|
ENTRESTO 49 MG-51 MG TABLET 1 ea, 60 eaches
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
4401357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENTRESTO 97 MG-103 MG TABLET 1 ea, 60 eaches
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
4401358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
ENT(WOODS LAMP)TRAY
|
Facility
OP
|
$52.00
|
|
| Hospital Charge Code |
4479119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| 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: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| 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 |
$37.44
|
| 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 |
$36.40
|
| 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: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
EON MINI CHARGING SYSTEM
|
Facility
OP
|
$5,470.00
|
|
| Hospital Charge Code |
4471308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,859.80 |
| Max. Negotiated Rate |
$4,403.35 |
| Rate for Payer: Aetna of NY Commercial |
$3,829.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,516.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,023.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,735.00
|
| Rate for Payer: Cash Price |
$4,102.50
|
| Rate for Payer: CDPHP Commercial |
$4,403.35
|
| Rate for Payer: CDPHP Medicare |
$2,023.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,376.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,376.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,376.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,859.80
|
| Rate for Payer: EmblemHealth Select Care |
$3,938.40
|
| Rate for Payer: Fidelis Medicare |
$2,084.62
|
| Rate for Payer: Galaxy Health Commercial |
$3,555.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,023.90
|
| Rate for Payer: Humana Medicare |
$2,023.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,829.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,516.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,102.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,079.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,125.10
|
| Rate for Payer: United Healthcare Medicare |
$2,023.90
|
| Rate for Payer: WellCare Medicare |
$3,008.50
|
|
|
EON MINI IPG
|
Facility
OP
|
$62,491.00
|
|
| Hospital Charge Code |
4471322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21,246.94 |
| Max. Negotiated Rate |
$50,305.26 |
| Rate for Payer: Aetna of NY Commercial |
$43,743.70
|
| Rate for Payer: Aetna of NY Medicare |
$28,745.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$46,868.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$46,868.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23,121.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31,245.50
|
| Rate for Payer: Cash Price |
$46,868.25
|
| Rate for Payer: CDPHP Commercial |
$50,305.26
|
| Rate for Payer: CDPHP Medicare |
$23,121.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49,992.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49,992.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$49,992.80
|
| Rate for Payer: EmblemHealth Medicaid |
$49,992.80
|
| Rate for Payer: EmblemHealth Medicare |
$21,246.94
|
| Rate for Payer: EmblemHealth Select Care |
$44,993.52
|
| Rate for Payer: Fidelis Medicare |
$23,815.32
|
| Rate for Payer: Galaxy Health Commercial |
$40,619.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$23,121.67
|
| Rate for Payer: Humana Medicare |
$23,121.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$43,743.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28,745.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46,868.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,182.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24,277.75
|
| Rate for Payer: United Healthcare Medicare |
$23,121.67
|
| Rate for Payer: WellCare Medicare |
$34,370.05
|
|
|
EON PROGRAMMER
|
Facility
OP
|
$4,304.00
|
|
| Hospital Charge Code |
4471324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,463.36 |
| Max. Negotiated Rate |
$3,464.72 |
| Rate for Payer: Aetna of NY Commercial |
$3,012.80
|
| Rate for Payer: Aetna of NY Medicare |
$1,979.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,228.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,228.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,592.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,152.00
|
| Rate for Payer: Cash Price |
$3,228.00
|
| Rate for Payer: CDPHP Commercial |
$3,464.72
|
| Rate for Payer: CDPHP Medicare |
$1,592.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,443.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,443.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,443.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,443.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,463.36
|
| Rate for Payer: EmblemHealth Select Care |
$3,098.88
|
| Rate for Payer: Fidelis Medicare |
$1,640.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,797.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,592.48
|
| Rate for Payer: Humana Medicare |
$1,592.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,012.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,979.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,228.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,423.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,672.10
|
| Rate for Payer: United Healthcare Medicare |
$1,592.48
|
| Rate for Payer: WellCare Medicare |
$2,367.20
|
|
|
EPHEDRINE SULFATE
|
Facility
OP
|
$127.46
|
|
| Hospital Charge Code |
4408983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$102.61 |
| Rate for Payer: Aetna of NY Commercial |
$89.22
|
| Rate for Payer: Aetna of NY Medicare |
$58.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$95.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$95.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$63.73
|
| Rate for Payer: Cash Price |
$95.60
|
| Rate for Payer: CDPHP Commercial |
$102.61
|
| Rate for Payer: CDPHP Medicare |
$47.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$101.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$101.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.97
|
| Rate for Payer: EmblemHealth Medicaid |
$101.97
|
| Rate for Payer: EmblemHealth Medicare |
$43.34
|
| Rate for Payer: EmblemHealth Select Care |
$91.77
|
| Rate for Payer: Fidelis Medicare |
$48.58
|
| Rate for Payer: Galaxy Health Commercial |
$82.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.16
|
| Rate for Payer: Humana Medicare |
$47.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$89.22
|
| Rate for Payer: Local 1199SEIU Medicare |
$58.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$71.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.52
|
| Rate for Payer: United Healthcare Medicare |
$47.16
|
| Rate for Payer: WellCare Medicare |
$70.10
|
|
|
EPIDIDYMECTOMY UNILATERAL
|
Facility
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54860
|
| Hospital Charge Code |
4002057
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| 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 |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
EPIDURAL CATHETER HMS# 2000
|
Facility
OP
|
$360.00
|
|
| Hospital Charge Code |
4479082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna of NY Commercial |
$252.00
|
| Rate for Payer: Aetna of NY Medicare |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$180.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: CDPHP Commercial |
$289.80
|
| Rate for Payer: CDPHP Medicare |
$133.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$288.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$288.00
|
| Rate for Payer: EmblemHealth Medicaid |
$288.00
|
| Rate for Payer: EmblemHealth Medicare |
$122.40
|
| Rate for Payer: EmblemHealth Select Care |
$259.20
|
| Rate for Payer: Fidelis Medicare |
$137.20
|
| Rate for Payer: Galaxy Health Commercial |
$234.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$252.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$165.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$202.68
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$198.00
|
|
|
EPIDURAL CATHETER SET
|
Facility
OP
|
$229.00
|
|
| Hospital Charge Code |
4479153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna of NY Commercial |
$160.30
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$171.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$114.50
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Commercial |
$184.34
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$183.20
|
| Rate for Payer: EmblemHealth Medicaid |
$183.20
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$87.27
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.73
|
| Rate for Payer: Humana Medicare |
$84.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$128.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.97
|
| Rate for Payer: United Healthcare Medicare |
$84.73
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EPISTAT NASAL CATH II
|
Facility
OP
|
$166.00
|
|
| Hospital Charge Code |
4471334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of NY Commercial |
$116.20
|
| Rate for Payer: Aetna of NY Medicare |
$76.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$83.00
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: CDPHP Commercial |
$133.63
|
| Rate for Payer: CDPHP Medicare |
$61.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$132.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.80
|
| Rate for Payer: EmblemHealth Medicaid |
$132.80
|
| Rate for Payer: EmblemHealth Medicare |
$56.44
|
| Rate for Payer: EmblemHealth Select Care |
$119.52
|
| Rate for Payer: Fidelis Medicare |
$63.26
|
| Rate for Payer: Galaxy Health Commercial |
$107.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.42
|
| Rate for Payer: Humana Medicare |
$61.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$116.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$76.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$93.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.49
|
| Rate for Payer: United Healthcare Medicare |
$61.42
|
| Rate for Payer: WellCare Medicare |
$91.30
|
|
|
ER ABSORBABLE HEMOSTATE 4 X 8 INCHES
|
Facility
OP
|
$107.00
|
|
| Hospital Charge Code |
4472203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$86.14 |
| Rate for Payer: Aetna of NY Commercial |
$74.90
|
| Rate for Payer: Aetna of NY Medicare |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.50
|
| Rate for Payer: Cash Price |
$80.25
|
| Rate for Payer: CDPHP Commercial |
$86.14
|
| Rate for Payer: CDPHP Medicare |
$39.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.60
|
| Rate for Payer: EmblemHealth Medicaid |
$85.60
|
| Rate for Payer: EmblemHealth Medicare |
$36.38
|
| Rate for Payer: EmblemHealth Select Care |
$77.04
|
| Rate for Payer: Fidelis Medicare |
$40.78
|
| Rate for Payer: Galaxy Health Commercial |
$69.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.59
|
| Rate for Payer: Humana Medicare |
$39.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$39.59
|
| Rate for Payer: WellCare Medicare |
$58.85
|
|
|
ER ARM SLING ADULT
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4472162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
ER ARM SLING CHILD
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4472161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
ER CARDIOVERSION ELECTIVE EXT
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4600049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$856.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$688.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: CDPHP Commercial |
$1,498.91
|
| Rate for Payer: CDPHP Medicare |
$688.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,489.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.60
|
| Rate for Payer: EmblemHealth Medicare |
$633.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$709.61
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$688.94
|
| Rate for Payer: Humana Medicare |
$688.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$620.10
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$688.94
|
| Rate for Payer: WellCare Medicare |
$1,024.10
|
|
|
ER CATH FOLEY(BARD) ANY SIZE
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
4472175
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
ER CATH FOLEY(DOVER) ANY SIZE
|
Facility
OP
|
$59.00
|
|
| Hospital Charge Code |
4472174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of NY Commercial |
$41.30
|
| Rate for Payer: Aetna of NY Medicare |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.50
|
| Rate for Payer: Cash Price |
$44.25
|
| Rate for Payer: CDPHP Commercial |
$47.50
|
| Rate for Payer: CDPHP Medicare |
$21.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.20
|
| Rate for Payer: EmblemHealth Medicaid |
$47.20
|
| Rate for Payer: EmblemHealth Medicare |
$20.06
|
| Rate for Payer: EmblemHealth Select Care |
$42.48
|
| Rate for Payer: Fidelis Medicare |
$22.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.83
|
| Rate for Payer: Humana Medicare |
$21.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.92
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WellCare Medicare |
$32.45
|
|
|
ER CATH TROCAR ANY SIZE
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
4472173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
ER CERVICAL COLLAR
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
4472170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.50
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Commercial |
$20.12
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: EmblemHealth Select Care |
$18.00
|
| Rate for Payer: Fidelis Medicare |
$9.53
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.25
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.71
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
ER COLD PACK
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
4609645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
ER HOT PACK
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
4609646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna of NY Commercial |
$11.20
|
| Rate for Payer: Aetna of NY Medicare |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.92
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: CDPHP Commercial |
$12.88
|
| Rate for Payer: CDPHP Medicare |
$5.92
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.80
|
| Rate for Payer: EmblemHealth Medicaid |
$12.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.44
|
| Rate for Payer: EmblemHealth Select Care |
$11.52
|
| Rate for Payer: Fidelis Medicare |
$6.10
|
| Rate for Payer: Galaxy Health Commercial |
$10.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.92
|
| Rate for Payer: Humana Medicare |
$5.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: WellCare Medicare |
$8.80
|
|
|
ER IODOFORM PAC </=1/2X5YD
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4472158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| 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 |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| 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 |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
ER IODOFORM PAC >/= 1X5YD
|
Facility
OP
|
$19.00
|
|
| Hospital Charge Code |
4472159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$13.30
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$13.68
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
ER IODOFORM PACKING STRIP
|
Facility
OP
|
$17.00
|
|
| Hospital Charge Code |
4472193
|
|
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
|
|
|
ER LEG SPLINT
|
Facility
OP
|
$52.00
|
|
| Hospital Charge Code |
4472166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| 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: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| 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 |
$37.44
|
| 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 |
$36.40
|
| 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: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
