|
HEELBO LARGE WHITE
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
4471290
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
HEELBO MEDIUM BLUE
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
4471289
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
HEELBO SMALL YELLOW
|
Facility
OP
|
$37.00
|
|
| Hospital Charge Code |
4471196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
HEEL FLOAT LARGE
|
Facility
OP
|
$137.00
|
|
| Hospital Charge Code |
4471262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$95.90
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
HEEL FLOAT MEDIUM
|
Facility
OP
|
$120.00
|
|
| Hospital Charge Code |
4471397
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna of NY Commercial |
$84.00
|
| Rate for Payer: Aetna of NY Medicare |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$60.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: CDPHP Commercial |
$96.60
|
| Rate for Payer: CDPHP Medicare |
$44.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$96.00
|
| Rate for Payer: EmblemHealth Medicaid |
$96.00
|
| Rate for Payer: EmblemHealth Medicare |
$40.80
|
| Rate for Payer: EmblemHealth Select Care |
$86.40
|
| Rate for Payer: Fidelis Medicare |
$45.73
|
| Rate for Payer: Galaxy Health Commercial |
$78.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.40
|
| Rate for Payer: Humana Medicare |
$44.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$84.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$55.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$67.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.62
|
| Rate for Payer: United Healthcare Medicare |
$44.40
|
| Rate for Payer: WellCare Medicare |
$66.00
|
|
|
HEEL FLOAT SMALL
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
4471250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
HEMATOCRIT
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
4300402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.05
|
| 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: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| 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: 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 |
$11.05
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$12.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$12.75
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
HEMOGLOBIN
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
4300390
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
heparin 25,000 UNIT/250-1/2 NS 25000 unit, 250 mL
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4401514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna of NY Commercial |
$14.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: CDPHP Commercial |
$20.93
|
| Rate for Payer: CDPHP Medicare |
$9.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.80
|
| Rate for Payer: EmblemHealth Medicaid |
$20.80
|
| Rate for Payer: EmblemHealth Medicare |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$9.91
|
| Rate for Payer: Galaxy Health Commercial |
$16.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.62
|
| Rate for Payer: Humana Medicare |
$9.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.64
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WellCare Medicare |
$14.30
|
|
|
heparin 25,000 UNIT/500 ML-D5W 25000 unit, 500 mL
|
Facility
OP
|
$42.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4401505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$34.21 |
| Rate for Payer: Aetna of NY Commercial |
$23.38
|
| Rate for Payer: Aetna of NY Medicare |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.25
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: CDPHP Commercial |
$34.21
|
| Rate for Payer: CDPHP Medicare |
$15.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.00
|
| Rate for Payer: EmblemHealth Medicaid |
$34.00
|
| Rate for Payer: EmblemHealth Medicare |
$14.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$16.20
|
| Rate for Payer: Galaxy Health Commercial |
$27.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.72
|
| Rate for Payer: Humana Medicare |
$15.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$15.72
|
| Rate for Payer: WellCare Medicare |
$23.38
|
|
|
HEPARIN FLUSH 100 UNITS/ML 500UNITS 5ML
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
4409196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
OP
|
$9.53
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4400347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$7.67 |
| Rate for Payer: Aetna of NY Commercial |
$5.24
|
| Rate for Payer: Aetna of NY Medicare |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.76
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: CDPHP Commercial |
$7.67
|
| Rate for Payer: CDPHP Medicare |
$3.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.62
|
| Rate for Payer: EmblemHealth Medicaid |
$7.62
|
| Rate for Payer: EmblemHealth Medicare |
$3.24
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$3.63
|
| Rate for Payer: Galaxy Health Commercial |
$6.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.53
|
| Rate for Payer: Humana Medicare |
$3.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.24
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WellCare Medicare |
$5.24
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4408964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$24.87 |
| Rate for Payer: Aetna of NY Commercial |
$17.00
|
| Rate for Payer: Aetna of NY Medicare |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.45
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: CDPHP Commercial |
$24.87
|
| Rate for Payer: CDPHP Medicare |
$11.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.72
|
| Rate for Payer: EmblemHealth Medicaid |
$24.72
|
| Rate for Payer: EmblemHealth Medicare |
$10.51
|
| Rate for Payer: EmblemHealth Select Care |
$0.27
|
| Rate for Payer: Fidelis Medicare |
$11.78
|
| Rate for Payer: Galaxy Health Commercial |
$20.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.43
|
| Rate for Payer: Humana Medicare |
$11.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$11.43
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
4300426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Commercial |
$32.20
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: Fidelis Medicare |
$15.24
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
HEPATITIS B VACCINE 20MCG/ML SDPF 10X1ML
|
Facility
OP
|
$200.08
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.03 |
| Max. Negotiated Rate |
$161.06 |
| Rate for Payer: Aetna of NY Commercial |
$110.04
|
| Rate for Payer: Aetna of NY Medicare |
$92.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$90.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$90.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.04
|
| Rate for Payer: Cash Price |
$150.06
|
| Rate for Payer: CDPHP Commercial |
$161.06
|
| Rate for Payer: CDPHP Medicare |
$74.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.06
|
| Rate for Payer: EmblemHealth Medicaid |
$160.06
|
| Rate for Payer: EmblemHealth Medicare |
$68.03
|
| Rate for Payer: EmblemHealth Select Care |
$144.06
|
| Rate for Payer: Fidelis Medicare |
$76.25
|
| Rate for Payer: Galaxy Health Commercial |
$130.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.03
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$110.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$74.03
|
| Rate for Payer: WellCare Medicare |
$110.04
|
|
|
HEP B PREVACCINATION
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
4300421
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
HEP B SURF ANTIBODY
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
4300422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
HEP C RNA (PCR)
|
Facility
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
4300434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna of NY Commercial |
$161.20
|
| Rate for Payer: Aetna of NY Medicare |
$114.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$124.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: CDPHP Commercial |
$199.64
|
| Rate for Payer: CDPHP Medicare |
$91.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$198.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$198.40
|
| Rate for Payer: EmblemHealth Medicaid |
$198.40
|
| Rate for Payer: EmblemHealth Medicare |
$84.32
|
| Rate for Payer: Fidelis Medicare |
$94.51
|
| Rate for Payer: Galaxy Health Commercial |
$161.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.76
|
| Rate for Payer: Humana Medicare |
$91.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$114.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$186.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$186.00
|
| Rate for Payer: United Healthcare Medicare |
$91.76
|
| Rate for Payer: WellCare Medicare |
$136.40
|
|
|
HEP C VIRUS AB
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
4300424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
HERCULES 3 STAGE #431928
|
Facility
OP
|
$345.00
|
|
| Hospital Charge Code |
4479314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$277.72 |
| Rate for Payer: Aetna of NY Commercial |
$241.50
|
| Rate for Payer: Aetna of NY Medicare |
$158.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.50
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: CDPHP Commercial |
$277.72
|
| Rate for Payer: CDPHP Medicare |
$127.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$276.00
|
| Rate for Payer: EmblemHealth Medicare |
$117.30
|
| Rate for Payer: EmblemHealth Select Care |
$248.40
|
| Rate for Payer: Fidelis Medicare |
$131.48
|
| Rate for Payer: Galaxy Health Commercial |
$224.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.65
|
| Rate for Payer: Humana Medicare |
$127.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$241.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$194.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.03
|
| Rate for Payer: United Healthcare Medicare |
$127.65
|
| Rate for Payer: WellCare Medicare |
$189.75
|
|
|
HERCULES 3 STAGE BALLOON 18-19-20
|
Facility
OP
|
$629.00
|
|
| Hospital Charge Code |
4473038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: Aetna of NY Commercial |
$440.30
|
| Rate for Payer: Aetna of NY Medicare |
$289.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$232.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$314.50
|
| Rate for Payer: Cash Price |
$471.75
|
| Rate for Payer: CDPHP Commercial |
$506.34
|
| Rate for Payer: CDPHP Medicare |
$232.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$503.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$503.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$503.20
|
| Rate for Payer: EmblemHealth Medicaid |
$503.20
|
| Rate for Payer: EmblemHealth Medicare |
$213.86
|
| Rate for Payer: EmblemHealth Select Care |
$452.88
|
| Rate for Payer: Fidelis Medicare |
$239.71
|
| Rate for Payer: Galaxy Health Commercial |
$408.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$232.73
|
| Rate for Payer: Humana Medicare |
$232.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$440.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$289.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$354.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$244.37
|
| Rate for Payer: United Healthcare Medicare |
$232.73
|
| Rate for Payer: WellCare Medicare |
$345.95
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
OP
|
$704.00
|
|
| Hospital Charge Code |
4471892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
OP
|
$704.00
|
|
| Hospital Charge Code |
4471890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
OP
|
$704.00
|
|
| Hospital Charge Code |
4471891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
|
HERCULES 3-STAGE DIALATOR 8CM
|
Facility
OP
|
$704.00
|
|
| Hospital Charge Code |
4471894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna of NY Commercial |
$492.80
|
| Rate for Payer: Aetna of NY Medicare |
$323.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$352.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: CDPHP Commercial |
$566.72
|
| Rate for Payer: CDPHP Medicare |
$260.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$563.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$563.20
|
| Rate for Payer: EmblemHealth Medicaid |
$563.20
|
| Rate for Payer: EmblemHealth Medicare |
$239.36
|
| Rate for Payer: EmblemHealth Select Care |
$506.88
|
| Rate for Payer: Fidelis Medicare |
$268.29
|
| Rate for Payer: Galaxy Health Commercial |
$457.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.48
|
| Rate for Payer: Humana Medicare |
$260.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$492.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$323.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$396.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.50
|
| Rate for Payer: United Healthcare Medicare |
$260.48
|
| Rate for Payer: WellCare Medicare |
$387.20
|
|
