|
PARATHYROID IMAGING
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 78070 26
|
| Hospital Charge Code |
5210029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
|
|
PARATHYROID IMAGING
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
4210029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
PARE BENIGN LES; SGL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
4855444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$430.50
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$430.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$346.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
PARE BENIGN LES; SGL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
4855444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
PARE BENIGN LES; SINGLE
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
4600990
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
PARE BENIGN LES; SINGLE
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
4600990
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
PAROXETINE HCL 10MG TABS 10X10EA
|
Facility
|
IP
|
$8.24
|
|
|
Service Code
|
NDC 63739088810
|
| Hospital Charge Code |
4400608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Galaxy Health Commercial |
$5.36
|
| Rate for Payer: WellCare Medicare |
$4.53
|
|
|
PAROXETINE HCL 10MG TABS 10X10EA
|
Facility
|
OP
|
$8.24
|
|
|
Service Code
|
NDC 63739088810
|
| Hospital Charge Code |
4400608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$6.59 |
| Rate for Payer: Aetna of NY Commercial |
$5.77
|
| Rate for Payer: Aetna of NY Medicare |
$3.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.30
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: CDPHP Medicare |
$3.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.59
|
| Rate for Payer: EmblemHealth Medicaid |
$6.59
|
| Rate for Payer: EmblemHealth Medicare |
$2.80
|
| Rate for Payer: EmblemHealth Select Care |
$5.93
|
| Rate for Payer: Fidelis Medicare |
$3.30
|
| Rate for Payer: Galaxy Health Commercial |
$5.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.30
|
| Rate for Payer: Humana Medicare |
$3.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
| Rate for Payer: WellCare Medicare |
$4.53
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
4853009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,203.20 |
| Max. Negotiated Rate |
$3,203.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
4853009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$3,942.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,449.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,266.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,971.20
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: CDPHP Medicare |
$1,823.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,675.52
|
| Rate for Payer: EmblemHealth Select Care |
$3,548.16
|
| Rate for Payer: Fidelis Medicare |
$1,971.20
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,971.20
|
| Rate for Payer: Humana Medicare |
$1,971.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,449.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,266.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,696.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,774.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,069.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$739.20
|
| Rate for Payer: United Healthcare Medicare |
$1,971.20
|
| Rate for Payer: WellCare Medicare |
$2,710.40
|
|
|
PARTIAL REMOVAL PHALANX OF TOE
|
Facility
|
OP
|
$10,029.00
|
|
|
Service Code
|
HCPCS 28124
|
| Hospital Charge Code |
4853010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,504.35 |
| Max. Negotiated Rate |
$8,023.20 |
| Rate for Payer: Aetna of NY Commercial |
$7,020.30
|
| Rate for Payer: Aetna of NY Medicare |
$4,613.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,011.60
|
| Rate for Payer: Cash Price |
$7,521.75
|
| Rate for Payer: CDPHP Medicare |
$3,710.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,409.86
|
| Rate for Payer: EmblemHealth Select Care |
$7,220.88
|
| Rate for Payer: Fidelis Medicare |
$4,011.60
|
| Rate for Payer: Galaxy Health Commercial |
$6,518.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,011.60
|
| Rate for Payer: Humana Medicare |
$4,011.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,020.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,613.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,521.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,646.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,212.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,504.35
|
| Rate for Payer: United Healthcare Medicare |
$4,011.60
|
| Rate for Payer: WellCare Medicare |
$5,515.95
|
|
|
PARTIAL REMOVAL PHALANX OF TOE
|
Facility
|
IP
|
$10,029.00
|
|
|
Service Code
|
HCPCS 28124
|
| Hospital Charge Code |
4853010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,518.85 |
| Max. Negotiated Rate |
$6,518.85 |
| Rate for Payer: Cash Price |
$7,521.75
|
| Rate for Payer: Galaxy Health Commercial |
$6,518.85
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
IP
|
$4,970.78
|
|
| Hospital Charge Code |
4472065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,231.01 |
| Max. Negotiated Rate |
$3,231.01 |
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
OP
|
$4,970.78
|
|
| Hospital Charge Code |
4472065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$745.62 |
| Max. Negotiated Rate |
$3,976.62 |
| Rate for Payer: Aetna of NY Commercial |
$3,479.55
|
| Rate for Payer: Aetna of NY Medicare |
$2,286.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,988.31
|
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: CDPHP Medicare |
$1,839.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicaid |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicare |
$1,690.07
|
| Rate for Payer: EmblemHealth Select Care |
$3,578.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.31
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,988.31
|
| Rate for Payer: Humana Medicare |
$1,988.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,479.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,286.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,728.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,798.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,087.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$745.62
|
| Rate for Payer: United Healthcare Medicare |
$1,988.31
|
| Rate for Payer: WellCare Medicare |
$2,733.93
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
OP
|
$4,970.78
|
|
| Hospital Charge Code |
4472064
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$745.62 |
| Max. Negotiated Rate |
$3,976.62 |
| Rate for Payer: Aetna of NY Commercial |
$3,479.55
|
| Rate for Payer: Aetna of NY Medicare |
$2,286.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,988.31
|
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: CDPHP Medicare |
$1,839.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicaid |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicare |
$1,690.07
|
| Rate for Payer: EmblemHealth Select Care |
$3,578.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.31
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,988.31
|
| Rate for Payer: Humana Medicare |
$1,988.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,479.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,286.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,728.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,798.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,087.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$745.62
|
| Rate for Payer: United Healthcare Medicare |
$1,988.31
|
| Rate for Payer: WellCare Medicare |
$2,733.93
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
IP
|
$4,970.78
|
|
| Hospital Charge Code |
4472064
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,231.01 |
| Max. Negotiated Rate |
$3,231.01 |
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
IP
|
$4,970.78
|
|
| Hospital Charge Code |
4472063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,231.01 |
| Max. Negotiated Rate |
$3,231.01 |
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
|
|
PATIENT PROGRAMMER KIT
|
Facility
|
OP
|
$4,970.78
|
|
| Hospital Charge Code |
4472063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$745.62 |
| Max. Negotiated Rate |
$3,976.62 |
| Rate for Payer: Aetna of NY Commercial |
$3,479.55
|
| Rate for Payer: Aetna of NY Medicare |
$2,286.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,988.31
|
| Rate for Payer: Cash Price |
$3,728.08
|
| Rate for Payer: CDPHP Medicare |
$1,839.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,976.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicaid |
$3,976.62
|
| Rate for Payer: EmblemHealth Medicare |
$1,690.07
|
| Rate for Payer: EmblemHealth Select Care |
$3,578.96
|
| Rate for Payer: Fidelis Medicare |
$1,988.31
|
| Rate for Payer: Galaxy Health Commercial |
$3,231.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,988.31
|
| Rate for Payer: Humana Medicare |
$1,988.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,479.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,286.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,728.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,798.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,087.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$745.62
|
| Rate for Payer: United Healthcare Medicare |
$1,988.31
|
| Rate for Payer: WellCare Medicare |
$2,733.93
|
|
|
PATRIOT COLLAR
|
Facility
|
OP
|
$25.75
|
|
| Hospital Charge Code |
4478141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.02
|
| Rate for Payer: Aetna of NY Medicare |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.30
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: CDPHP Medicare |
$9.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.60
|
| Rate for Payer: EmblemHealth Medicaid |
$20.60
|
| Rate for Payer: EmblemHealth Medicare |
$8.76
|
| Rate for Payer: EmblemHealth Select Care |
$18.54
|
| Rate for Payer: Fidelis Medicare |
$10.30
|
| Rate for Payer: Galaxy Health Commercial |
$16.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.30
|
| Rate for Payer: Humana Medicare |
$10.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.86
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: WellCare Medicare |
$14.16
|
|
|
PATRIOT COLLAR
|
Facility
|
IP
|
$25.75
|
|
| Hospital Charge Code |
4478141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Galaxy Health Commercial |
$16.74
|
|
|
PCA TUBING
|
Facility
|
IP
|
$42.23
|
|
| Hospital Charge Code |
4471922
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
|
|
PCA TUBING
|
Facility
|
OP
|
$42.23
|
|
| Hospital Charge Code |
4471922
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: Aetna of NY Commercial |
$29.56
|
| Rate for Payer: Aetna of NY Medicare |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: CDPHP Medicare |
$15.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.78
|
| Rate for Payer: EmblemHealth Medicaid |
$33.78
|
| Rate for Payer: EmblemHealth Medicare |
$14.36
|
| Rate for Payer: EmblemHealth Select Care |
$30.41
|
| Rate for Payer: Fidelis Medicare |
$16.89
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.89
|
| Rate for Payer: Humana Medicare |
$16.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$16.89
|
| Rate for Payer: WellCare Medicare |
$23.23
|
|
|
PEDIA LAX 4 OZ LIQ
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 132010624
|
| Hospital Charge Code |
4408980
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| 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 Aetna Signature Administrators |
$4.33
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PEDIA LAX 4 OZ LIQ
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 132010624
|
| Hospital Charge Code |
4408980
|
|
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
|
|
|
PEDIATRIC CAPNOLINE (CANNULA)
|
Facility
|
OP
|
$43.26
|
|
| Hospital Charge Code |
4479200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: Aetna of NY Commercial |
$30.28
|
| Rate for Payer: Aetna of NY Medicare |
$19.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.30
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: CDPHP Medicare |
$16.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.61
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.61
|
| Rate for Payer: EmblemHealth Medicaid |
$34.61
|
| Rate for Payer: EmblemHealth Medicare |
$14.71
|
| Rate for Payer: EmblemHealth Select Care |
$31.15
|
| Rate for Payer: Fidelis Medicare |
$17.30
|
| Rate for Payer: Galaxy Health Commercial |
$28.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.30
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.28
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.49
|
| Rate for Payer: United Healthcare Medicare |
$17.30
|
| Rate for Payer: WellCare Medicare |
$23.79
|
|
