|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
IP
|
$29.87
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna of NY Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$19.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.43
|
| Rate for Payer: WellCare Medicare |
$16.43
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
OP
|
$29.75
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna of NY Commercial |
$16.36
|
| Rate for Payer: Aetna of NY Medicare |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.88
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: CDPHP Commercial |
$23.95
|
| Rate for Payer: CDPHP Medicare |
$11.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.80
|
| Rate for Payer: EmblemHealth Medicaid |
$23.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.12
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$11.34
|
| Rate for Payer: Galaxy Health Commercial |
$19.34
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.01
|
| Rate for Payer: Humana Medicare |
$11.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$11.01
|
| Rate for Payer: WellCare Medicare |
$16.36
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
IP
|
$29.75
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$19.34 |
| Rate for Payer: Aetna of NY Commercial |
$16.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$19.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.36
|
| Rate for Payer: WellCare Medicare |
$16.36
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4301020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4301020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4200050
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4200050
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.18 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of NY Commercial |
$455.65
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$350.50
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: EmblemHealth Select Care |
$455.65
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$455.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$394.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$272.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$279.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Medicare |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
4002062
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$161,026.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,680.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,623.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,610.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,156.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,610.26
|
| Rate for Payer: CDPHP Commercial |
$4,691.54
|
| Rate for Payer: CDPHP Essential Plan |
$3,623.08
|
| Rate for Payer: CDPHP Medicare |
$2,156.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,662.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,932.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,610.26
|
| Rate for Payer: EmblemHealth Medicaid |
$1,610.26
|
| Rate for Payer: EmblemHealth Medicare |
$1,981.52
|
| Rate for Payer: EmblemHealth Select Care |
$4,196.16
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,623.08
|
| Rate for Payer: Fidelis Medicare |
$2,221.05
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,367.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$161,026.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,156.36
|
| Rate for Payer: Humana Medicare |
$2,156.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,680.88
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$161,026.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,371.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,462.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,462.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,281.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,264.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,610.26
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$2,156.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,690.77
|
| Rate for Payer: WellCare Medicare |
$3,205.40
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
4002062
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,788.20 |
| Max. Negotiated Rate |
$3,788.20 |
| Rate for Payer: Cash Price |
$4,371.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,788.20
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
4650078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
4650078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59
|
| Hospital Charge Code |
4650393
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59
|
| Hospital Charge Code |
4650393
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59,KX
|
| Hospital Charge Code |
4650445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,59,KX
|
| Hospital Charge Code |
4650445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,KX
|
| Hospital Charge Code |
4650341
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97016 GP,KX
|
| Hospital Charge Code |
4650341
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
VASOPRESSIN 20U/ML MDV 25X1ML
|
Facility
|
OP
|
$137.25
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
4400792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$110.49 |
| Rate for Payer: Aetna of NY Commercial |
$96.08
|
| Rate for Payer: Aetna of NY Medicare |
$63.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.62
|
| Rate for Payer: Cash Price |
$102.94
|
| Rate for Payer: CDPHP Commercial |
$110.49
|
| Rate for Payer: CDPHP Medicare |
$50.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.80
|
| Rate for Payer: EmblemHealth Medicaid |
$109.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.66
|
| Rate for Payer: EmblemHealth Select Care |
$98.82
|
| Rate for Payer: Fidelis Medicare |
$52.31
|
| Rate for Payer: Galaxy Health Commercial |
$89.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.78
|
| Rate for Payer: Humana Medicare |
$50.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$96.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.32
|
| Rate for Payer: United Healthcare Medicare |
$50.78
|
| Rate for Payer: WellCare Medicare |
$75.49
|
|
|
VASOPRESSIN 20U/ML MDV 25X1ML
|
Facility
|
IP
|
$137.25
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
4400792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$89.21 |
| Rate for Payer: Cash Price |
$102.94
|
| Rate for Payer: Galaxy Health Commercial |
$89.21
|
| Rate for Payer: WellCare Medicare |
$75.49
|
|
|
VDRL CSF
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
4300823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Aetna of NY Commercial |
$27.30
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Commercial |
$33.81
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$16.01
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.54
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$31.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Medicare |
$15.54
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
VDRL CSF
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
4300823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
VECURONIUM BR INJ 10 MG
|
Facility
|
OP
|
$32.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna of NY Commercial |
$17.98
|
| Rate for Payer: Aetna of NY Medicare |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.35
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: CDPHP Commercial |
$26.32
|
| Rate for Payer: CDPHP Medicare |
$12.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.16
|
| Rate for Payer: EmblemHealth Medicaid |
$26.16
|
| Rate for Payer: EmblemHealth Medicare |
$11.12
|
| Rate for Payer: EmblemHealth Select Care |
$23.54
|
| Rate for Payer: Fidelis Medicare |
$12.46
|
| Rate for Payer: Galaxy Health Commercial |
$21.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.10
|
| Rate for Payer: Humana Medicare |
$12.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.70
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
VECURONIUM BR INJ 10 MG
|
Facility
|
IP
|
$32.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$21.26 |
| Rate for Payer: Aetna of NY Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.72
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: Galaxy Health Commercial |
$21.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.98
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
VENELEX OINTMENT 1 ea, 28.35 g
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
NDC 58980078011
|
| Hospital Charge Code |
4401533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna of NY Commercial |
$62.30
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.50
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Commercial |
$71.64
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: EmblemHealth Select Care |
$64.08
|
| Rate for Payer: Fidelis Medicare |
$33.92
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.93
|
| Rate for Payer: Humana Medicare |
$32.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.58
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
VENELEX OINTMENT 1 ea, 28.35 g
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
NDC 58980078011
|
| Hospital Charge Code |
4401533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
