|
OR 4 1/2HOURS OPERATION
|
Facility
|
IP
|
$11,146.00
|
|
| Hospital Charge Code |
4000120
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,244.90 |
| Max. Negotiated Rate |
$7,244.90 |
| Rate for Payer: Cash Price |
$8,359.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,244.90
|
|
|
OR 4 1/4 HOURS OPERATION
|
Facility
|
IP
|
$10,566.00
|
|
| Hospital Charge Code |
4000119
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,867.90 |
| Max. Negotiated Rate |
$6,867.90 |
| Rate for Payer: Cash Price |
$7,924.50
|
| Rate for Payer: Galaxy Health Commercial |
$6,867.90
|
|
|
OR 4 1/4 HOURS OPERATION
|
Facility
|
OP
|
$10,566.00
|
|
| Hospital Charge Code |
4000119
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$8,505.63 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,860.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,924.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,924.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,909.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,283.00
|
| Rate for Payer: Cash Price |
$7,924.50
|
| Rate for Payer: Cash Price |
$7,924.50
|
| Rate for Payer: CDPHP Commercial |
$8,505.63
|
| Rate for Payer: CDPHP Medicare |
$3,909.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,452.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,452.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,452.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8,452.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,592.44
|
| Rate for Payer: EmblemHealth Select Care |
$7,607.52
|
| Rate for Payer: Fidelis Medicare |
$4,026.70
|
| Rate for Payer: Galaxy Health Commercial |
$6,867.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,909.42
|
| Rate for Payer: Humana Medicare |
$3,909.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,860.36
|
| Rate for Payer: Multiplan Commercial |
$8,452.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,924.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,948.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,104.89
|
| Rate for Payer: United Healthcare Medicare |
$3,909.42
|
| Rate for Payer: WellCare Medicare |
$5,811.30
|
|
|
OR 4 3/4 HOURS OPERATION
|
Facility
|
IP
|
$11,726.00
|
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,621.90 |
| Max. Negotiated Rate |
$7,621.90 |
| Rate for Payer: Cash Price |
$8,794.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,621.90
|
|
|
OR 4 3/4 HOURS OPERATION
|
Facility
|
OP
|
$11,726.00
|
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$9,439.43 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,393.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8,794.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8,794.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,338.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5,863.00
|
| Rate for Payer: Cash Price |
$8,794.50
|
| Rate for Payer: Cash Price |
$8,794.50
|
| Rate for Payer: CDPHP Commercial |
$9,439.43
|
| Rate for Payer: CDPHP Medicare |
$4,338.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,380.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,380.80
|
| Rate for Payer: EmblemHealth Medicaid |
$9,380.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,986.84
|
| Rate for Payer: EmblemHealth Select Care |
$8,442.72
|
| Rate for Payer: Fidelis Medicare |
$4,468.78
|
| Rate for Payer: Galaxy Health Commercial |
$7,621.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,338.62
|
| Rate for Payer: Humana Medicare |
$4,338.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,393.96
|
| Rate for Payer: Multiplan Commercial |
$9,380.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,794.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,601.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,555.55
|
| Rate for Payer: United Healthcare Medicare |
$4,338.62
|
| Rate for Payer: WellCare Medicare |
$6,449.30
|
|
|
OR 4 HOURS OPERATION
|
Facility
|
OP
|
$9,985.00
|
|
| Hospital Charge Code |
4000118
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$8,037.92 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,593.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,488.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,488.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,694.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,992.50
|
| Rate for Payer: Cash Price |
$7,488.75
|
| Rate for Payer: Cash Price |
$7,488.75
|
| Rate for Payer: CDPHP Commercial |
$8,037.92
|
| Rate for Payer: CDPHP Medicare |
$3,694.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,988.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,988.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,988.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,988.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,394.90
|
| Rate for Payer: EmblemHealth Select Care |
$7,189.20
|
| Rate for Payer: Fidelis Medicare |
$3,805.28
|
| Rate for Payer: Galaxy Health Commercial |
$6,490.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,694.45
|
| Rate for Payer: Humana Medicare |
$3,694.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,593.10
|
| Rate for Payer: Multiplan Commercial |
$7,988.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,488.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,621.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,879.17
|
| Rate for Payer: United Healthcare Medicare |
$3,694.45
|
| Rate for Payer: WellCare Medicare |
$5,491.75
|
|
|
OR 4 HOURS OPERATION
|
Facility
|
IP
|
$9,985.00
|
|
| Hospital Charge Code |
4000118
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,490.25 |
| Max. Negotiated Rate |
$6,490.25 |
| Rate for Payer: Cash Price |
$7,488.75
|
| Rate for Payer: Galaxy Health Commercial |
$6,490.25
|
|
|
OR 5 1/2 HOURS OPERATION
|
Facility
|
IP
|
$13,467.00
|
|
| Hospital Charge Code |
4000124
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$8,753.55 |
| Max. Negotiated Rate |
$8,753.55 |
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Galaxy Health Commercial |
$8,753.55
|
|
|
OR 5 1/2 HOURS OPERATION
|
Facility
|
OP
|
$13,467.00
|
|
| Hospital Charge Code |
4000124
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$10,840.94 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,194.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10,100.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10,100.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,982.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6,733.50
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: CDPHP Commercial |
$10,840.94
|
| Rate for Payer: CDPHP Medicare |
$4,982.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,773.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10,773.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10,773.60
|
| Rate for Payer: EmblemHealth Medicaid |
$10,773.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,578.78
|
| Rate for Payer: EmblemHealth Select Care |
$9,696.24
|
| Rate for Payer: Fidelis Medicare |
$5,132.27
|
| Rate for Payer: Galaxy Health Commercial |
$8,753.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,982.79
|
| Rate for Payer: Humana Medicare |
$4,982.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,194.82
|
| Rate for Payer: Multiplan Commercial |
$10,773.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,100.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,581.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,231.93
|
| Rate for Payer: United Healthcare Medicare |
$4,982.79
|
| Rate for Payer: WellCare Medicare |
$7,406.85
|
|
|
OR 5 1/4 HOURS OPERATION
|
Facility
|
IP
|
$12,887.00
|
|
| Hospital Charge Code |
4000123
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$8,376.55 |
| Max. Negotiated Rate |
$8,376.55 |
| Rate for Payer: Cash Price |
$9,665.25
|
| Rate for Payer: Galaxy Health Commercial |
$8,376.55
|
|
|
OR 5 1/4 HOURS OPERATION
|
Facility
|
OP
|
$12,887.00
|
|
| Hospital Charge Code |
4000123
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$10,374.04 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,928.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9,665.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9,665.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,768.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6,443.50
|
| Rate for Payer: Cash Price |
$9,665.25
|
| Rate for Payer: Cash Price |
$9,665.25
|
| Rate for Payer: CDPHP Commercial |
$10,374.04
|
| Rate for Payer: CDPHP Medicare |
$4,768.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,309.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10,309.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10,309.60
|
| Rate for Payer: EmblemHealth Medicaid |
$10,309.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,381.58
|
| Rate for Payer: EmblemHealth Select Care |
$9,278.64
|
| Rate for Payer: Fidelis Medicare |
$4,911.24
|
| Rate for Payer: Galaxy Health Commercial |
$8,376.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,768.19
|
| Rate for Payer: Humana Medicare |
$4,768.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,928.02
|
| Rate for Payer: Multiplan Commercial |
$10,309.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,665.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,255.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,006.60
|
| Rate for Payer: United Healthcare Medicare |
$4,768.19
|
| Rate for Payer: WellCare Medicare |
$7,087.85
|
|
|
OR 5 3/4 HOURS OPERATION
|
Facility
|
IP
|
$14,048.00
|
|
| Hospital Charge Code |
4000125
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,131.20 |
| Max. Negotiated Rate |
$9,131.20 |
| Rate for Payer: Cash Price |
$10,536.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,131.20
|
|
|
OR 5 3/4 HOURS OPERATION
|
Facility
|
OP
|
$14,048.00
|
|
| Hospital Charge Code |
4000125
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$11,308.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,462.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,197.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,024.00
|
| Rate for Payer: Cash Price |
$10,536.00
|
| Rate for Payer: Cash Price |
$10,536.00
|
| Rate for Payer: CDPHP Commercial |
$11,308.64
|
| Rate for Payer: CDPHP Medicare |
$5,197.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$11,238.40
|
| Rate for Payer: EmblemHealth Medicare |
$4,776.32
|
| Rate for Payer: EmblemHealth Select Care |
$10,114.56
|
| Rate for Payer: Fidelis Medicare |
$5,353.69
|
| Rate for Payer: Galaxy Health Commercial |
$9,131.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,197.76
|
| Rate for Payer: Humana Medicare |
$5,197.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,462.08
|
| Rate for Payer: Multiplan Commercial |
$11,238.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,536.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,909.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,457.65
|
| Rate for Payer: United Healthcare Medicare |
$5,197.76
|
| Rate for Payer: WellCare Medicare |
$7,726.40
|
|
|
OR 5 HOURS OPERATION
|
Facility
|
IP
|
$12,307.00
|
|
| Hospital Charge Code |
4000122
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,999.55 |
| Max. Negotiated Rate |
$7,999.55 |
| Rate for Payer: Cash Price |
$9,230.25
|
| Rate for Payer: Galaxy Health Commercial |
$7,999.55
|
|
|
OR 5 HOURS OPERATION
|
Facility
|
OP
|
$12,307.00
|
|
| Hospital Charge Code |
4000122
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$9,907.14 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,661.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9,230.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9,230.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,553.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6,153.50
|
| Rate for Payer: Cash Price |
$9,230.25
|
| Rate for Payer: Cash Price |
$9,230.25
|
| Rate for Payer: CDPHP Commercial |
$9,907.14
|
| Rate for Payer: CDPHP Medicare |
$4,553.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9,845.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,845.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9,845.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9,845.60
|
| Rate for Payer: EmblemHealth Medicare |
$4,184.38
|
| Rate for Payer: EmblemHealth Select Care |
$8,861.04
|
| Rate for Payer: Fidelis Medicare |
$4,690.20
|
| Rate for Payer: Galaxy Health Commercial |
$7,999.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,553.59
|
| Rate for Payer: Humana Medicare |
$4,553.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,661.22
|
| Rate for Payer: Multiplan Commercial |
$9,845.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,230.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,928.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,781.27
|
| Rate for Payer: United Healthcare Medicare |
$4,553.59
|
| Rate for Payer: WellCare Medicare |
$6,768.85
|
|
|
OR 6 HOURS OPERATION
|
Facility
|
IP
|
$14,628.00
|
|
| Hospital Charge Code |
4000126
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,508.20 |
| Max. Negotiated Rate |
$9,508.20 |
| Rate for Payer: Cash Price |
$10,971.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,508.20
|
|
|
OR 6 HOURS OPERATION
|
Facility
|
OP
|
$14,628.00
|
|
| Hospital Charge Code |
4000126
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,857.00 |
| Max. Negotiated Rate |
$11,775.54 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,728.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10,971.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10,971.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,412.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,314.00
|
| Rate for Payer: Cash Price |
$10,971.00
|
| Rate for Payer: Cash Price |
$10,971.00
|
| Rate for Payer: CDPHP Commercial |
$11,775.54
|
| Rate for Payer: CDPHP Medicare |
$5,412.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,702.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,702.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,702.40
|
| Rate for Payer: EmblemHealth Medicaid |
$11,702.40
|
| Rate for Payer: EmblemHealth Medicare |
$4,973.52
|
| Rate for Payer: EmblemHealth Select Care |
$10,532.16
|
| Rate for Payer: Fidelis Medicare |
$5,574.73
|
| Rate for Payer: Galaxy Health Commercial |
$9,508.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,412.36
|
| Rate for Payer: Humana Medicare |
$5,412.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,728.88
|
| Rate for Payer: Multiplan Commercial |
$11,702.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,971.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,235.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,682.98
|
| Rate for Payer: United Healthcare Medicare |
$5,412.36
|
| Rate for Payer: WellCare Medicare |
$8,045.40
|
|
|
ORACIT
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 46287001430
|
| Hospital Charge Code |
4408979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
ORACIT
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 46287001430
|
| Hospital Charge Code |
4408979
|
|
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
|
|
|
ORAL DEXAMETHASONE 0.25 MG
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 00054817425
|
| Hospital Charge Code |
4401254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Galaxy Health Commercial |
$0.18
|
| Rate for Payer: WellCare Medicare |
$0.15
|
|
|
ORAL DEXAMETHASONE 0.25 MG
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 00054817425
|
| Hospital Charge Code |
4401254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of NY Commercial |
$0.19
|
| Rate for Payer: Aetna of NY Medicare |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.14
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: CDPHP Commercial |
$0.22
|
| Rate for Payer: CDPHP Medicare |
$0.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.22
|
| Rate for Payer: EmblemHealth Medicaid |
$0.22
|
| Rate for Payer: EmblemHealth Medicare |
$0.09
|
| Rate for Payer: EmblemHealth Select Care |
$0.19
|
| Rate for Payer: Fidelis Medicare |
$0.10
|
| Rate for Payer: Galaxy Health Commercial |
$0.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.10
|
| Rate for Payer: Humana Medicare |
$0.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WellCare Medicare |
$0.15
|
|
|
ORAL DEXAMETHASONE 4MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
4401256
|
|
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
|
|
|
ORAL DEXAMETHASONE 4MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
4401256
|
|
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
|
|
|
ORAL MR CONTRAST, 100 ML
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS Q9954
|
| Hospital Charge Code |
4230200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$570.52 |
| Max. Negotiated Rate |
$1,350.79 |
| Rate for Payer: Aetna of NY Commercial |
$922.90
|
| Rate for Payer: Aetna of NY Medicare |
$771.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$755.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$755.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$620.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$839.00
|
| Rate for Payer: Cash Price |
$1,258.50
|
| Rate for Payer: CDPHP Commercial |
$1,350.79
|
| Rate for Payer: CDPHP Medicare |
$620.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,342.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,342.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,342.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,342.40
|
| Rate for Payer: EmblemHealth Medicare |
$570.52
|
| Rate for Payer: EmblemHealth Select Care |
$1,208.16
|
| Rate for Payer: Fidelis Medicare |
$639.49
|
| Rate for Payer: Galaxy Health Commercial |
$1,090.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$620.86
|
| Rate for Payer: Humana Medicare |
$620.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$922.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$771.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,258.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$944.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$651.90
|
| Rate for Payer: United Healthcare Medicare |
$620.86
|
| Rate for Payer: WellCare Medicare |
$922.90
|
|
|
ORAL MR CONTRAST, 100 ML
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS Q9954
|
| Hospital Charge Code |
4230200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$755.10 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna of NY Commercial |
$922.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$755.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$755.10
|
| Rate for Payer: Cash Price |
$1,258.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,090.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$922.90
|
| Rate for Payer: WellCare Medicare |
$922.90
|
|
