|
1.2 MICRON FILTER EXTENTION SE
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4471902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
12" PANEL BINDER 30-45"
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4479168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
12" PANEL BINDER 30-45"
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4479168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
12" PANEL BINDER 45-62"
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4479169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
12" PANEL BINDER 45-62"
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4479169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
12" PERSONAL BINDER
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4479170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
12" PERSONAL BINDER
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4479170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
1/3TH TUBULAR PLATE W/ COLLAR
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
4472226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: Aetna of NY Commercial |
$179.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$115.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$128.00
|
| Rate for Payer: EmblemHealth Select Care |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$166.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$166.40
|
| Rate for Payer: WellCare Medicare |
$140.80
|
|
|
1/3TH TUBULAR PLATE W/ COLLAR
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
4472226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.04 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna of NY Commercial |
$179.20
|
| Rate for Payer: Aetna of NY Medicare |
$117.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$128.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: CDPHP Commercial |
$206.08
|
| Rate for Payer: CDPHP Medicare |
$94.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$204.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$204.80
|
| Rate for Payer: EmblemHealth Medicaid |
$204.80
|
| Rate for Payer: EmblemHealth Medicare |
$87.04
|
| Rate for Payer: EmblemHealth Select Care |
$128.00
|
| Rate for Payer: Fidelis Medicare |
$97.56
|
| Rate for Payer: Galaxy Health Commercial |
$166.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.72
|
| Rate for Payer: Humana Medicare |
$94.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$179.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$117.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$166.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.46
|
| Rate for Payer: United Healthcare Medicare |
$94.72
|
| Rate for Payer: WellCare Medicare |
$140.80
|
|
|
14FR 23CM LOOP SUPRAPUBIC CATH
|
Facility
|
OP
|
$190.00
|
|
| Hospital Charge Code |
4478208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Aetna of NY Commercial |
$133.00
|
| Rate for Payer: Aetna of NY Medicare |
$87.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$95.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: CDPHP Commercial |
$152.95
|
| Rate for Payer: CDPHP Medicare |
$70.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$152.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$152.00
|
| Rate for Payer: EmblemHealth Medicaid |
$152.00
|
| Rate for Payer: EmblemHealth Medicare |
$64.60
|
| Rate for Payer: EmblemHealth Select Care |
$136.80
|
| Rate for Payer: Fidelis Medicare |
$72.41
|
| Rate for Payer: Galaxy Health Commercial |
$123.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.30
|
| Rate for Payer: Humana Medicare |
$70.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$133.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$87.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$106.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.82
|
| Rate for Payer: United Healthcare Medicare |
$70.30
|
| Rate for Payer: WellCare Medicare |
$104.50
|
|
|
14FR 23CM LOOP SUPRAPUBIC CATH
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
4478208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Galaxy Health Commercial |
$123.50
|
|
|
14FR COUDE CATH
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
4471427
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
14FR COUDE CATH
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
4471427
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
|
|
14FR FOLEY CATHETER 8760514
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4479177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
14FR FOLEY CATHETER 8760514
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4479177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
1.4 K-WIRE
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
4471232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$85.33 |
| Rate for Payer: Aetna of NY Commercial |
$74.20
|
| Rate for Payer: Aetna of NY Medicare |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.00
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: CDPHP Commercial |
$85.33
|
| Rate for Payer: CDPHP Medicare |
$39.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.80
|
| Rate for Payer: EmblemHealth Medicaid |
$84.80
|
| Rate for Payer: EmblemHealth Medicare |
$36.04
|
| Rate for Payer: EmblemHealth Select Care |
$76.32
|
| Rate for Payer: Fidelis Medicare |
$40.40
|
| Rate for Payer: Galaxy Health Commercial |
$68.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.22
|
| Rate for Payer: Humana Medicare |
$39.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.18
|
| Rate for Payer: United Healthcare Medicare |
$39.22
|
| Rate for Payer: WellCare Medicare |
$58.30
|
|
|
1.4 K-WIRE
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
4471232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Galaxy Health Commercial |
$68.90
|
|
|
15G HYDROMARK COIL 3 TITANIUM - COIL SHAPE
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4470951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$233.80 |
| Rate for Payer: Aetna of NY Commercial |
$233.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.30
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.00
|
| Rate for Payer: EmblemHealth Select Care |
$167.00
|
| Rate for Payer: Galaxy Health Commercial |
$217.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.80
|
| Rate for Payer: Multiplan Commercial |
$150.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.10
|
| Rate for Payer: WellCare Medicare |
$183.70
|
|
|
15G HYDROMARK COIL 3 TITANIUM - COIL SHAPE
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4470951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna of NY Commercial |
$233.80
|
| Rate for Payer: Aetna of NY Medicare |
$153.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$123.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$167.00
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: CDPHP Commercial |
$268.87
|
| Rate for Payer: CDPHP Medicare |
$123.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$267.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$267.20
|
| Rate for Payer: EmblemHealth Medicaid |
$267.20
|
| Rate for Payer: EmblemHealth Medicare |
$113.56
|
| Rate for Payer: EmblemHealth Select Care |
$167.00
|
| Rate for Payer: Fidelis Medicare |
$127.29
|
| Rate for Payer: Galaxy Health Commercial |
$217.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$123.58
|
| Rate for Payer: Humana Medicare |
$123.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$153.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$129.76
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
| Rate for Payer: WellCare Medicare |
$183.70
|
|
|
15G HYDROMARK COIL 4 TITANIUM
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4470952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$233.80 |
| Rate for Payer: Aetna of NY Commercial |
$233.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.30
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.00
|
| Rate for Payer: EmblemHealth Select Care |
$167.00
|
| Rate for Payer: Galaxy Health Commercial |
$217.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.80
|
| Rate for Payer: Multiplan Commercial |
$150.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.10
|
| Rate for Payer: WellCare Medicare |
$183.70
|
|
|
15G HYDROMARK COIL 4 TITANIUM
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
4470952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna of NY Commercial |
$233.80
|
| Rate for Payer: Aetna of NY Medicare |
$153.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$123.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$167.00
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: CDPHP Commercial |
$268.87
|
| Rate for Payer: CDPHP Medicare |
$123.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$267.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$267.20
|
| Rate for Payer: EmblemHealth Medicaid |
$267.20
|
| Rate for Payer: EmblemHealth Medicare |
$113.56
|
| Rate for Payer: EmblemHealth Select Care |
$167.00
|
| Rate for Payer: Fidelis Medicare |
$127.29
|
| Rate for Payer: Galaxy Health Commercial |
$217.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$123.58
|
| Rate for Payer: Humana Medicare |
$123.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$153.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$129.76
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
| Rate for Payer: WellCare Medicare |
$183.70
|
|
|
15X7MM OSCILLATING BLADES
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4471197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
15X7MM OSCILLATING BLADES
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4471197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
16FR FOLEY CATHETER 8760516
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
4479178
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
|
|
16FR FOLEY CATHETER 8760516
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
4479178
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
