|
40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML
|
Facility
|
OP
|
$11.85
|
|
|
Service Code
|
NDC 00409710909
|
| Hospital Charge Code |
4450031
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Aetna of NY Commercial |
$8.30
|
| Rate for Payer: Aetna of NY Medicare |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.92
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: CDPHP Commercial |
$9.54
|
| Rate for Payer: CDPHP Medicare |
$4.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.48
|
| Rate for Payer: EmblemHealth Medicaid |
$9.48
|
| Rate for Payer: EmblemHealth Medicare |
$4.03
|
| Rate for Payer: EmblemHealth Select Care |
$8.53
|
| Rate for Payer: Fidelis Medicare |
$4.52
|
| Rate for Payer: Galaxy Health Commercial |
$7.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.38
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.60
|
| Rate for Payer: United Healthcare Medicare |
$4.38
|
| Rate for Payer: WellCare Medicare |
$6.52
|
|
|
4.0MM 12 FLUTEBARREL BUR-HOLLO
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM 12 FLUTEBARREL BUR-HOLLO
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4.0MM 12 FLUTE ROUND BUR-HOLLO
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4.0MM 12 FLUTE ROUND BUR-HOLLO
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM 1/3 THREAD CANULATED SCREW 00-1147
|
Facility
|
OP
|
$262.00
|
|
| Hospital Charge Code |
4479266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$210.91 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$131.00
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Commercial |
$210.91
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: EmblemHealth Select Care |
$188.64
|
| Rate for Payer: Fidelis Medicare |
$99.85
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.94
|
| Rate for Payer: Humana Medicare |
$96.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$96.94
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
4.0MM 1/3 THREAD CANULATED SCREW 00-1147
|
Facility
|
IP
|
$262.00
|
|
| Hospital Charge Code |
4479266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
4.0MM AGRESSIVE PLUS CUTTER
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM AGRESSIVE PLUS CUTTER
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4.0MM CANCELLOUS SCREW, SMALL HEX RECESS
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna of NY Commercial |
$55.30
|
| Rate for Payer: Aetna of NY Medicare |
$36.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: CDPHP Commercial |
$63.60
|
| Rate for Payer: CDPHP Medicare |
$29.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
| Rate for Payer: EmblemHealth Medicaid |
$63.20
|
| Rate for Payer: EmblemHealth Medicare |
$26.86
|
| Rate for Payer: EmblemHealth Select Care |
$39.50
|
| Rate for Payer: Fidelis Medicare |
$30.11
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
4.0MM CANCELLOUS SCREW, SMALL HEX RECESS
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$55.30 |
| Rate for Payer: Aetna of NY Commercial |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.55
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.50
|
| Rate for Payer: EmblemHealth Select Care |
$39.50
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$35.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.35
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
4.0MM CANCELLOUS SCREW SM HEX FULL RECES
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
4479265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
4.0MM CANCELLOUS SCREW SM HEX FULL RECES
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
4479265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
4.0MM CANNULATED SCREW
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.50 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna of NY Commercial |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$310.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$345.00
|
| Rate for Payer: EmblemHealth Select Care |
$345.00
|
| Rate for Payer: Galaxy Health Commercial |
$448.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$483.00
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$448.50
|
| Rate for Payer: WellCare Medicare |
$379.50
|
|
|
4.0MM CANNULATED SCREW
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$555.45 |
| Rate for Payer: Aetna of NY Commercial |
$483.00
|
| Rate for Payer: Aetna of NY Medicare |
$317.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$255.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$345.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: CDPHP Commercial |
$555.45
|
| Rate for Payer: CDPHP Medicare |
$255.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$345.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$552.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$552.00
|
| Rate for Payer: EmblemHealth Medicaid |
$552.00
|
| Rate for Payer: EmblemHealth Medicare |
$234.60
|
| Rate for Payer: EmblemHealth Select Care |
$345.00
|
| Rate for Payer: Fidelis Medicare |
$262.96
|
| Rate for Payer: Galaxy Health Commercial |
$448.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$255.30
|
| Rate for Payer: Humana Medicare |
$255.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$483.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$317.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$448.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$268.06
|
| Rate for Payer: United Healthcare Medicare |
$255.30
|
| Rate for Payer: WellCare Medicare |
$379.50
|
|
|
4.0MM END CUTTER
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4.0MM END CUTTER
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM RESECTOR CUTTER
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM RESECTOR CUTTER
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4.0 MM TOMCAT ARTHROSCOPY BLAD
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
4471241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Commercial |
$136.85
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: EmblemHealth Select Care |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$64.79
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.90
|
| Rate for Payer: Humana Medicare |
$62.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.04
|
| Rate for Payer: United Healthcare Medicare |
$62.90
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
4.0 MM TOMCAT ARTHROSCOPY BLAD
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
4471241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
|
|
4.0MM TOMCAT CUTTER
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
4471312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM TOMCAT CUTTER
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
4471312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
|
|
4-0 MONOSOF P-12
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
4478150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
4-0 MONOSOF P-12
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
4478150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
