX
|
| Hospital Charge Code |
4650431
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,KX
|
| Hospital Charge Code |
4650324
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
