|
OXYMETAZOLINE HCL 0.0005 SPIN 15 ML
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 85411201
|
| Hospital Charge Code |
4400023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$12.98 |
| Rate for Payer: Aetna of NY Commercial |
$11.35
|
| Rate for Payer: Aetna of NY Medicare |
$7.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.49
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: CDPHP Medicare |
$6.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.98
|
| Rate for Payer: EmblemHealth Medicaid |
$12.98
|
| Rate for Payer: EmblemHealth Medicare |
$5.51
|
| Rate for Payer: EmblemHealth Select Care |
$11.68
|
| Rate for Payer: Fidelis Medicare |
$6.49
|
| Rate for Payer: Galaxy Health Commercial |
$10.54
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.49
|
| Rate for Payer: Humana Medicare |
$6.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.43
|
| Rate for Payer: United Healthcare Medicare |
$6.49
|
| Rate for Payer: WellCare Medicare |
$8.92
|
|
|
OXYMETAZOLINE HCL 0.0005 SPIN 15 ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 904676130
|
| Hospital Charge Code |
4400548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna of NY Commercial |
$6.31
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.60
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.60
|
| Rate for Payer: Humana Medicare |
$3.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
OXYMETAZOLINE HCL 0.0005 SPIN 15 ML
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 85411201
|
| Hospital Charge Code |
4400023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Galaxy Health Commercial |
$10.54
|
| Rate for Payer: WellCare Medicare |
$8.92
|
|
|
OXYTOCIN INJECTION TO 10 UNITS
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
4400604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
OXYTOCIN INJECTION TO 10 UNITS
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
4400604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PACKED RED BLOOD CELLS (BLOOD BANK)
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4301004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of NY Commercial |
$316.40
|
| Rate for Payer: Aetna of NY Medicare |
$207.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.80
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: CDPHP Medicare |
$167.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$226.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$361.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$361.60
|
| Rate for Payer: EmblemHealth Medicaid |
$361.60
|
| Rate for Payer: EmblemHealth Medicare |
$153.68
|
| Rate for Payer: EmblemHealth Select Care |
$226.00
|
| Rate for Payer: Fidelis Medicare |
$180.80
|
| Rate for Payer: Galaxy Health Commercial |
$293.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.80
|
| Rate for Payer: Humana Medicare |
$180.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$316.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$254.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$339.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$67.80
|
| Rate for Payer: United Healthcare Commercial |
$339.00
|
| Rate for Payer: United Healthcare Medicare |
$180.80
|
| Rate for Payer: WellCare Medicare |
$248.60
|
|
|
PACKED RED BLOOD CELLS (BLOOD BANK)
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4301004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$226.00
|
| Rate for Payer: EmblemHealth Select Care |
$226.00
|
| Rate for Payer: Galaxy Health Commercial |
$293.80
|
| Rate for Payer: WellCare Medicare |
$248.60
|
|
|
PANTOPRAZOLE SODIUM 40MG TABS 10X10EA
|
Facility
|
IP
|
$12.62
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
4400606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: Galaxy Health Commercial |
$8.20
|
| Rate for Payer: WellCare Medicare |
$6.94
|
|
|
PANTOPRAZOLE SODIUM 40MG TABS 10X10EA
|
Facility
|
OP
|
$12.62
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
4400606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna of NY Commercial |
$8.83
|
| Rate for Payer: Aetna of NY Medicare |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.05
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: CDPHP Medicare |
$4.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.10
|
| Rate for Payer: EmblemHealth Medicaid |
$10.10
|
| Rate for Payer: EmblemHealth Medicare |
$4.29
|
| Rate for Payer: EmblemHealth Select Care |
$9.09
|
| Rate for Payer: Fidelis Medicare |
$5.05
|
| Rate for Payer: Galaxy Health Commercial |
$8.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.05
|
| Rate for Payer: Humana Medicare |
$5.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.89
|
| Rate for Payer: United Healthcare Medicare |
$5.05
|
| Rate for Payer: WellCare Medicare |
$6.94
|
|
|
PANTOPRAZOLE SODIUM, PER VIAL
|
Facility
|
OP
|
$30.15
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
4400667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna of NY Medicare |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.06
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: CDPHP Medicare |
$11.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.12
|
| Rate for Payer: EmblemHealth Medicaid |
$24.12
|
| Rate for Payer: EmblemHealth Medicare |
$10.25
|
| Rate for Payer: EmblemHealth Select Care |
$21.71
|
| Rate for Payer: Fidelis Medicare |
$12.06
|
| Rate for Payer: Galaxy Health Commercial |
$19.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.06
|
| Rate for Payer: Humana Medicare |
$12.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.52
|
| Rate for Payer: United Healthcare Medicare |
$12.06
|
| Rate for Payer: WellCare Medicare |
$16.58
|
|
|
PANTOPRAZOLE SODIUM, PER VIAL
|
Facility
|
IP
|
$30.15
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
4400667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna of NY Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Galaxy Health Commercial |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.58
|
| Rate for Payer: WellCare Medicare |
$16.58
|
|
|
PANTOPRAZOLE TAB20MG
|
Facility
|
IP
|
$12.36
|
|
|
Service Code
|
NDC 50268063615
|
| Hospital Charge Code |
4409222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Galaxy Health Commercial |
$8.03
|
| Rate for Payer: WellCare Medicare |
$6.80
|
|
|
PANTOPRAZOLE TAB20MG
|
Facility
|
OP
|
$12.36
|
|
|
Service Code
|
NDC 50268063615
|
| Hospital Charge Code |
4409222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna of NY Commercial |
$8.65
|
| Rate for Payer: Aetna of NY Medicare |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.94
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: CDPHP Medicare |
$4.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.89
|
| Rate for Payer: EmblemHealth Medicaid |
$9.89
|
| Rate for Payer: EmblemHealth Medicare |
$4.20
|
| Rate for Payer: EmblemHealth Select Care |
$8.90
|
| Rate for Payer: Fidelis Medicare |
$4.94
|
| Rate for Payer: Galaxy Health Commercial |
$8.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.94
|
| Rate for Payer: Humana Medicare |
$4.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.85
|
| Rate for Payer: United Healthcare Medicare |
$4.94
|
| Rate for Payer: WellCare Medicare |
$6.80
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP
|
| Hospital Charge Code |
4650030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP
|
| Hospital Charge Code |
4650030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
PARAFFIN BATH (MOD 59)
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,59
|
| Hospital Charge Code |
4650374
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
PARAFFIN BATH (MOD 59)
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,59
|
| Hospital Charge Code |
4650374
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
PARAFFIN BATH (MOD 59 W KX)
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,59,KX
|
| Hospital Charge Code |
4650426
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
PARAFFIN BATH (MOD 59 W KX)
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,59,KX
|
| Hospital Charge Code |
4650426
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
PARAFFIN BATH (W/ KX)
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,KX
|
| Hospital Charge Code |
4650319
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
PARAFFIN BATH (W/ KX)
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 97018 GP,KX
|
| Hospital Charge Code |
4650319
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
PARATHYROID HORMONE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
4300608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
|
|
PARATHYROID HORMONE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
4300608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of NY Commercial |
$104.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: CDPHP Medicare |
$59.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.00
|
| Rate for Payer: EmblemHealth Medicaid |
$128.00
|
| Rate for Payer: EmblemHealth Medicare |
$54.40
|
| Rate for Payer: EmblemHealth Select Care |
$96.00
|
| Rate for Payer: Fidelis Medicare |
$64.00
|
| Rate for Payer: Galaxy Health Commercial |
$104.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.00
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$104.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$90.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$120.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WellCare Medicare |
$88.00
|
|
|
PARATHYROID IMAGING
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 78070 26
|
| Hospital Charge Code |
5210029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of NY Commercial |
$81.90
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.80
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: Fidelis Medicare |
$46.80
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.80
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$81.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.55
|
| Rate for Payer: United Healthcare Medicare |
$46.80
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
|
PARATHYROID IMAGING
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
4210029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
