|
OR 4 HOURS OPERATION
|
Facility
|
OP
|
$10,696.00
|
|
| Hospital Charge Code |
4000118
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$8,556.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,920.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,278.40
|
| Rate for Payer: Cash Price |
$8,022.00
|
| Rate for Payer: Cash Price |
$8,022.00
|
| Rate for Payer: CDPHP Medicare |
$3,957.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,556.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,556.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,556.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8,556.80
|
| Rate for Payer: EmblemHealth Medicare |
$3,636.64
|
| Rate for Payer: EmblemHealth Select Care |
$7,701.12
|
| Rate for Payer: Fidelis Medicare |
$4,278.40
|
| Rate for Payer: Galaxy Health Commercial |
$6,952.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,278.40
|
| Rate for Payer: Humana Medicare |
$4,278.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,920.16
|
| Rate for Payer: Multiplan Commercial |
$8,556.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,022.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,021.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,492.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,604.40
|
| Rate for Payer: United Healthcare Medicare |
$4,278.40
|
| Rate for Payer: WellCare Medicare |
$5,882.80
|
|
|
OR 4 HOURS OPERATION
|
Facility
|
IP
|
$10,696.00
|
|
| Hospital Charge Code |
4000118
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,952.40 |
| Max. Negotiated Rate |
$6,952.40 |
| Rate for Payer: Cash Price |
$8,022.00
|
| Rate for Payer: Galaxy Health Commercial |
$6,952.40
|
|
|
OR 5 1/2 HOURS OPERATION
|
Facility
|
OP
|
$14,426.00
|
|
| Hospital Charge Code |
4000124
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$11,540.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,635.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,770.40
|
| Rate for Payer: Cash Price |
$10,819.50
|
| Rate for Payer: Cash Price |
$10,819.50
|
| Rate for Payer: CDPHP Medicare |
$5,337.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,540.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,540.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,540.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,540.80
|
| Rate for Payer: EmblemHealth Medicare |
$4,904.84
|
| Rate for Payer: EmblemHealth Select Care |
$10,386.72
|
| Rate for Payer: Fidelis Medicare |
$5,770.40
|
| Rate for Payer: Galaxy Health Commercial |
$9,376.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,770.40
|
| Rate for Payer: Humana Medicare |
$5,770.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,635.96
|
| Rate for Payer: Multiplan Commercial |
$11,540.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,819.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,121.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,058.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,163.90
|
| Rate for Payer: United Healthcare Medicare |
$5,770.40
|
| Rate for Payer: WellCare Medicare |
$7,934.30
|
|
|
OR 5 1/2 HOURS OPERATION
|
Facility
|
IP
|
$14,426.00
|
|
| Hospital Charge Code |
4000124
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,376.90 |
| Max. Negotiated Rate |
$9,376.90 |
| Rate for Payer: Cash Price |
$10,819.50
|
| Rate for Payer: Galaxy Health Commercial |
$9,376.90
|
|
|
OR 5 1/4 HOURS OPERATION
|
Facility
|
IP
|
$13,805.00
|
|
| Hospital Charge Code |
4000123
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$8,973.25 |
| Max. Negotiated Rate |
$8,973.25 |
| Rate for Payer: Cash Price |
$10,353.75
|
| Rate for Payer: Galaxy Health Commercial |
$8,973.25
|
|
|
OR 5 1/4 HOURS OPERATION
|
Facility
|
OP
|
$13,805.00
|
|
| Hospital Charge Code |
4000123
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$11,044.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,350.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,522.00
|
| Rate for Payer: Cash Price |
$10,353.75
|
| Rate for Payer: Cash Price |
$10,353.75
|
| Rate for Payer: CDPHP Medicare |
$5,107.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11,044.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,044.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,044.00
|
| Rate for Payer: EmblemHealth Medicaid |
$11,044.00
|
| Rate for Payer: EmblemHealth Medicare |
$4,693.70
|
| Rate for Payer: EmblemHealth Select Care |
$9,939.60
|
| Rate for Payer: Fidelis Medicare |
$5,522.00
|
| Rate for Payer: Galaxy Health Commercial |
$8,973.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,522.00
|
| Rate for Payer: Humana Medicare |
$5,522.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,350.30
|
| Rate for Payer: Multiplan Commercial |
$11,044.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,353.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,772.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,798.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,070.75
|
| Rate for Payer: United Healthcare Medicare |
$5,522.00
|
| Rate for Payer: WellCare Medicare |
$7,592.75
|
|
|
OR 5 3/4 HOURS OPERATION
|
Facility
|
OP
|
$15,048.00
|
|
| Hospital Charge Code |
4000125
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$12,038.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,922.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,019.20
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: CDPHP Medicare |
$5,567.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12,038.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,038.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,038.40
|
| Rate for Payer: EmblemHealth Medicaid |
$12,038.40
|
| Rate for Payer: EmblemHealth Medicare |
$5,116.32
|
| Rate for Payer: EmblemHealth Select Care |
$10,834.56
|
| Rate for Payer: Fidelis Medicare |
$6,019.20
|
| Rate for Payer: Galaxy Health Commercial |
$9,781.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,019.20
|
| Rate for Payer: Humana Medicare |
$6,019.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,922.08
|
| Rate for Payer: Multiplan Commercial |
$12,038.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,286.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,472.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,320.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,257.20
|
| Rate for Payer: United Healthcare Medicare |
$6,019.20
|
| Rate for Payer: WellCare Medicare |
$8,276.40
|
|
|
OR 5 3/4 HOURS OPERATION
|
Facility
|
IP
|
$15,048.00
|
|
| Hospital Charge Code |
4000125
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$9,781.20 |
| Max. Negotiated Rate |
$9,781.20 |
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Galaxy Health Commercial |
$9,781.20
|
|
|
OR 5 HOURS OPERATION
|
Facility
|
OP
|
$13,183.00
|
|
| Hospital Charge Code |
4000122
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$10,546.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,064.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,273.20
|
| Rate for Payer: Cash Price |
$9,887.25
|
| Rate for Payer: Cash Price |
$9,887.25
|
| Rate for Payer: CDPHP Medicare |
$4,877.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10,546.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10,546.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10,546.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10,546.40
|
| Rate for Payer: EmblemHealth Medicare |
$4,482.22
|
| Rate for Payer: EmblemHealth Select Care |
$9,491.76
|
| Rate for Payer: Fidelis Medicare |
$5,273.20
|
| Rate for Payer: Galaxy Health Commercial |
$8,568.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,273.20
|
| Rate for Payer: Humana Medicare |
$5,273.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,064.18
|
| Rate for Payer: Multiplan Commercial |
$10,546.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,887.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7,422.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,536.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,977.45
|
| Rate for Payer: United Healthcare Medicare |
$5,273.20
|
| Rate for Payer: WellCare Medicare |
$7,250.65
|
|
|
OR 5 HOURS OPERATION
|
Facility
|
IP
|
$13,183.00
|
|
| Hospital Charge Code |
4000122
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$8,568.95 |
| Max. Negotiated Rate |
$8,568.95 |
| Rate for Payer: Cash Price |
$9,887.25
|
| Rate for Payer: Galaxy Health Commercial |
$8,568.95
|
|
|
OR 6 HOURS OPERATION
|
Facility
|
OP
|
$15,670.00
|
|
| Hospital Charge Code |
4000126
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$12,536.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$7,208.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,268.00
|
| Rate for Payer: Cash Price |
$11,752.50
|
| Rate for Payer: Cash Price |
$11,752.50
|
| Rate for Payer: CDPHP Medicare |
$5,797.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12,536.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12,536.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,536.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12,536.00
|
| Rate for Payer: EmblemHealth Medicare |
$5,327.80
|
| Rate for Payer: EmblemHealth Select Care |
$11,282.40
|
| Rate for Payer: Fidelis Medicare |
$6,268.00
|
| Rate for Payer: Galaxy Health Commercial |
$10,185.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,268.00
|
| Rate for Payer: Humana Medicare |
$6,268.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,208.20
|
| Rate for Payer: Multiplan Commercial |
$12,536.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,752.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,822.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,581.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,350.50
|
| Rate for Payer: United Healthcare Medicare |
$6,268.00
|
| Rate for Payer: WellCare Medicare |
$8,618.50
|
|
|
OR 6 HOURS OPERATION
|
Facility
|
IP
|
$15,670.00
|
|
| Hospital Charge Code |
4000126
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$10,185.50 |
| Max. Negotiated Rate |
$10,185.50 |
| Rate for Payer: Cash Price |
$11,752.50
|
| Rate for Payer: Galaxy Health Commercial |
$10,185.50
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$5.77 |
| 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) Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$5.41
|
| 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 |
$2.88
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.88
|
| Rate for Payer: Humana Medicare |
$2.88
|
| 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 |
$3.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
ORAL DEXAMETHASONE 0.25 MG
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 54817425
|
| Hospital Charge Code |
4401254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| 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) Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 |
$0.11
|
| Rate for Payer: Galaxy Health Commercial |
$0.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.11
|
| Rate for Payer: Humana Medicare |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WellCare Medicare |
$0.15
|
|
|
ORAL DEXAMETHASONE 0.25 MG
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 54817425
|
| 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 4MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 54817525
|
| 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 54817525
|
| Hospital Charge Code |
4401256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| 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 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ORAL MR CONTRAST, 100 ML
|
Facility
|
OP
|
$1,728.34
|
|
|
Service Code
|
HCPCS Q9954
|
| Hospital Charge Code |
4230200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.25 |
| Max. Negotiated Rate |
$1,382.67 |
| Rate for Payer: Aetna of NY Medicare |
$795.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$691.34
|
| Rate for Payer: Cash Price |
$1,296.25
|
| Rate for Payer: CDPHP Medicare |
$639.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,382.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,382.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,382.67
|
| Rate for Payer: EmblemHealth Medicaid |
$1,382.67
|
| Rate for Payer: EmblemHealth Medicare |
$587.64
|
| Rate for Payer: EmblemHealth Select Care |
$1,244.40
|
| Rate for Payer: Fidelis Medicare |
$691.34
|
| Rate for Payer: Galaxy Health Commercial |
$1,123.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$691.34
|
| Rate for Payer: Humana Medicare |
$691.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$795.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,296.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$973.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$725.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$259.25
|
| Rate for Payer: United Healthcare Medicare |
$691.34
|
| Rate for Payer: WellCare Medicare |
$950.59
|
|
|
ORAL MR CONTRAST, 100 ML
|
Facility
|
IP
|
$1,728.34
|
|
|
Service Code
|
HCPCS Q9954
|
| Hospital Charge Code |
4230200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$950.59 |
| Max. Negotiated Rate |
$1,123.42 |
| Rate for Payer: Aetna of NY Commercial |
$950.59
|
| Rate for Payer: Cash Price |
$1,296.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,123.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$950.59
|
| Rate for Payer: WellCare Medicare |
$950.59
|
|
|
OR CABLE 2X8 AND EXTENSION (SC-4108)
|
Facility
|
OP
|
$1,980.00
|
|
| Hospital Charge Code |
4472058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,386.00
|
| Rate for Payer: Aetna of NY Medicare |
$910.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$792.00
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: CDPHP Medicare |
$732.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,584.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,584.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,584.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,584.00
|
| Rate for Payer: EmblemHealth Medicare |
$673.20
|
| Rate for Payer: EmblemHealth Select Care |
$1,425.60
|
| Rate for Payer: Fidelis Medicare |
$792.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,287.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$792.00
|
| Rate for Payer: Humana Medicare |
$792.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,386.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$910.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,485.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,114.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$831.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$297.00
|
| Rate for Payer: United Healthcare Medicare |
$792.00
|
| Rate for Payer: WellCare Medicare |
$1,089.00
|
|
|
OR CABLE 2X8 AND EXTENSION (SC-4108)
|
Facility
|
IP
|
$1,980.00
|
|
| Hospital Charge Code |
4472058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,287.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,287.00
|
|
|
ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Facility
|
IP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
4002051
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,133.10 |
| Max. Negotiated Rate |
$7,133.10 |
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
|
|
ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Facility
|
OP
|
$10,974.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
4002051
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,646.10 |
| Max. Negotiated Rate |
$8,779.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$5,048.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,389.60
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: Cash Price |
$8,230.50
|
| Rate for Payer: CDPHP Medicare |
$4,060.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,779.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,779.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,731.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,901.28
|
| Rate for Payer: Fidelis Medicare |
$4,389.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,133.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,389.60
|
| Rate for Payer: Humana Medicare |
$4,389.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$5,048.04
|
| Rate for Payer: Multiplan Commercial |
$8,779.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,230.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,178.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,609.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,646.10
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,389.60
|
| Rate for Payer: WellCare Medicare |
$6,035.70
|
|
|
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
4002050
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,022.60 |
| Max. Negotiated Rate |
$7,022.60 |
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
|
