|
DURAGESIC 100 MCG/HR PATCH 100 mcg, 5 eaches
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
NDC 50458010605
|
| Hospital Charge Code |
4401436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Galaxy Health Commercial |
$397.80
|
| Rate for Payer: WellCare Medicare |
$336.60
|
|
|
DUTASTERIDE 0.5 MG CAPSULE 0.5 mg, 30 eaches
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
4401320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.60
|
| Rate for Payer: Aetna of NY Medicare |
$8.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: CDPHP Medicare |
$6.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.40
|
| Rate for Payer: EmblemHealth Medicaid |
$14.40
|
| Rate for Payer: EmblemHealth Medicare |
$6.12
|
| Rate for Payer: EmblemHealth Select Care |
$12.96
|
| Rate for Payer: Fidelis Medicare |
$7.20
|
| Rate for Payer: Galaxy Health Commercial |
$11.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.20
|
| Rate for Payer: Humana Medicare |
$7.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.70
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
| Rate for Payer: WellCare Medicare |
$9.90
|
|
|
DUTASTERIDE 0.5 MG CAPSULE 0.5 mg, 30 eaches
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
4401320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Galaxy Health Commercial |
$11.70
|
| Rate for Payer: WellCare Medicare |
$9.90
|
|
|
DUTASTERIDE 0.5MG GCAP 30 EA
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 173071215
|
| Hospital Charge Code |
4400086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Galaxy Health Commercial |
$13.56
|
| Rate for Payer: WellCare Medicare |
$11.47
|
|
|
DUTASTERIDE 0.5MG GCAP 30 EA
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 173071215
|
| Hospital Charge Code |
4400086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna of NY Commercial |
$14.60
|
| Rate for Payer: Aetna of NY Medicare |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.34
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: CDPHP Medicare |
$7.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.69
|
| Rate for Payer: EmblemHealth Medicaid |
$16.69
|
| Rate for Payer: EmblemHealth Medicare |
$7.09
|
| Rate for Payer: EmblemHealth Select Care |
$15.02
|
| Rate for Payer: Fidelis Medicare |
$8.34
|
| Rate for Payer: Galaxy Health Commercial |
$13.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.34
|
| Rate for Payer: Humana Medicare |
$8.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.13
|
| Rate for Payer: United Healthcare Medicare |
$8.34
|
| Rate for Payer: WellCare Medicare |
$11.47
|
|
|
DVT BOOT FOR FLOWTRON 17"
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
4471951
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
|
|
DVT BOOT FOR FLOWTRON 17"
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
4471951
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna of NY Commercial |
$36.05
|
| Rate for Payer: Aetna of NY Medicare |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.60
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: CDPHP Medicare |
$19.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.20
|
| Rate for Payer: EmblemHealth Medicaid |
$41.20
|
| Rate for Payer: EmblemHealth Medicare |
$17.51
|
| Rate for Payer: EmblemHealth Select Care |
$37.08
|
| Rate for Payer: Fidelis Medicare |
$20.60
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.60
|
| Rate for Payer: Humana Medicare |
$20.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
DVT BOOT FOR FLOWTRON 23"
|
Facility
|
IP
|
$75.19
|
|
| Hospital Charge Code |
4471952
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$48.87 |
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: Galaxy Health Commercial |
$48.87
|
|
|
DVT BOOT FOR FLOWTRON 23"
|
Facility
|
OP
|
$75.19
|
|
| Hospital Charge Code |
4471952
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$60.15 |
| Rate for Payer: Aetna of NY Commercial |
$52.63
|
| Rate for Payer: Aetna of NY Medicare |
$34.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.08
|
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: CDPHP Medicare |
$27.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.15
|
| Rate for Payer: EmblemHealth Medicaid |
$60.15
|
| Rate for Payer: EmblemHealth Medicare |
$25.56
|
| Rate for Payer: EmblemHealth Select Care |
$54.14
|
| Rate for Payer: Fidelis Medicare |
$30.08
|
| Rate for Payer: Galaxy Health Commercial |
$48.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.08
|
| Rate for Payer: Humana Medicare |
$30.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.28
|
| Rate for Payer: United Healthcare Medicare |
$30.08
|
| Rate for Payer: WellCare Medicare |
$41.35
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 77080 26
|
| Hospital Charge Code |
5150311
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 77080 26
|
| Hospital Charge Code |
5150311
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of NY Commercial |
$21.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
4150311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$192.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$192.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
4150311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
DXA BONE DENSITY/PERIPHERAL 1+ SITES
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 77081
|
| Hospital Charge Code |
4150312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
|
|
DXA BONE DENSITY/PERIPHERAL 1+ SITES
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 77081
|
| Hospital Charge Code |
4150312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$160.20
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$106.80
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$186.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: EmblemHealth Select Care |
$173.55
|
| Rate for Payer: Fidelis Medicare |
$106.80
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$106.80
|
| Rate for Payer: Humana Medicare |
$106.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$112.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$106.80
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
|
DXA BONE DENSITY/PERIPHERAL, 1+ SITES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 77081 26
|
| Hospital Charge Code |
5150312
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of NY Commercial |
$21.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
DXA BONE DENSITY/PERIPHERAL, 1+ SITES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 77081 26
|
| Hospital Charge Code |
5150312
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
|
|
EAPG 3.18: ABDOMINAL HERNIA REPAIR
|
Facility
|
OP
|
$4,564.16
|
|
|
Service Code
|
EAPG 3035
|
| Min. Negotiated Rate |
$2,080.33 |
| Max. Negotiated Rate |
$4,564.16 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,547.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,122.84
|
| Rate for Payer: EmblemHealth Medicaid |
$2,122.84
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,080.33
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,122.84
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,229.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,564.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,564.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,122.84
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,229.00
|
|
|
EAPG 3.18: ABDOMINAL PAIN
|
Facility
|
OP
|
$297.11
|
|
|
Service Code
|
EAPG 628
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$297.11 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$165.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$138.19
|
| Rate for Payer: EmblemHealth Medicaid |
$138.19
|
| Rate for Payer: Galaxy Health Workers Comp |
$135.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$138.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$145.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$297.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$297.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$138.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$145.10
|
|
|
EAPG 3.18: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES
|
Facility
|
OP
|
$1,264.51
|
|
|
Service Code
|
EAPG 150
|
| Min. Negotiated Rate |
$576.36 |
| Max. Negotiated Rate |
$1,264.51 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$705.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$588.14
|
| Rate for Payer: EmblemHealth Medicaid |
$588.14
|
| Rate for Payer: Galaxy Health Workers Comp |
$576.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$588.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$617.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,264.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,264.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$588.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$617.55
|
|
|
EAPG 3.18: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES
|
Facility
|
OP
|
$1,594.17
|
|
|
Service Code
|
EAPG 194
|
| Min. Negotiated Rate |
$726.62 |
| Max. Negotiated Rate |
$1,594.17 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$889.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$741.47
|
| Rate for Payer: EmblemHealth Medicaid |
$741.47
|
| Rate for Payer: Galaxy Health Workers Comp |
$726.62
|
| Rate for Payer: Hamaspik Choice Medicaid |
$741.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$778.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,594.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,594.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$741.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$778.55
|
|
|
EAPG 3.18: ABORTION RELATED DIAGNOSES
|
Facility
|
OP
|
$283.97
|
|
|
Service Code
|
EAPG 763
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$283.97 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.08
|
| Rate for Payer: EmblemHealth Medicaid |
$132.08
|
| Rate for Payer: Galaxy Health Workers Comp |
$129.43
|
| Rate for Payer: Hamaspik Choice Medicaid |
$132.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$138.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$283.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$283.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$138.68
|
|
|
EAPG 3.18: ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
OP
|
$273.32
|
|
|
Service Code
|
EAPG 608
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$273.32 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$127.12
|
| Rate for Payer: EmblemHealth Medicaid |
$127.12
|
| Rate for Payer: Galaxy Health Workers Comp |
$124.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$127.12
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$133.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$273.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$273.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$127.12
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$133.48
|
|
|
EAPG 3.18: ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
|
OP
|
$254.45
|
|
|
Service Code
|
EAPG 826
|
| Min. Negotiated Rate |
$115.98 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.35
|
| Rate for Payer: EmblemHealth Medicaid |
$118.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$115.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$118.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$254.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$254.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$124.26
|
|
|
EAPG 3.18: ACUTE BRONCHITIS
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
EAPG 584
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$177.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.02
|
| Rate for Payer: EmblemHealth Medicaid |
$148.02
|
| Rate for Payer: Galaxy Health Workers Comp |
$145.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$148.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$155.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$318.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$318.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$155.42
|
|
