|
CARPAL TUNNEL INJECTION
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
4850025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$592.90
|
| Rate for Payer: Aetna of NY Medicare |
$389.62
|
| 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) Medicare |
$313.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$423.50
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: CDPHP Commercial |
$681.84
|
| Rate for Payer: CDPHP Medicare |
$313.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$677.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$677.60
|
| Rate for Payer: EmblemHealth Medicaid |
$677.60
|
| Rate for Payer: EmblemHealth Medicare |
$287.98
|
| Rate for Payer: EmblemHealth Select Care |
$609.84
|
| Rate for Payer: Fidelis Medicare |
$322.79
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$313.39
|
| Rate for Payer: Humana Medicare |
$313.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$592.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$389.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$476.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$329.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.20
|
| Rate for Payer: United Healthcare Medicare |
$313.39
|
| Rate for Payer: WellCare Medicare |
$465.85
|
|
|
CARPAL TUNNEL INJECTION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
4850025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.55 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Galaxy Health Commercial |
$550.55
|
|
|
CARVEDILOL 12.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
4400134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
CARVEDILOL 12.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
4400134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
CARVEDILOL 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904630361
|
| Hospital Charge Code |
4400135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CARVEDILOL 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904630361
|
| Hospital Charge Code |
4400135
|
|
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
|
|
|
CARVEDILOL 3.125MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
4400136
|
|
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
|
|
|
CARVEDILOL 3.125MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
4400136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CARVEDILOL 6.25MG TABS 10X10EA
|
Facility
|
OP
|
$6.44
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
4400137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna of NY Commercial |
$4.51
|
| Rate for Payer: Aetna of NY Medicare |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.22
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: CDPHP Commercial |
$5.18
|
| Rate for Payer: CDPHP Medicare |
$2.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.15
|
| Rate for Payer: EmblemHealth Medicaid |
$5.15
|
| Rate for Payer: EmblemHealth Medicare |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$4.64
|
| Rate for Payer: Fidelis Medicare |
$2.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.38
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
CARVEDILOL 6.25MG TABS 10X10EA
|
Facility
|
IP
|
$6.44
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
4400137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: WellCare Medicare |
$3.54
|
|
|
CASPOFUNGIN ACETATE 50 MG VIAL 50 mg, 1 each
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
4401553
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna of NY Commercial |
$141.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.63
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.63
|
| Rate for Payer: EmblemHealth Select Care |
$6.63
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.35
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
CASPOFUNGIN ACETATE 50 MG VIAL 50 mg, 1 each
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
4401553
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$206.88 |
| Rate for Payer: Aetna of NY Commercial |
$141.35
|
| Rate for Payer: Aetna of NY Medicare |
$118.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$95.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$128.50
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: CDPHP Commercial |
$206.88
|
| Rate for Payer: CDPHP Medicare |
$95.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$205.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$205.60
|
| Rate for Payer: EmblemHealth Medicaid |
$205.60
|
| Rate for Payer: EmblemHealth Medicare |
$87.38
|
| Rate for Payer: EmblemHealth Select Care |
$6.63
|
| Rate for Payer: Fidelis Medicare |
$97.94
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$95.09
|
| Rate for Payer: Humana Medicare |
$95.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$118.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$144.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.63
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$95.09
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
CATECHOL FRACT PLASMA
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
4300156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna of NY Commercial |
$159.25
|
| Rate for Payer: Aetna of NY Medicare |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$183.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$183.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$90.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$122.50
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: CDPHP Commercial |
$197.22
|
| Rate for Payer: CDPHP Medicare |
$90.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$147.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$196.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$196.00
|
| Rate for Payer: EmblemHealth Medicaid |
$196.00
|
| Rate for Payer: EmblemHealth Medicare |
$83.30
|
| Rate for Payer: EmblemHealth Select Care |
$147.00
|
| Rate for Payer: Fidelis Medicare |
$93.37
|
| Rate for Payer: Galaxy Health Commercial |
$159.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$90.65
|
| Rate for Payer: Humana Medicare |
$90.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$159.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$112.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$137.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$95.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$183.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$183.75
|
| Rate for Payer: United Healthcare Medicare |
$90.65
|
| Rate for Payer: WellCare Medicare |
$134.75
|
|
|
CATECHOL FRACT PLASMA
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
4300156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Galaxy Health Commercial |
$159.25
|
|
|
CATH 16FR 2WAY COUDE
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
4471033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
|
|
CATH 16FR 2WAY COUDE
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
4471033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Commercial |
$46.90
|
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$48.24
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
CATH 8709SC 1PC SUTHERLESS US TRAY MED
|
Facility
|
OP
|
$2,513.00
|
|
| Hospital Charge Code |
4479124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$854.42 |
| Max. Negotiated Rate |
$2,022.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,759.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,155.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,884.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,884.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$929.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,256.50
|
| Rate for Payer: Cash Price |
$1,884.75
|
| Rate for Payer: CDPHP Commercial |
$2,022.96
|
| Rate for Payer: CDPHP Medicare |
$929.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$854.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,809.36
|
| Rate for Payer: Fidelis Medicare |
$957.70
|
| Rate for Payer: Galaxy Health Commercial |
$1,633.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$929.81
|
| Rate for Payer: Humana Medicare |
$929.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,759.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,155.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,884.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,414.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$976.30
|
| Rate for Payer: United Healthcare Medicare |
$929.81
|
| Rate for Payer: WellCare Medicare |
$1,382.15
|
|
|
CATH 8709SC 1PC SUTHERLESS US TRAY MED
|
Facility
|
IP
|
$2,513.00
|
|
| Hospital Charge Code |
4479124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,633.45 |
| Max. Negotiated Rate |
$1,633.45 |
| Rate for Payer: Cash Price |
$1,884.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,633.45
|
|
|
CATHETHER SECUREMENT KIT
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
4472216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
CATHETHER SECUREMENT KIT
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
4472216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
|
|
CATH FOLEY 14FR DOVER
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
4471530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
CATH FOLEY 14FR DOVER
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
4471530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CATH FOLEY 16FR BARDEX SI
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
4471354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
CATH FOLEY 16FR BARDEX SI
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
4471354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
CATH FOLEY 16FR DOVER
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
4471546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
