|
4-0 ETHILON 18" PS-4 CUTTING
|
Facility
|
OP
|
$37.08
|
|
| Hospital Charge Code |
4471171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna of NY Commercial |
$25.96
|
| Rate for Payer: Aetna of NY Medicare |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.83
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: CDPHP Medicare |
$13.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.66
|
| Rate for Payer: EmblemHealth Medicaid |
$29.66
|
| Rate for Payer: EmblemHealth Medicare |
$12.61
|
| Rate for Payer: EmblemHealth Select Care |
$26.70
|
| Rate for Payer: Fidelis Medicare |
$14.83
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.83
|
| Rate for Payer: Humana Medicare |
$14.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.56
|
| Rate for Payer: United Healthcare Medicare |
$14.83
|
| Rate for Payer: WellCare Medicare |
$20.39
|
|
|
40MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
OP
|
$8.76
|
|
|
Service Code
|
NDC 409790409
|
| Hospital Charge Code |
4450030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna of NY Commercial |
$6.13
|
| Rate for Payer: Aetna of NY Medicare |
$4.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.50
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: CDPHP Medicare |
$3.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.01
|
| Rate for Payer: EmblemHealth Medicaid |
$7.01
|
| Rate for Payer: EmblemHealth Medicare |
$2.98
|
| Rate for Payer: EmblemHealth Select Care |
$6.31
|
| Rate for Payer: Fidelis Medicare |
$3.50
|
| Rate for Payer: Galaxy Health Commercial |
$5.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.50
|
| Rate for Payer: Humana Medicare |
$3.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.13
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.31
|
| Rate for Payer: United Healthcare Medicare |
$3.50
|
| Rate for Payer: WellCare Medicare |
$4.82
|
|
|
40MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
|
IP
|
$8.76
|
|
|
Service Code
|
NDC 409790409
|
| Hospital Charge Code |
4450030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Galaxy Health Commercial |
$5.69
|
|
|
40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML
|
Facility
|
IP
|
$11.85
|
|
|
Service Code
|
NDC 409710909
|
| Hospital Charge Code |
4450031
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Galaxy Health Commercial |
$7.70
|
|
|
40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML
|
Facility
|
OP
|
$11.85
|
|
|
Service Code
|
NDC 409710909
|
| Hospital Charge Code |
4450031
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna of NY Commercial |
$8.29
|
| Rate for Payer: Aetna of NY Medicare |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.74
|
| Rate for Payer: Cash Price |
$8.89
|
| 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 |
$4.74
|
| Rate for Payer: Galaxy Health Commercial |
$7.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.74
|
| Rate for Payer: Humana Medicare |
$4.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.29
|
| 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 |
$4.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.78
|
| Rate for Payer: United Healthcare Medicare |
$4.74
|
| Rate for Payer: WellCare Medicare |
$6.52
|
|
|
4.0MM 12 FLUTEBARREL BUR-HOLLO
|
Facility
|
OP
|
$179.22
|
|
| Hospital Charge Code |
4471315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna of NY Commercial |
$125.45
|
| Rate for Payer: Aetna of NY Medicare |
$82.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: CDPHP Medicare |
$66.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.38
|
| Rate for Payer: EmblemHealth Medicaid |
$143.38
|
| Rate for Payer: EmblemHealth Medicare |
$60.93
|
| Rate for Payer: EmblemHealth Select Care |
$129.04
|
| Rate for Payer: Fidelis Medicare |
$71.69
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.69
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$125.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
| Rate for Payer: WellCare Medicare |
$98.57
|
|
|
4.0MM 12 FLUTEBARREL BUR-HOLLO
|
Facility
|
IP
|
$179.22
|
|
| Hospital Charge Code |
4471315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
|
|
4.0MM 12 FLUTE ROUND BUR-HOLLO
|
Facility
|
IP
|
$179.22
|
|
| Hospital Charge Code |
4471314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
|
|
4.0MM 12 FLUTE ROUND BUR-HOLLO
|
Facility
|
OP
|
$179.22
|
|
| Hospital Charge Code |
4471314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna of NY Commercial |
$125.45
|
| Rate for Payer: Aetna of NY Medicare |
$82.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: CDPHP Medicare |
$66.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.38
|
| Rate for Payer: EmblemHealth Medicaid |
$143.38
|
| Rate for Payer: EmblemHealth Medicare |
$60.93
|
| Rate for Payer: EmblemHealth Select Care |
$129.04
|
| Rate for Payer: Fidelis Medicare |
$71.69
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.69
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$125.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
| Rate for Payer: WellCare Medicare |
$98.57
|
|
|
4.0MM 1/3 THREAD CANULATED SCREW 00-1147
|
Facility
|
IP
|
$269.86
|
|
| Hospital Charge Code |
4479266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$175.41 |
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Galaxy Health Commercial |
$175.41
|
|
|
4.0MM 1/3 THREAD CANULATED SCREW 00-1147
|
Facility
|
OP
|
$269.86
|
|
| Hospital Charge Code |
4479266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$215.89 |
| Rate for Payer: Aetna of NY Commercial |
$188.90
|
| Rate for Payer: Aetna of NY Medicare |
$124.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$107.94
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: CDPHP Medicare |
$99.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$215.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$215.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$215.89
|
| Rate for Payer: EmblemHealth Medicaid |
$215.89
|
| Rate for Payer: EmblemHealth Medicare |
$91.75
|
| Rate for Payer: EmblemHealth Select Care |
$194.30
|
| Rate for Payer: Fidelis Medicare |
$107.94
|
| Rate for Payer: Galaxy Health Commercial |
$175.41
|
| Rate for Payer: Hamaspik Choice Medicare |
$107.94
|
| Rate for Payer: Humana Medicare |
$107.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$188.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$124.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$151.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$113.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.48
|
| Rate for Payer: United Healthcare Medicare |
$107.94
|
| Rate for Payer: WellCare Medicare |
$148.42
|
|
|
4.0MM AGRESSIVE PLUS CUTTER
|
Facility
|
OP
|
$179.22
|
|
| Hospital Charge Code |
4471311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna of NY Commercial |
$125.45
|
| Rate for Payer: Aetna of NY Medicare |
$82.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: CDPHP Medicare |
$66.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.38
|
| Rate for Payer: EmblemHealth Medicaid |
$143.38
|
| Rate for Payer: EmblemHealth Medicare |
$60.93
|
| Rate for Payer: EmblemHealth Select Care |
$129.04
|
| Rate for Payer: Fidelis Medicare |
$71.69
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.69
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$125.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
| Rate for Payer: WellCare Medicare |
$98.57
|
|
|
4.0MM AGRESSIVE PLUS CUTTER
|
Facility
|
IP
|
$179.22
|
|
| Hospital Charge Code |
4471311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
|
|
4.0MM CANCELLOUS SCREW, SMALL HEX RECESS
|
Facility
|
IP
|
$81.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$56.96 |
| Rate for Payer: Aetna of NY Commercial |
$56.96
|
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.69
|
| Rate for Payer: EmblemHealth Select Care |
$40.69
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.96
|
| Rate for Payer: Multiplan Commercial |
$36.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.89
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
4.0MM CANCELLOUS SCREW, SMALL HEX RECESS
|
Facility
|
OP
|
$81.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna of NY Commercial |
$56.96
|
| Rate for Payer: Aetna of NY Medicare |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: CDPHP Medicare |
$30.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.10
|
| Rate for Payer: EmblemHealth Medicaid |
$65.10
|
| Rate for Payer: EmblemHealth Medicare |
$27.67
|
| Rate for Payer: EmblemHealth Select Care |
$40.69
|
| Rate for Payer: Fidelis Medicare |
$32.55
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.55
|
| Rate for Payer: Humana Medicare |
$32.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$52.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.21
|
| Rate for Payer: United Healthcare Medicare |
$32.55
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
4.0MM CANCELLOUS SCREW SM HEX FULL RECES
|
Facility
|
IP
|
$108.15
|
|
| Hospital Charge Code |
4479265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
4.0MM CANCELLOUS SCREW SM HEX FULL RECES
|
Facility
|
OP
|
$108.15
|
|
| Hospital Charge Code |
4479265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$86.52 |
| Rate for Payer: Aetna of NY Commercial |
$75.70
|
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.52
|
| Rate for Payer: EmblemHealth Medicaid |
$86.52
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
4.0MM CANNULATED SCREW
|
Facility
|
OP
|
$710.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.61 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Aetna of NY Commercial |
$497.49
|
| Rate for Payer: Aetna of NY Medicare |
$326.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$284.28
|
| Rate for Payer: Cash Price |
$533.03
|
| Rate for Payer: CDPHP Medicare |
$262.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$355.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$568.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$568.56
|
| Rate for Payer: EmblemHealth Medicaid |
$568.56
|
| Rate for Payer: EmblemHealth Medicare |
$241.64
|
| Rate for Payer: EmblemHealth Select Care |
$355.35
|
| Rate for Payer: Fidelis Medicare |
$284.28
|
| Rate for Payer: Galaxy Health Commercial |
$461.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.28
|
| Rate for Payer: Humana Medicare |
$284.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$497.49
|
| Rate for Payer: Local 1199SEIU Medicare |
$326.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$461.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.61
|
| Rate for Payer: United Healthcare Medicare |
$284.28
|
| Rate for Payer: WellCare Medicare |
$390.88
|
|
|
4.0MM CANNULATED SCREW
|
Facility
|
IP
|
$710.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.81 |
| Max. Negotiated Rate |
$497.49 |
| Rate for Payer: Aetna of NY Commercial |
$497.49
|
| Rate for Payer: Cash Price |
$533.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$355.35
|
| Rate for Payer: EmblemHealth Select Care |
$355.35
|
| Rate for Payer: Galaxy Health Commercial |
$461.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$497.49
|
| Rate for Payer: Multiplan Commercial |
$319.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.95
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$461.95
|
| Rate for Payer: WellCare Medicare |
$390.88
|
|
|
4.0MM END CUTTER
|
Facility
|
OP
|
$179.22
|
|
| Hospital Charge Code |
4471313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna of NY Commercial |
$125.45
|
| Rate for Payer: Aetna of NY Medicare |
$82.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: CDPHP Medicare |
$66.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.38
|
| Rate for Payer: EmblemHealth Medicaid |
$143.38
|
| Rate for Payer: EmblemHealth Medicare |
$60.93
|
| Rate for Payer: EmblemHealth Select Care |
$129.04
|
| Rate for Payer: Fidelis Medicare |
$71.69
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.69
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$125.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
| Rate for Payer: WellCare Medicare |
$98.57
|
|
|
4.0MM END CUTTER
|
Facility
|
IP
|
$179.22
|
|
| Hospital Charge Code |
4471313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
|
|
4.0MM RESECTOR CUTTER
|
Facility
|
OP
|
$179.22
|
|
| Hospital Charge Code |
4471310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna of NY Commercial |
$125.45
|
| Rate for Payer: Aetna of NY Medicare |
$82.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: CDPHP Medicare |
$66.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.38
|
| Rate for Payer: EmblemHealth Medicaid |
$143.38
|
| Rate for Payer: EmblemHealth Medicare |
$60.93
|
| Rate for Payer: EmblemHealth Select Care |
$129.04
|
| Rate for Payer: Fidelis Medicare |
$71.69
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.69
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$125.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$75.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
| Rate for Payer: WellCare Medicare |
$98.57
|
|
|
4.0MM RESECTOR CUTTER
|
Facility
|
IP
|
$179.22
|
|
| Hospital Charge Code |
4471310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Galaxy Health Commercial |
$116.49
|
|
|
4.0 MM TOMCAT ARTHROSCOPY BLAD
|
Facility
|
OP
|
$175.10
|
|
| Hospital Charge Code |
4471241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna of NY Commercial |
$122.57
|
| Rate for Payer: Aetna of NY Medicare |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.04
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: CDPHP Medicare |
$64.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.08
|
| Rate for Payer: EmblemHealth Medicaid |
$140.08
|
| Rate for Payer: EmblemHealth Medicare |
$59.53
|
| Rate for Payer: EmblemHealth Select Care |
$126.07
|
| Rate for Payer: Fidelis Medicare |
$70.04
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.04
|
| Rate for Payer: Humana Medicare |
$70.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$70.04
|
| Rate for Payer: WellCare Medicare |
$96.31
|
|
|
4.0 MM TOMCAT ARTHROSCOPY BLAD
|
Facility
|
IP
|
$175.10
|
|
| Hospital Charge Code |
4471241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$113.81 |
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Galaxy Health Commercial |
$113.81
|
|
