|
CARPAL TUNNEL INJECTION
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
4850025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Cash Price |
$705.75
|
| Rate for Payer: Galaxy Health Commercial |
$611.65
|
|
|
CARR-LOCKE INJECTION NEEDLE (00711811)
|
Facility
|
IP
|
$1,040.00
|
|
| Hospital Charge Code |
4473044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Galaxy Health Commercial |
$676.00
|
|
|
CARR-LOCKE INJECTION NEEDLE (00711811)
|
Facility
|
OP
|
$1,040.00
|
|
| Hospital Charge Code |
4473044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna of NY Commercial |
$728.00
|
| Rate for Payer: Aetna of NY Medicare |
$478.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$416.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: CDPHP Medicare |
$384.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$832.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$832.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$832.00
|
| Rate for Payer: EmblemHealth Medicaid |
$832.00
|
| Rate for Payer: EmblemHealth Medicare |
$353.60
|
| Rate for Payer: EmblemHealth Select Care |
$748.80
|
| Rate for Payer: Fidelis Medicare |
$416.00
|
| Rate for Payer: Galaxy Health Commercial |
$676.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$416.00
|
| Rate for Payer: Humana Medicare |
$416.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$728.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$478.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$585.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$436.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$416.00
|
| Rate for Payer: WellCare Medicare |
$572.00
|
|
|
CARVEDILOL 12.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 904630261
|
| Hospital Charge Code |
4400134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| 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 |
$3.69
|
|
|
CARVEDILOL 12.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 904630261
|
| Hospital Charge Code |
4400134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| 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) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| 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 |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| 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 |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
CARVEDILOL 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904630361
|
| Hospital Charge Code |
4400135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CARVEDILOL 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904630361
|
| 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
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904630061
|
| Hospital Charge Code |
4400136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CARVEDILOL 3.125MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904630061
|
| 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 6.25MG TABS 10X10EA
|
Facility
|
IP
|
$6.44
|
|
|
Service Code
|
NDC 904630161
|
| 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
|
|
|
CARVEDILOL 6.25MG TABS 10X10EA
|
Facility
|
OP
|
$6.44
|
|
|
Service Code
|
NDC 904630161
|
| Hospital Charge Code |
4400137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$5.15 |
| 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) Medicare |
$2.58
|
| Rate for Payer: Cash Price |
$4.83
|
| 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 |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$4.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.58
|
| Rate for Payer: Humana Medicare |
$2.58
|
| 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 |
$2.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.97
|
| Rate for Payer: United Healthcare Medicare |
$2.58
|
| 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 |
$3.58 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna of NY Commercial |
$141.35
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.58
|
| Rate for Payer: EmblemHealth Select Care |
$3.58
|
| 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 |
$3.58 |
| Max. Negotiated Rate |
$205.60 |
| Rate for Payer: Aetna of NY Medicare |
$118.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.80
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: Cash Price |
$192.75
|
| Rate for Payer: CDPHP Medicare |
$95.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.58
|
| 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 |
$3.58
|
| Rate for Payer: Fidelis Medicare |
$102.80
|
| Rate for Payer: Galaxy Health Commercial |
$167.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.80
|
| Rate for Payer: Humana Medicare |
$102.80
|
| 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 |
$107.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$14.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.55
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$102.80
|
| Rate for Payer: WellCare Medicare |
$141.35
|
|
|
CATECHOL FRACT PLASMA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
4300156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
|
|
CATECHOL FRACT PLASMA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
4300156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of NY Commercial |
$49.40
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: EmblemHealth Select Care |
$45.60
|
| Rate for Payer: Fidelis Medicare |
$30.40
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.40
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.40
|
| Rate for Payer: United Healthcare Commercial |
$57.00
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
CATH 16FR 2WAY COUDE
|
Facility
|
OP
|
$69.01
|
|
| Hospital Charge Code |
4471033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna of NY Commercial |
$48.31
|
| Rate for Payer: Aetna of NY Medicare |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.60
|
| Rate for Payer: Cash Price |
$51.76
|
| Rate for Payer: CDPHP Medicare |
$25.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.21
|
| Rate for Payer: EmblemHealth Medicaid |
$55.21
|
| Rate for Payer: EmblemHealth Medicare |
$23.46
|
| Rate for Payer: EmblemHealth Select Care |
$49.69
|
| Rate for Payer: Fidelis Medicare |
$27.60
|
| Rate for Payer: Galaxy Health Commercial |
$44.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.60
|
| Rate for Payer: Humana Medicare |
$27.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.31
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.35
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
| Rate for Payer: WellCare Medicare |
$37.96
|
|
|
CATH 16FR 2WAY COUDE
|
Facility
|
IP
|
$69.01
|
|
| Hospital Charge Code |
4471033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$44.86 |
| Rate for Payer: Cash Price |
$51.76
|
| Rate for Payer: Galaxy Health Commercial |
$44.86
|
|
|
CATH 8709SC 1PC SUTHERLESS US TRAY MED
|
Facility
|
IP
|
$2,588.39
|
|
| Hospital Charge Code |
4479124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,682.45 |
| Max. Negotiated Rate |
$1,682.45 |
| Rate for Payer: Cash Price |
$1,941.29
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.45
|
|
|
CATH 8709SC 1PC SUTHERLESS US TRAY MED
|
Facility
|
OP
|
$2,588.39
|
|
| Hospital Charge Code |
4479124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$388.26 |
| Max. Negotiated Rate |
$2,070.71 |
| Rate for Payer: Aetna of NY Commercial |
$1,811.87
|
| Rate for Payer: Aetna of NY Medicare |
$1,190.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,035.36
|
| Rate for Payer: Cash Price |
$1,941.29
|
| Rate for Payer: CDPHP Medicare |
$957.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,070.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,070.71
|
| Rate for Payer: EmblemHealth Medicaid |
$2,070.71
|
| Rate for Payer: EmblemHealth Medicare |
$880.05
|
| Rate for Payer: EmblemHealth Select Care |
$1,863.64
|
| Rate for Payer: Fidelis Medicare |
$1,035.36
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,035.36
|
| Rate for Payer: Humana Medicare |
$1,035.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,811.87
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,190.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,941.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,457.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,087.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$388.26
|
| Rate for Payer: United Healthcare Medicare |
$1,035.36
|
| Rate for Payer: WellCare Medicare |
$1,423.61
|
|
|
CATHETHER SECUREMENT KIT
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4472216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
CATHETHER SECUREMENT KIT
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4472216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
CATH FOLEY 14FR DOVER
|
Facility
|
IP
|
$55.62
|
|
| Hospital Charge Code |
4471530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
|
|
CATH FOLEY 14FR DOVER
|
Facility
|
OP
|
$55.62
|
|
| Hospital Charge Code |
4471530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
|
CATH FOLEY 16FR BARDEX SI
|
Facility
|
IP
|
$55.62
|
|
| Hospital Charge Code |
4471354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
|
|
CATH FOLEY 16FR BARDEX SI
|
Facility
|
OP
|
$55.62
|
|
| Hospital Charge Code |
4471354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna of NY Commercial |
$38.93
|
| Rate for Payer: Aetna of NY Medicare |
$25.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.25
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: CDPHP Medicare |
$20.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.50
|
| Rate for Payer: EmblemHealth Medicaid |
$44.50
|
| Rate for Payer: EmblemHealth Medicare |
$18.91
|
| Rate for Payer: EmblemHealth Select Care |
$40.05
|
| Rate for Payer: Fidelis Medicare |
$22.25
|
| Rate for Payer: Galaxy Health Commercial |
$36.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.25
|
| Rate for Payer: Humana Medicare |
$22.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: WellCare Medicare |
$30.59
|
|
