|
ADDITIONAL IVP SAME DRUG INJ SEQ
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
4450109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Galaxy Health Commercial |
$124.80
|
|
|
ADENOSINE INJ 1MG
|
Facility
|
IP
|
$40.69
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
4400018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.56
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.56
|
| Rate for Payer: EmblemHealth Select Care |
$0.56
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.38
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
ADENOSINE INJ 1MG
|
Facility
|
OP
|
$40.69
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
4400018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Aetna of NY Medicare |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.34
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: CDPHP Commercial |
$32.76
|
| Rate for Payer: CDPHP Medicare |
$15.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.55
|
| Rate for Payer: EmblemHealth Medicaid |
$32.55
|
| Rate for Payer: EmblemHealth Medicare |
$13.83
|
| Rate for Payer: EmblemHealth Select Care |
$0.56
|
| Rate for Payer: Fidelis Medicare |
$15.51
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.06
|
| Rate for Payer: Humana Medicare |
$15.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.81
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$15.06
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
ADENOVIRUS AG EIA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
4301409
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ADENOVIRUS AG EIA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
4301409
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
4403000
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
4403000
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna of NY Commercial |
$87.50
|
| Rate for Payer: Aetna of NY Medicare |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$93.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$93.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$62.50
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: CDPHP Commercial |
$100.62
|
| Rate for Payer: CDPHP Medicare |
$46.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.00
|
| Rate for Payer: EmblemHealth Medicaid |
$100.00
|
| Rate for Payer: EmblemHealth Medicare |
$42.50
|
| Rate for Payer: EmblemHealth Select Care |
$90.00
|
| Rate for Payer: Fidelis Medicare |
$47.64
|
| Rate for Payer: Galaxy Health Commercial |
$81.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.25
|
| Rate for Payer: Humana Medicare |
$46.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$87.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$57.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.00
|
| Rate for Payer: United Healthcare Medicare |
$46.25
|
| Rate for Payer: WellCare Medicare |
$68.75
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4400274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.81
|
| Rate for Payer: EmblemHealth Select Care |
$0.81
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$46.35
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4409190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Aetna of NY Commercial |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.81
|
| Rate for Payer: EmblemHealth Select Care |
$0.81
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.49
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4409190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna of NY Commercial |
$25.49
|
| Rate for Payer: Aetna of NY Medicare |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.18
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: CDPHP Commercial |
$37.31
|
| Rate for Payer: CDPHP Medicare |
$17.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.08
|
| Rate for Payer: EmblemHealth Medicaid |
$37.08
|
| Rate for Payer: EmblemHealth Medicare |
$15.76
|
| Rate for Payer: EmblemHealth Select Care |
$0.81
|
| Rate for Payer: Fidelis Medicare |
$17.66
|
| Rate for Payer: Galaxy Health Commercial |
$30.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.15
|
| Rate for Payer: Humana Medicare |
$17.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$17.15
|
| Rate for Payer: WellCare Medicare |
$25.49
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4400274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$0.81
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4408984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.81
|
| Rate for Payer: EmblemHealth Select Care |
$0.81
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
ADRENALIN EPINEPHRINE INJ 0.1 MG
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
4408984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.81
|
| 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: 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 |
$0.81
|
| 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 |
$0.81
|
| 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 |
$4.25
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
ADULT BREATHING CIRCUIT
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4478196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
ADULT BREATHING CIRCUIT
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4478196
|
|
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
|
|
|
ADULT PACER PADS
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4479115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna of NY Commercial |
$44.80
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.86
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
ADULT PACER PADS
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4479115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
AEROBIC/ANAEROBIC CULTURE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4304875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
AEROBIC/ANAEROBIC CULTURE
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
4304875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
AFLEX VERTEBRAL BALLOON TRAY10X20AFB1020
|
Facility
|
IP
|
$9,319.00
|
|
| Hospital Charge Code |
4479295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6,057.35 |
| Max. Negotiated Rate |
$6,057.35 |
| Rate for Payer: Cash Price |
$6,989.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,057.35
|
|
|
AFLEX VERTEBRAL BALLOON TRAY10X20AFB1020
|
Facility
|
OP
|
$9,319.00
|
|
| Hospital Charge Code |
4479295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,168.46 |
| Max. Negotiated Rate |
$7,501.80 |
| Rate for Payer: Aetna of NY Commercial |
$6,523.30
|
| Rate for Payer: Aetna of NY Medicare |
$4,286.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,989.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,989.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,448.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,659.50
|
| Rate for Payer: Cash Price |
$6,989.25
|
| Rate for Payer: CDPHP Commercial |
$7,501.80
|
| Rate for Payer: CDPHP Medicare |
$3,448.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,455.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,455.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,455.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7,455.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,168.46
|
| Rate for Payer: EmblemHealth Select Care |
$6,709.68
|
| Rate for Payer: Fidelis Medicare |
$3,551.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,057.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,448.03
|
| Rate for Payer: Humana Medicare |
$3,448.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,523.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,286.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,989.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,246.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,620.43
|
| Rate for Payer: United Healthcare Medicare |
$3,448.03
|
| Rate for Payer: WellCare Medicare |
$5,125.45
|
|
|
AFP TUMOR MARKER SERUM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.50
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Commercial |
$52.32
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: EmblemHealth Select Care |
$39.00
|
| Rate for Payer: Fidelis Medicare |
$24.77
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.05
|
| Rate for Payer: Humana Medicare |
$24.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$48.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$48.75
|
| Rate for Payer: United Healthcare Medicare |
$24.05
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
AFP TUMOR MARKER SERUM
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
AIR MATTRESS
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
4472143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna of NY Commercial |
$130.90
|
| Rate for Payer: Aetna of NY Medicare |
$86.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.50
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: CDPHP Commercial |
$150.54
|
| Rate for Payer: CDPHP Medicare |
$69.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.60
|
| Rate for Payer: EmblemHealth Medicaid |
$149.60
|
| Rate for Payer: EmblemHealth Medicare |
$63.58
|
| Rate for Payer: EmblemHealth Select Care |
$134.64
|
| Rate for Payer: Fidelis Medicare |
$71.27
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.19
|
| Rate for Payer: Humana Medicare |
$69.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$130.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.65
|
| Rate for Payer: United Healthcare Medicare |
$69.19
|
| Rate for Payer: WellCare Medicare |
$102.85
|
|
|
AIR MATTRESS
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
4472143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
|
