|
ONDANSETRON 4 MG TABLET
|
Facility
|
IP
|
$76.48
|
|
|
Service Code
|
NDC 904655161
|
| Hospital Charge Code |
4401246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Galaxy Health Commercial |
$49.71
|
| Rate for Payer: WellCare Medicare |
$42.06
|
|
|
ONDANSETRON 4MG TDIS 30 EA
|
Facility
|
IP
|
$68.75
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
4400590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$44.69 |
| Rate for Payer: Cash Price |
$51.56
|
| Rate for Payer: Galaxy Health Commercial |
$44.69
|
| Rate for Payer: WellCare Medicare |
$37.81
|
|
|
ONDANSETRON 4MG TDIS 30 EA
|
Facility
|
OP
|
$68.75
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
4400590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of NY Commercial |
$48.12
|
| Rate for Payer: Aetna of NY Medicare |
$31.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$51.56
|
| Rate for Payer: CDPHP Medicare |
$25.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.00
|
| Rate for Payer: EmblemHealth Medicaid |
$55.00
|
| Rate for Payer: EmblemHealth Medicare |
$23.38
|
| Rate for Payer: EmblemHealth Select Care |
$49.50
|
| Rate for Payer: Fidelis Medicare |
$27.50
|
| Rate for Payer: Galaxy Health Commercial |
$44.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.50
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.56
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.31
|
| Rate for Payer: United Healthcare Medicare |
$27.50
|
| Rate for Payer: WellCare Medicare |
$37.81
|
|
|
ONDANSETRON HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
4400589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| 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 |
$0.09
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ONDANSETRON HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
4400589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| Rate for Payer: EmblemHealth Select Care |
$0.09
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ONE STEP INTRODUCER
|
Facility
|
IP
|
$209.09
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4472114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$135.91 |
| Rate for Payer: Cash Price |
$156.82
|
| Rate for Payer: Galaxy Health Commercial |
$135.91
|
|
|
ONE STEP INTRODUCER
|
Facility
|
OP
|
$209.09
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4472114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$167.27 |
| Rate for Payer: Aetna of NY Commercial |
$146.36
|
| Rate for Payer: Aetna of NY Medicare |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$83.64
|
| Rate for Payer: Cash Price |
$156.82
|
| Rate for Payer: CDPHP Medicare |
$77.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$167.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$167.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$167.27
|
| Rate for Payer: EmblemHealth Medicaid |
$167.27
|
| Rate for Payer: EmblemHealth Medicare |
$71.09
|
| Rate for Payer: EmblemHealth Select Care |
$150.54
|
| Rate for Payer: Fidelis Medicare |
$83.64
|
| Rate for Payer: Galaxy Health Commercial |
$135.91
|
| Rate for Payer: Hamaspik Choice Medicare |
$83.64
|
| Rate for Payer: Humana Medicare |
$83.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$146.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$96.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.82
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$117.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.36
|
| Rate for Payer: United Healthcare Medicare |
$83.64
|
| Rate for Payer: WellCare Medicare |
$115.00
|
|
|
ONE-THIRD TUBULAR PLATE WITH COLLAR
|
Facility
|
OP
|
$65.92
|
|
| Hospital Charge Code |
4479267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of NY Commercial |
$46.14
|
| Rate for Payer: Aetna of NY Medicare |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.37
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: CDPHP Medicare |
$24.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.74
|
| Rate for Payer: EmblemHealth Medicaid |
$52.74
|
| Rate for Payer: EmblemHealth Medicare |
$22.41
|
| Rate for Payer: EmblemHealth Select Care |
$47.46
|
| Rate for Payer: Fidelis Medicare |
$26.37
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.37
|
| Rate for Payer: Humana Medicare |
$26.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.14
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.44
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.69
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.89
|
| Rate for Payer: United Healthcare Medicare |
$26.37
|
| Rate for Payer: WellCare Medicare |
$36.26
|
|
|
ONE-THIRD TUBULAR PLATE WITH COLLAR
|
Facility
|
IP
|
$65.92
|
|
| Hospital Charge Code |
4479267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: Galaxy Health Commercial |
$42.85
|
|
|
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
|
|
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 25608
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
|
|
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27829
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
|
|
OPERATING RM 1/2 HOUR
|
Facility
|
IP
|
$1,996.00
|
|
| Hospital Charge Code |
4000104
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,297.40 |
| Max. Negotiated Rate |
$1,297.40 |
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,297.40
|
|
|
OPERATING RM 1/2 HOUR
|
Facility
|
OP
|
$1,996.00
|
|
| Hospital Charge Code |
4000104
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$299.40 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$918.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$798.40
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: CDPHP Medicare |
$738.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,596.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,596.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,596.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,596.80
|
| Rate for Payer: EmblemHealth Medicare |
$678.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,437.12
|
| Rate for Payer: Fidelis Medicare |
$798.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,297.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$798.40
|
| Rate for Payer: Humana Medicare |
$798.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$918.16
|
| Rate for Payer: Multiplan Commercial |
$1,596.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,497.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,123.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$838.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$299.40
|
| Rate for Payer: United Healthcare Medicare |
$798.40
|
| Rate for Payer: WellCare Medicare |
$1,097.80
|
|
|
OPERATING RM 1/4 HOUR
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
4000103
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$893.10 |
| Max. Negotiated Rate |
$893.10 |
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Galaxy Health Commercial |
$893.10
|
|
|
OPERATING RM 1/4 HOUR
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
4000103
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$206.10 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$632.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$549.60
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: CDPHP Medicare |
$508.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,099.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,099.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,099.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,099.20
|
| Rate for Payer: EmblemHealth Medicare |
$467.16
|
| Rate for Payer: EmblemHealth Select Care |
$989.28
|
| Rate for Payer: Fidelis Medicare |
$549.60
|
| Rate for Payer: Galaxy Health Commercial |
$893.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$549.60
|
| Rate for Payer: Humana Medicare |
$549.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,030.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$773.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$577.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$206.10
|
| Rate for Payer: United Healthcare Medicare |
$549.60
|
| Rate for Payer: WellCare Medicare |
$755.70
|
|
|
OPTICAL ACCESS KII THREADED
|
Facility
|
OP
|
$106.09
|
|
| Hospital Charge Code |
4471764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$84.87 |
| Rate for Payer: Aetna of NY Commercial |
$74.26
|
| Rate for Payer: Aetna of NY Medicare |
$48.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.44
|
| Rate for Payer: Cash Price |
$79.57
|
| Rate for Payer: CDPHP Medicare |
$39.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.87
|
| Rate for Payer: EmblemHealth Medicaid |
$84.87
|
| Rate for Payer: EmblemHealth Medicare |
$36.07
|
| Rate for Payer: EmblemHealth Select Care |
$76.38
|
| Rate for Payer: Fidelis Medicare |
$42.44
|
| Rate for Payer: Galaxy Health Commercial |
$68.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.44
|
| Rate for Payer: Humana Medicare |
$42.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.91
|
| Rate for Payer: United Healthcare Medicare |
$42.44
|
| Rate for Payer: WellCare Medicare |
$58.35
|
|
|
OPTICAL ACCESS KII THREADED
|
Facility
|
IP
|
$106.09
|
|
| Hospital Charge Code |
4471764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$68.96 |
| Rate for Payer: Cash Price |
$79.57
|
| Rate for Payer: Galaxy Health Commercial |
$68.96
|
|
|
OR 1 1/2 HOUR OPERATION
|
Facility
|
OP
|
$4,481.00
|
|
| Hospital Charge Code |
4000108
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$672.15 |
| Max. Negotiated Rate |
$3,584.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,061.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,792.40
|
| Rate for Payer: Cash Price |
$3,360.75
|
| Rate for Payer: Cash Price |
$3,360.75
|
| Rate for Payer: CDPHP Medicare |
$1,657.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,584.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,584.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,523.54
|
| Rate for Payer: EmblemHealth Select Care |
$3,226.32
|
| Rate for Payer: Fidelis Medicare |
$1,792.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,912.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,792.40
|
| Rate for Payer: Humana Medicare |
$1,792.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,061.26
|
| Rate for Payer: Multiplan Commercial |
$3,584.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,360.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,522.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,882.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$672.15
|
| Rate for Payer: United Healthcare Medicare |
$1,792.40
|
| Rate for Payer: WellCare Medicare |
$2,464.55
|
|
|
OR 1 1/2 HOUR OPERATION
|
Facility
|
IP
|
$4,481.00
|
|
| Hospital Charge Code |
4000108
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,912.65 |
| Max. Negotiated Rate |
$2,912.65 |
| Rate for Payer: Cash Price |
$3,360.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,912.65
|
|
|
OR 1 1/4 HOUR OPERATION
|
Facility
|
IP
|
$3,862.00
|
|
| Hospital Charge Code |
4000107
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,510.30 |
| Max. Negotiated Rate |
$2,510.30 |
| Rate for Payer: Cash Price |
$2,896.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,510.30
|
|
|
OR 1 1/4 HOUR OPERATION
|
Facility
|
OP
|
$3,862.00
|
|
| Hospital Charge Code |
4000107
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$3,089.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,776.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,544.80
|
| Rate for Payer: Cash Price |
$2,896.50
|
| Rate for Payer: Cash Price |
$2,896.50
|
| Rate for Payer: CDPHP Medicare |
$1,428.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,089.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,089.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,089.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,089.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,313.08
|
| Rate for Payer: EmblemHealth Select Care |
$2,780.64
|
| Rate for Payer: Fidelis Medicare |
$1,544.80
|
| Rate for Payer: Galaxy Health Commercial |
$2,510.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,544.80
|
| Rate for Payer: Humana Medicare |
$1,544.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,776.52
|
| Rate for Payer: Multiplan Commercial |
$3,089.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,896.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,174.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,622.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$579.30
|
| Rate for Payer: United Healthcare Medicare |
$1,544.80
|
| Rate for Payer: WellCare Medicare |
$2,124.10
|
|
|
OR 1 3/4 HOUR OPERATION
|
Facility
|
IP
|
$5,102.00
|
|
| Hospital Charge Code |
4000109
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,316.30 |
| Max. Negotiated Rate |
$3,316.30 |
| Rate for Payer: Cash Price |
$3,826.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,316.30
|
|
|
OR 1 3/4 HOUR OPERATION
|
Facility
|
OP
|
$5,102.00
|
|
| Hospital Charge Code |
4000109
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$765.30 |
| Max. Negotiated Rate |
$4,081.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,346.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,040.80
|
| Rate for Payer: Cash Price |
$3,826.50
|
| Rate for Payer: Cash Price |
$3,826.50
|
| Rate for Payer: CDPHP Medicare |
$1,887.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,081.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,081.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,081.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,081.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,734.68
|
| Rate for Payer: EmblemHealth Select Care |
$3,673.44
|
| Rate for Payer: Fidelis Medicare |
$2,040.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,316.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,040.80
|
| Rate for Payer: Humana Medicare |
$2,040.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,346.92
|
| Rate for Payer: Multiplan Commercial |
$4,081.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,826.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,872.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,142.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$765.30
|
| Rate for Payer: United Healthcare Medicare |
$2,040.80
|
| Rate for Payer: WellCare Medicare |
$2,806.10
|
|
|
OR 1 HOUR OPERATION
|
Facility
|
OP
|
$3,240.00
|
|
| Hospital Charge Code |
4000106
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,490.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,296.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: CDPHP Medicare |
$1,198.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,592.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,592.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,592.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,592.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,101.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,332.80
|
| Rate for Payer: Fidelis Medicare |
$1,296.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,106.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,296.00
|
| Rate for Payer: Humana Medicare |
$1,296.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,490.40
|
| Rate for Payer: Multiplan Commercial |
$2,592.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,430.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,824.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,360.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$486.00
|
| Rate for Payer: United Healthcare Medicare |
$1,296.00
|
| Rate for Payer: WellCare Medicare |
$1,782.00
|
|
