|
PLATELET PHERESIS LEUKOREDUCED
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
4300634
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$638.10 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.10
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$709.00
|
| Rate for Payer: EmblemHealth Select Care |
$709.00
|
| Rate for Payer: Galaxy Health Commercial |
$921.70
|
| Rate for Payer: WellCare Medicare |
$779.90
|
|
|
PLATELET PHERESIS LEUKOREDUCED
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
4300634
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$1,141.49 |
| Rate for Payer: Aetna of NY Commercial |
$992.60
|
| Rate for Payer: Aetna of NY Medicare |
$652.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$524.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$709.00
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: CDPHP Commercial |
$1,141.49
|
| Rate for Payer: CDPHP Medicare |
$524.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$709.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,134.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,134.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,134.40
|
| Rate for Payer: EmblemHealth Medicare |
$482.12
|
| Rate for Payer: EmblemHealth Select Care |
$709.00
|
| Rate for Payer: Fidelis Medicare |
$540.40
|
| Rate for Payer: Galaxy Health Commercial |
$921.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$524.66
|
| Rate for Payer: Humana Medicare |
$524.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$992.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$652.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,063.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$798.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$550.89
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,063.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$472.33
|
| Rate for Payer: United Healthcare Commercial |
$1,063.50
|
| Rate for Payer: United Healthcare Medicare |
$524.66
|
| Rate for Payer: WellCare Medicare |
$779.90
|
|
|
PLATELET RICH PLASMA - ONE UNIT
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
HCPCS P9020
|
| Hospital Charge Code |
4600270
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$741.60 |
| Max. Negotiated Rate |
$1,071.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$741.60
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$824.00
|
| Rate for Payer: EmblemHealth Select Care |
$824.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,071.20
|
| Rate for Payer: WellCare Medicare |
$906.40
|
|
|
PLATELET RICH PLASMA - ONE UNIT
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
HCPCS P9020
|
| Hospital Charge Code |
4600270
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$1,326.64 |
| Rate for Payer: Aetna of NY Commercial |
$1,153.60
|
| Rate for Payer: Aetna of NY Medicare |
$758.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,236.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,236.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$609.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$824.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: CDPHP Commercial |
$1,326.64
|
| Rate for Payer: CDPHP Medicare |
$609.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$824.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,318.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,318.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,318.40
|
| Rate for Payer: EmblemHealth Medicare |
$560.32
|
| Rate for Payer: EmblemHealth Select Care |
$824.00
|
| Rate for Payer: Fidelis Medicare |
$628.05
|
| Rate for Payer: Galaxy Health Commercial |
$1,071.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$609.76
|
| Rate for Payer: Humana Medicare |
$609.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,153.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$758.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,236.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$927.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$640.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,236.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$548.80
|
| Rate for Payer: United Healthcare Commercial |
$1,236.00
|
| Rate for Payer: United Healthcare Medicare |
$609.76
|
| Rate for Payer: WellCare Medicare |
$906.40
|
|
|
PLATE, PHERESIS, PATHOGEN-REDUCED, EA
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
4302002
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$745.20 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$745.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$745.20
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$828.00
|
| Rate for Payer: EmblemHealth Select Care |
$828.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
| Rate for Payer: WellCare Medicare |
$910.80
|
|
|
PLATE, PHERESIS, PATHOGEN-REDUCED, EA
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
4302002
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$551.28 |
| Max. Negotiated Rate |
$1,333.08 |
| Rate for Payer: Aetna of NY Commercial |
$1,159.20
|
| Rate for Payer: Aetna of NY Medicare |
$761.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$612.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$828.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: CDPHP Commercial |
$1,333.08
|
| Rate for Payer: CDPHP Medicare |
$612.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$828.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,324.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicare |
$563.04
|
| Rate for Payer: EmblemHealth Select Care |
$828.00
|
| Rate for Payer: Fidelis Medicare |
$631.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$612.72
|
| Rate for Payer: Humana Medicare |
$612.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,159.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$761.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,242.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$932.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$643.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,242.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$551.28
|
| Rate for Payer: United Healthcare Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare Medicare |
$612.72
|
| Rate for Payer: WellCare Medicare |
$910.80
|
|
|
PLEUR EVAC
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
4471133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna of NY Commercial |
$94.50
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.50
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Commercial |
$108.68
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.00
|
| Rate for Payer: EmblemHealth Medicaid |
$108.00
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$51.45
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.95
|
| Rate for Payer: Humana Medicare |
$49.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$94.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.45
|
| Rate for Payer: United Healthcare Medicare |
$49.95
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
PLEUR EVAC
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
4471133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
PLEURX VACUUM BOTTLE 5072102
|
Facility
|
IP
|
$192.00
|
|
| Hospital Charge Code |
4479316
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
PLEURX VACUUM BOTTLE 5072102
|
Facility
|
OP
|
$192.00
|
|
| Hospital Charge Code |
4479316
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna of NY Commercial |
$134.40
|
| Rate for Payer: Aetna of NY Medicare |
$88.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$96.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: CDPHP Commercial |
$154.56
|
| Rate for Payer: CDPHP Medicare |
$71.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$153.60
|
| Rate for Payer: EmblemHealth Medicare |
$65.28
|
| Rate for Payer: EmblemHealth Select Care |
$138.24
|
| Rate for Payer: Fidelis Medicare |
$73.17
|
| Rate for Payer: Galaxy Health Commercial |
$124.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.04
|
| Rate for Payer: Humana Medicare |
$71.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$134.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$108.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.59
|
| Rate for Payer: United Healthcare Medicare |
$71.04
|
| Rate for Payer: WellCare Medicare |
$105.60
|
|
|
PNEUMOCOCCAL 23 VAL PSAC VACC 25MCG/0.5M
|
Facility
|
IP
|
$292.52
|
|
|
Service Code
|
NDC 00006494300
|
| Hospital Charge Code |
4400628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.89 |
| Max. Negotiated Rate |
$190.14 |
| Rate for Payer: Cash Price |
$219.39
|
| Rate for Payer: Galaxy Health Commercial |
$190.14
|
| Rate for Payer: WellCare Medicare |
$160.89
|
|
|
PNEUMOCOCCAL 23 VAL PSAC VACC 25MCG/0.5M
|
Facility
|
OP
|
$292.52
|
|
|
Service Code
|
NDC 00006494300
|
| Hospital Charge Code |
4400628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: Aetna of NY Commercial |
$204.76
|
| Rate for Payer: Aetna of NY Medicare |
$134.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$219.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$219.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$108.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$146.26
|
| Rate for Payer: Cash Price |
$219.39
|
| Rate for Payer: CDPHP Commercial |
$235.48
|
| Rate for Payer: CDPHP Medicare |
$108.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$234.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$234.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$234.02
|
| Rate for Payer: EmblemHealth Medicaid |
$234.02
|
| Rate for Payer: EmblemHealth Medicare |
$99.46
|
| Rate for Payer: EmblemHealth Select Care |
$210.61
|
| Rate for Payer: Fidelis Medicare |
$111.48
|
| Rate for Payer: Galaxy Health Commercial |
$190.14
|
| Rate for Payer: Hamaspik Choice Medicare |
$108.23
|
| Rate for Payer: Humana Medicare |
$108.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$204.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$134.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$164.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$113.64
|
| Rate for Payer: United Healthcare Medicare |
$108.23
|
| Rate for Payer: WellCare Medicare |
$160.89
|
|
|
PNEUMOTHORAX TRAY
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
4479274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$460.20 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
|
|
PNEUMOTHORAX TRAY
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
4479274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$569.94 |
| Rate for Payer: Aetna of NY Commercial |
$495.60
|
| Rate for Payer: Aetna of NY Medicare |
$325.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$354.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: CDPHP Commercial |
$569.94
|
| Rate for Payer: CDPHP Medicare |
$261.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$566.40
|
| Rate for Payer: EmblemHealth Medicaid |
$566.40
|
| Rate for Payer: EmblemHealth Medicare |
$240.72
|
| Rate for Payer: EmblemHealth Select Care |
$509.76
|
| Rate for Payer: Fidelis Medicare |
$269.82
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.96
|
| Rate for Payer: Humana Medicare |
$261.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$495.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$275.06
|
| Rate for Payer: United Healthcare Medicare |
$261.96
|
| Rate for Payer: WellCare Medicare |
$389.40
|
|
|
POLYETHYLENE GLYCOL PCKT 14 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904642286
|
| Hospital Charge Code |
4400629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
POLYETHYLENE GLYCOL PCKT 14 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904642286
|
| Hospital Charge Code |
4400629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
POLYMYXIN B SULF/TMP 10MU-0.1% DROP 10 M
|
Facility
|
OP
|
$41.46
|
|
|
Service Code
|
NDC 24208031510
|
| Hospital Charge Code |
4400631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$33.38 |
| Rate for Payer: Aetna of NY Commercial |
$29.02
|
| Rate for Payer: Aetna of NY Medicare |
$19.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.73
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: CDPHP Commercial |
$33.38
|
| Rate for Payer: CDPHP Medicare |
$15.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.17
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.17
|
| Rate for Payer: EmblemHealth Medicaid |
$33.17
|
| Rate for Payer: EmblemHealth Medicare |
$14.10
|
| Rate for Payer: EmblemHealth Select Care |
$29.85
|
| Rate for Payer: Fidelis Medicare |
$15.80
|
| Rate for Payer: Galaxy Health Commercial |
$26.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.34
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.11
|
| Rate for Payer: United Healthcare Medicare |
$15.34
|
| Rate for Payer: WellCare Medicare |
$22.80
|
|
|
POLYMYXIN B SULF/TMP 10MU-0.1% DROP 10 M
|
Facility
|
IP
|
$41.46
|
|
|
Service Code
|
NDC 24208031510
|
| Hospital Charge Code |
4400631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Galaxy Health Commercial |
$26.95
|
| Rate for Payer: WellCare Medicare |
$22.80
|
|
|
POLYPECTOMY SNARE
|
Facility
|
OP
|
$192.00
|
|
| Hospital Charge Code |
4479013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna of NY Commercial |
$134.40
|
| Rate for Payer: Aetna of NY Medicare |
$88.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$96.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: CDPHP Commercial |
$154.56
|
| Rate for Payer: CDPHP Medicare |
$71.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$153.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$153.60
|
| Rate for Payer: EmblemHealth Medicare |
$65.28
|
| Rate for Payer: EmblemHealth Select Care |
$138.24
|
| Rate for Payer: Fidelis Medicare |
$73.17
|
| Rate for Payer: Galaxy Health Commercial |
$124.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.04
|
| Rate for Payer: Humana Medicare |
$71.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$134.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$88.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$108.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.59
|
| Rate for Payer: United Healthcare Medicare |
$71.04
|
| Rate for Payer: WellCare Medicare |
$105.60
|
|
|
POLYPECTOMY SNARE
|
Facility
|
IP
|
$192.00
|
|
| Hospital Charge Code |
4479013
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
PORT-A-CATH
|
Facility
|
IP
|
$977.00
|
|
| Hospital Charge Code |
4473009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$635.05 |
| Max. Negotiated Rate |
$635.05 |
| Rate for Payer: Cash Price |
$732.75
|
| Rate for Payer: Galaxy Health Commercial |
$635.05
|
|
|
PORT-A-CATH
|
Facility
|
OP
|
$977.00
|
|
| Hospital Charge Code |
4473009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$332.18 |
| Max. Negotiated Rate |
$786.48 |
| Rate for Payer: Aetna of NY Commercial |
$683.90
|
| Rate for Payer: Aetna of NY Medicare |
$449.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$732.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$732.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$361.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$488.50
|
| Rate for Payer: Cash Price |
$732.75
|
| Rate for Payer: CDPHP Commercial |
$786.48
|
| Rate for Payer: CDPHP Medicare |
$361.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$781.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$781.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$781.60
|
| Rate for Payer: EmblemHealth Medicaid |
$781.60
|
| Rate for Payer: EmblemHealth Medicare |
$332.18
|
| Rate for Payer: EmblemHealth Select Care |
$703.44
|
| Rate for Payer: Fidelis Medicare |
$372.33
|
| Rate for Payer: Galaxy Health Commercial |
$635.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$361.49
|
| Rate for Payer: Humana Medicare |
$361.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$683.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$449.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$732.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$550.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$379.56
|
| Rate for Payer: United Healthcare Medicare |
$361.49
|
| Rate for Payer: WellCare Medicare |
$537.35
|
|
|
PORT-A-CATH II IMPLANTABLE VE
|
Facility
|
OP
|
$967.00
|
|
| Hospital Charge Code |
4471194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$328.78 |
| Max. Negotiated Rate |
$778.44 |
| Rate for Payer: Aetna of NY Commercial |
$676.90
|
| Rate for Payer: Aetna of NY Medicare |
$444.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$725.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$725.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$357.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$483.50
|
| Rate for Payer: Cash Price |
$725.25
|
| Rate for Payer: CDPHP Commercial |
$778.44
|
| Rate for Payer: CDPHP Medicare |
$357.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$773.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$773.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$773.60
|
| Rate for Payer: EmblemHealth Medicaid |
$773.60
|
| Rate for Payer: EmblemHealth Medicare |
$328.78
|
| Rate for Payer: EmblemHealth Select Care |
$696.24
|
| Rate for Payer: Fidelis Medicare |
$368.52
|
| Rate for Payer: Galaxy Health Commercial |
$628.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$357.79
|
| Rate for Payer: Humana Medicare |
$357.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$676.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$444.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$544.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$375.68
|
| Rate for Payer: United Healthcare Medicare |
$357.79
|
| Rate for Payer: WellCare Medicare |
$531.85
|
|
|
PORT-A-CATH II IMPLANTABLE VE
|
Facility
|
IP
|
$967.00
|
|
| Hospital Charge Code |
4471194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$628.55 |
| Max. Negotiated Rate |
$628.55 |
| Rate for Payer: Cash Price |
$725.25
|
| Rate for Payer: Galaxy Health Commercial |
$628.55
|
|
|
PORT FLUSH ER
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
4609637
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.50
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Commercial |
$140.88
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: EmblemHealth Select Care |
$126.00
|
| Rate for Payer: Fidelis Medicare |
$66.69
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.75
|
| Rate for Payer: Humana Medicare |
$64.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$131.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.28
|
| Rate for Payer: United Healthcare Commercial |
$131.25
|
| Rate for Payer: United Healthcare Medicare |
$64.75
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
