|
6"X.062 TROCAR 2 END K-WIRE
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
4479310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$15.50
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
6X5YD SPECIALIST EXTRA-FAST PL
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
4471917
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
|
|
6X5YD SPECIALIST EXTRA-FAST PL
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
4471917
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna of NY Commercial |
$65.10
|
| Rate for Payer: Aetna of NY Medicare |
$42.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.50
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: CDPHP Commercial |
$74.86
|
| Rate for Payer: CDPHP Medicare |
$34.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$74.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$74.40
|
| Rate for Payer: EmblemHealth Medicaid |
$74.40
|
| Rate for Payer: EmblemHealth Medicare |
$31.62
|
| Rate for Payer: EmblemHealth Select Care |
$66.96
|
| Rate for Payer: Fidelis Medicare |
$35.44
|
| Rate for Payer: Galaxy Health Commercial |
$60.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.41
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$36.13
|
| Rate for Payer: United Healthcare Medicare |
$34.41
|
| Rate for Payer: WellCare Medicare |
$51.15
|
|
|
6X6 AQUACEL EXTRATM DRESSING
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
4470500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
|
|
6X6 AQUACEL EXTRATM DRESSING
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
4470500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
7.0 ET TUBE
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4471473
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
7.0 ET TUBE
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4471473
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
7.0 ET TUBE CUFFED
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4479149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
7.0 ET TUBE CUFFED
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4479149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
70 MG TABLET (ALENDRONATE
|
Facility
|
IP
|
$63.35
|
|
|
Service Code
|
NDC 16252060144
|
| Hospital Charge Code |
4409114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Galaxy Health Commercial |
$41.18
|
| Rate for Payer: WellCare Medicare |
$34.84
|
|
|
70 MG TABLET (ALENDRONATE
|
Facility
|
OP
|
$63.35
|
|
|
Service Code
|
NDC 16252060144
|
| Hospital Charge Code |
4409114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of NY Commercial |
$44.34
|
| Rate for Payer: Aetna of NY Medicare |
$29.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.68
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: CDPHP Commercial |
$51.00
|
| Rate for Payer: CDPHP Medicare |
$23.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.68
|
| Rate for Payer: EmblemHealth Medicaid |
$50.68
|
| Rate for Payer: EmblemHealth Medicare |
$21.54
|
| Rate for Payer: EmblemHealth Select Care |
$45.61
|
| Rate for Payer: Fidelis Medicare |
$24.14
|
| Rate for Payer: Galaxy Health Commercial |
$41.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.44
|
| Rate for Payer: Humana Medicare |
$23.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.61
|
| Rate for Payer: United Healthcare Medicare |
$23.44
|
| Rate for Payer: WellCare Medicare |
$34.84
|
|
|
7.0 NEOPRENE SURG GLOVE
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
4471259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$2.10
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$2.16
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
7.0 NEOPRENE SURG GLOVE
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
4471259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
|
|
7.5 ET TUBE
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
4471474
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$5.60
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$5.76
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
7.5 ET TUBE
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
4471474
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
|
|
7.5 ET TUBE CUFFED
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4479150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
7.5 ET TUBE CUFFED
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4479150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
7.5 NEOPRENE SURG GLOVE
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
4471257
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
|
|
7.5 NEOPRENE SURG GLOVE
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
4471257
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.50
|
| Rate for Payer: Aetna of NY Medicare |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.50
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: CDPHP Commercial |
$4.02
|
| Rate for Payer: CDPHP Medicare |
$1.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4.00
|
| Rate for Payer: EmblemHealth Medicare |
$1.70
|
| Rate for Payer: EmblemHealth Select Care |
$3.60
|
| Rate for Payer: Fidelis Medicare |
$1.91
|
| Rate for Payer: Galaxy Health Commercial |
$3.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.85
|
| Rate for Payer: Humana Medicare |
$1.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.94
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WellCare Medicare |
$2.75
|
|
|
7.6CM HEX WRENCH
|
Facility
|
OP
|
$247.00
|
|
| Hospital Charge Code |
4479097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$123.50
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: CDPHP Commercial |
$198.84
|
| Rate for Payer: CDPHP Medicare |
$91.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$197.60
|
| Rate for Payer: EmblemHealth Medicaid |
$197.60
|
| Rate for Payer: EmblemHealth Medicare |
$83.98
|
| Rate for Payer: EmblemHealth Select Care |
$177.84
|
| Rate for Payer: Fidelis Medicare |
$94.13
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.39
|
| Rate for Payer: Humana Medicare |
$91.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$95.96
|
| Rate for Payer: United Healthcare Medicare |
$91.39
|
| Rate for Payer: WellCare Medicare |
$135.85
|
|
|
7.6CM HEX WRENCH
|
Facility
|
IP
|
$247.00
|
|
| Hospital Charge Code |
4479097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
|
|
8.0 ET TUBE
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4471475
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
8.0 ET TUBE
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4471475
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
8.5 ET TUBE
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
4478226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna of NY Commercial |
$72.80
|
| Rate for Payer: Aetna of NY Medicare |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: CDPHP Commercial |
$83.72
|
| Rate for Payer: CDPHP Medicare |
$38.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$83.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$83.20
|
| Rate for Payer: EmblemHealth Medicaid |
$83.20
|
| Rate for Payer: EmblemHealth Medicare |
$35.36
|
| Rate for Payer: EmblemHealth Select Care |
$74.88
|
| Rate for Payer: Fidelis Medicare |
$39.63
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.48
|
| Rate for Payer: Humana Medicare |
$38.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$58.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.40
|
| Rate for Payer: United Healthcare Medicare |
$38.48
|
| Rate for Payer: WellCare Medicare |
$57.20
|
|
|
8.5 ET TUBE
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
4478226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
|
