|
SIMVASTATIN 20 MG
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 68084051201
|
| Hospital Charge Code |
4408940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SIMVASTATIN 40MG TABS 10X10EA
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
4400702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SIMVASTATIN 40MG TABS 10X10EA
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
4400702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna of NY Commercial |
$10.63
|
| Rate for Payer: Aetna of NY Medicare |
$6.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.08
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: CDPHP Medicare |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.15
|
| Rate for Payer: EmblemHealth Medicaid |
$12.15
|
| Rate for Payer: EmblemHealth Medicare |
$5.16
|
| Rate for Payer: EmblemHealth Select Care |
$10.94
|
| Rate for Payer: Fidelis Medicare |
$6.08
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.08
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.28
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SINERGY EPSILON RULER SIA-E10
|
Facility
|
IP
|
$73.13
|
|
| Hospital Charge Code |
4479250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
|
|
SINERGY EPSILON RULER SIA-E10
|
Facility
|
OP
|
$73.13
|
|
| Hospital Charge Code |
4479250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of NY Commercial |
$51.19
|
| Rate for Payer: Aetna of NY Medicare |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.25
|
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: CDPHP Medicare |
$27.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.50
|
| Rate for Payer: EmblemHealth Medicaid |
$58.50
|
| Rate for Payer: EmblemHealth Medicare |
$24.86
|
| Rate for Payer: EmblemHealth Select Care |
$52.65
|
| Rate for Payer: Fidelis Medicare |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.25
|
| Rate for Payer: Humana Medicare |
$29.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.97
|
| Rate for Payer: United Healthcare Medicare |
$29.25
|
| Rate for Payer: WellCare Medicare |
$40.22
|
|
|
SINERGY INTRODUCER 17GX150 SII-17-1750
|
Facility
|
IP
|
$418.18
|
|
| Hospital Charge Code |
4479247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$271.82 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Cash Price |
$313.64
|
| Rate for Payer: Galaxy Health Commercial |
$271.82
|
|
|
SINERGY INTRODUCER 17GX150 SII-17-1750
|
Facility
|
OP
|
$418.18
|
|
| Hospital Charge Code |
4479247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.73 |
| Max. Negotiated Rate |
$334.54 |
| Rate for Payer: Aetna of NY Commercial |
$292.73
|
| Rate for Payer: Aetna of NY Medicare |
$192.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$167.27
|
| Rate for Payer: Cash Price |
$313.64
|
| Rate for Payer: CDPHP Medicare |
$154.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$334.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$334.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$334.54
|
| Rate for Payer: EmblemHealth Medicaid |
$334.54
|
| Rate for Payer: EmblemHealth Medicare |
$142.18
|
| Rate for Payer: EmblemHealth Select Care |
$301.09
|
| Rate for Payer: Fidelis Medicare |
$167.27
|
| Rate for Payer: Galaxy Health Commercial |
$271.82
|
| Rate for Payer: Hamaspik Choice Medicare |
$167.27
|
| Rate for Payer: Humana Medicare |
$167.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$292.73
|
| Rate for Payer: Local 1199SEIU Medicare |
$192.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$235.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$62.73
|
| Rate for Payer: United Healthcare Medicare |
$167.27
|
| Rate for Payer: WellCare Medicare |
$230.00
|
|
|
SINERGY INTRODUCER 17X75MM SII-75-5
|
Facility
|
IP
|
$210.12
|
|
| Hospital Charge Code |
4479249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$136.58 |
| Rate for Payer: Cash Price |
$157.59
|
| Rate for Payer: Galaxy Health Commercial |
$136.58
|
|
|
SINERGY INTRODUCER 17X75MM SII-75-5
|
Facility
|
OP
|
$210.12
|
|
| Hospital Charge Code |
4479249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$168.10 |
| Rate for Payer: Aetna of NY Commercial |
$147.08
|
| Rate for Payer: Aetna of NY Medicare |
$96.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.05
|
| Rate for Payer: Cash Price |
$157.59
|
| Rate for Payer: CDPHP Medicare |
$77.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$168.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.10
|
| Rate for Payer: EmblemHealth Medicaid |
$168.10
|
| Rate for Payer: EmblemHealth Medicare |
$71.44
|
| Rate for Payer: EmblemHealth Select Care |
$151.29
|
| Rate for Payer: Fidelis Medicare |
$84.05
|
| Rate for Payer: Galaxy Health Commercial |
$136.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.05
|
| Rate for Payer: Humana Medicare |
$84.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$147.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$96.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$118.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.52
|
| Rate for Payer: United Healthcare Medicare |
$84.05
|
| Rate for Payer: WellCare Medicare |
$115.57
|
|
|
SINERGY PROBE 17GX75MMX4MM SIK-17-75-4
|
Facility
|
OP
|
$3,131.20
|
|
| Hospital Charge Code |
4479248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$469.68 |
| Max. Negotiated Rate |
$2,504.96 |
| Rate for Payer: Aetna of NY Commercial |
$2,191.84
|
| Rate for Payer: Aetna of NY Medicare |
$1,440.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,252.48
|
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: CDPHP Medicare |
$1,158.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,064.61
|
| Rate for Payer: EmblemHealth Select Care |
$2,254.46
|
| Rate for Payer: Fidelis Medicare |
$1,252.48
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,252.48
|
| Rate for Payer: Humana Medicare |
$1,252.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,191.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,440.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,348.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,762.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,315.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$469.68
|
| Rate for Payer: United Healthcare Medicare |
$1,252.48
|
| Rate for Payer: WellCare Medicare |
$1,722.16
|
|
|
SINERGY PROBE 17GX75MMX4MM SIK-17-75-4
|
Facility
|
IP
|
$3,131.20
|
|
| Hospital Charge Code |
4479248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,035.28 |
| Max. Negotiated Rate |
$2,035.28 |
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
|
|
SINERGY STERILE PROBE TIP SIP-17-75-4
|
Facility
|
IP
|
$2,190.81
|
|
| Hospital Charge Code |
4479219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$1,424.03 |
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
|
|
SINERGY STERILE PROBE TIP SIP-17-75-4
|
Facility
|
OP
|
$2,190.81
|
|
| Hospital Charge Code |
4479219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$1,752.65 |
| Rate for Payer: Aetna of NY Commercial |
$1,533.57
|
| Rate for Payer: Aetna of NY Medicare |
$1,007.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$876.32
|
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: CDPHP Medicare |
$810.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicaid |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicare |
$744.88
|
| Rate for Payer: EmblemHealth Select Care |
$1,577.38
|
| Rate for Payer: Fidelis Medicare |
$876.32
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$876.32
|
| Rate for Payer: Humana Medicare |
$876.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,533.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,007.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,643.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,233.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$920.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$328.62
|
| Rate for Payer: United Healthcare Medicare |
$876.32
|
| Rate for Payer: WellCare Medicare |
$1,204.95
|
|
|
SINERGY SYSTEM 17GX150 SIK-17-150-4
|
Facility
|
IP
|
$3,131.20
|
|
| Hospital Charge Code |
4479246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,035.28 |
| Max. Negotiated Rate |
$2,035.28 |
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
|
|
SINERGY SYSTEM 17GX150 SIK-17-150-4
|
Facility
|
OP
|
$3,131.20
|
|
| Hospital Charge Code |
4479246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$469.68 |
| Max. Negotiated Rate |
$2,504.96 |
| Rate for Payer: Aetna of NY Commercial |
$2,191.84
|
| Rate for Payer: Aetna of NY Medicare |
$1,440.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,252.48
|
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: CDPHP Medicare |
$1,158.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,064.61
|
| Rate for Payer: EmblemHealth Select Care |
$2,254.46
|
| Rate for Payer: Fidelis Medicare |
$1,252.48
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,252.48
|
| Rate for Payer: Humana Medicare |
$1,252.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,191.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,440.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,348.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,762.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,315.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$469.68
|
| Rate for Payer: United Healthcare Medicare |
$1,252.48
|
| Rate for Payer: WellCare Medicare |
$1,722.16
|
|
|
SINGERY KIT (CERVICOOL) SIK-17-75-4
|
Facility
|
OP
|
$2,190.81
|
|
| Hospital Charge Code |
4479192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$1,752.65 |
| Rate for Payer: Aetna of NY Commercial |
$1,533.57
|
| Rate for Payer: Aetna of NY Medicare |
$1,007.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$876.32
|
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: CDPHP Medicare |
$810.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicaid |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicare |
$744.88
|
| Rate for Payer: EmblemHealth Select Care |
$1,577.38
|
| Rate for Payer: Fidelis Medicare |
$876.32
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$876.32
|
| Rate for Payer: Humana Medicare |
$876.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,533.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,007.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,643.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,233.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$920.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$328.62
|
| Rate for Payer: United Healthcare Medicare |
$876.32
|
| Rate for Payer: WellCare Medicare |
$1,204.95
|
|
|
SINGERY KIT (CERVICOOL) SIK-17-75-4
|
Facility
|
IP
|
$2,190.81
|
|
| Hospital Charge Code |
4479192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$1,424.03 |
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
|
|
SINGLE LUMEN CENTRAL VENOUS CA
|
Facility
|
IP
|
$142.14
|
|
| Hospital Charge Code |
4471812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
|
|
SINGLE LUMEN CENTRAL VENOUS CA
|
Facility
|
OP
|
$142.14
|
|
| Hospital Charge Code |
4471812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$113.71 |
| Rate for Payer: Aetna of NY Commercial |
$99.50
|
| Rate for Payer: Aetna of NY Medicare |
$65.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.86
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: CDPHP Medicare |
$52.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$113.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.71
|
| Rate for Payer: EmblemHealth Medicaid |
$113.71
|
| Rate for Payer: EmblemHealth Medicare |
$48.33
|
| Rate for Payer: EmblemHealth Select Care |
$102.34
|
| Rate for Payer: Fidelis Medicare |
$56.86
|
| Rate for Payer: Galaxy Health Commercial |
$92.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.86
|
| Rate for Payer: Humana Medicare |
$56.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$99.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$65.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$56.86
|
| Rate for Payer: WellCare Medicare |
$78.18
|
|
|
SINGLE NAIL AVULSION
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4609570
|
|
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
|
|
|
SINGLE NAIL AVULSION
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4609570
|
|
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
|
|
|
SINGLE US EF CANNULA CURVED 22G X 100 X 5 (C-1005-S-22-LC)
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
4473052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of NY Commercial |
$378.00
|
| Rate for Payer: Aetna of NY Medicare |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$216.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: CDPHP Medicare |
$199.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$432.00
|
| Rate for Payer: EmblemHealth Medicare |
$183.60
|
| Rate for Payer: EmblemHealth Select Care |
$388.80
|
| Rate for Payer: Fidelis Medicare |
$216.00
|
| Rate for Payer: Galaxy Health Commercial |
$351.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$216.00
|
| Rate for Payer: Humana Medicare |
$216.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$378.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$248.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$405.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$304.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$226.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$81.00
|
| Rate for Payer: United Healthcare Medicare |
$216.00
|
| Rate for Payer: WellCare Medicare |
$297.00
|
|
|
SINGLE US EF CANNULA CURVED 22G X 100 X 5 (C-1005-S-22-LC)
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
4473052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Galaxy Health Commercial |
$351.00
|
|
|
SINGLE USE RF CANNULA STRAIGHT 22G X100 X10 (S-1010-SS-LC)
|
Facility
|
OP
|
$690.00
|
|
| Hospital Charge Code |
4473053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of NY Commercial |
$483.00
|
| Rate for Payer: Aetna of NY Medicare |
$317.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$276.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: CDPHP Medicare |
$255.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$552.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$552.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$552.00
|
| Rate for Payer: EmblemHealth Medicaid |
$552.00
|
| Rate for Payer: EmblemHealth Medicare |
$234.60
|
| Rate for Payer: EmblemHealth Select Care |
$496.80
|
| Rate for Payer: Fidelis Medicare |
$276.00
|
| Rate for Payer: Galaxy Health Commercial |
$448.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$276.00
|
| Rate for Payer: Humana Medicare |
$276.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$483.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$317.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$517.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$388.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$289.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$103.50
|
| Rate for Payer: United Healthcare Medicare |
$276.00
|
| Rate for Payer: WellCare Medicare |
$379.50
|
|
|
SINGLE USE RF CANNULA STRAIGHT 22G X100 X10 (S-1010-SS-LC)
|
Facility
|
IP
|
$690.00
|
|
| Hospital Charge Code |
4473053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Galaxy Health Commercial |
$448.50
|
|
