|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
OP
|
$29.75
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of NY Medicare |
$13.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.90
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: Cash Price |
$22.31
|
| Rate for Payer: CDPHP Medicare |
$11.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.80
|
| 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 |
$21.42
|
| Rate for Payer: Fidelis Medicare |
$11.90
|
| Rate for Payer: Galaxy Health Commercial |
$19.34
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.90
|
| Rate for Payer: Humana Medicare |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.69
|
| 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 |
$12.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.46
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$11.90
|
| Rate for Payer: WellCare Medicare |
$16.36
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
IP
|
$29.87
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna of NY Commercial |
$16.43
|
| Rate for Payer: Cash Price |
$22.40
|
| 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 TROUGH
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4301020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$16.40
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.40
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.15
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4301020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 93975 26
|
| Hospital Charge Code |
5200050
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4200050
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Aetna of NY Commercial |
$475.15
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$475.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$411.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
4200050
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
VASCULAR DUPLEX STUDY OTHER VISCERAL COM
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 93975 26
|
| Hospital Charge Code |
5200050
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$135.20 |
| Rate for Payer: Aetna of NY Commercial |
$109.85
|
| Rate for Payer: Aetna of NY Medicare |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.60
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: CDPHP Medicare |
$62.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$135.20
|
| Rate for Payer: EmblemHealth Medicare |
$57.46
|
| Rate for Payer: Fidelis Medicare |
$67.60
|
| Rate for Payer: Galaxy Health Commercial |
$109.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.60
|
| Rate for Payer: Humana Medicare |
$67.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.35
|
| Rate for Payer: United Healthcare Medicare |
$67.60
|
| Rate for Payer: WellCare Medicare |
$92.95
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
4002062
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
4002062
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| 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 |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Galaxy Health Workers Comp |
$1,578.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,610.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,690.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| 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 |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,690.77
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
4650078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| 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 |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$28.08
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| 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 |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
4650078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,59
|
| Hospital Charge Code |
4650393
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| 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 |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$28.08
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| 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 |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,59
|
| Hospital Charge Code |
4650393
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,59,KX
|
| Hospital Charge Code |
4650445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| 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 |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$28.08
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| 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 |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,59,KX
|
| Hospital Charge Code |
4650445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,KX
|
| Hospital Charge Code |
4650341
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| 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 |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$28.08
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| 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 |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
VASOPNEUMATIC DEVICE THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 97016 GP,KX
|
| Hospital Charge Code |
4650341
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
VASOPRESSIN 20U/ML MDV 25X1ML
|
Facility
|
OP
|
$137.25
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
4400792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of NY Commercial |
$96.08
|
| Rate for Payer: Aetna of NY Medicare |
$63.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.90
|
| Rate for Payer: Cash Price |
$102.94
|
| 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 |
$54.90
|
| Rate for Payer: Galaxy Health Commercial |
$89.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.90
|
| Rate for Payer: Humana Medicare |
$54.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$96.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.13
|
| 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 |
$57.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.59
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| 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
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
4300823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
VDRL CSF
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
4300823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of NY Commercial |
$8.45
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$7.80
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.20
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
VECURONIUM BR INJ 10 MG
|
Facility
|
IP
|
$32.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of NY Commercial |
$17.98
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Galaxy Health Commercial |
$21.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.98
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
VECURONIUM BR INJ 10 MG
|
Facility
|
OP
|
$32.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna of NY Medicare |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$24.52
|
| 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 |
$13.08
|
| Rate for Payer: Galaxy Health Commercial |
$21.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.08
|
| Rate for Payer: Humana Medicare |
$13.08
|
| 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 |
$13.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.91
|
| Rate for Payer: United Healthcare Medicare |
$13.08
|
| 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 |
$13.35 |
| Max. Negotiated Rate |
$71.20 |
| 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) Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$66.75
|
| 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 |
$35.60
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.60
|
| Rate for Payer: Humana Medicare |
$35.60
|
| 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 |
$37.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$35.60
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
