|
4-0 MONOSOF P-13
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
4478152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
4-0 MONOSOF P-13
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
4478152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
|
|
4-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
4471910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
4-0 VICRYL 18" FS-2 CUTTING
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
4471910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
4.3 X 48MM COMPRSION SCREW
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$304.29 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: CDPHP Commercial |
$304.29
|
| Rate for Payer: CDPHP Medicare |
$139.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$302.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$302.40
|
| Rate for Payer: EmblemHealth Medicaid |
$302.40
|
| Rate for Payer: EmblemHealth Medicare |
$128.52
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Fidelis Medicare |
$144.06
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.86
|
| Rate for Payer: Humana Medicare |
$139.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.85
|
| Rate for Payer: United Healthcare Medicare |
$139.86
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.3 X 48MM COMPRSION SCREW
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Multiplan Commercial |
$170.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.3 X 50MM COMPRSION SCREW
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Multiplan Commercial |
$170.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.3 X 50MM COMPRSION SCREW
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$304.29 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: CDPHP Commercial |
$304.29
|
| Rate for Payer: CDPHP Medicare |
$139.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$302.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$302.40
|
| Rate for Payer: EmblemHealth Medicaid |
$302.40
|
| Rate for Payer: EmblemHealth Medicare |
$128.52
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Fidelis Medicare |
$144.06
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.86
|
| Rate for Payer: Humana Medicare |
$139.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.85
|
| Rate for Payer: United Healthcare Medicare |
$139.86
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.5CM SMALL ANATOMY/PEDIATRICS
|
Facility
|
IP
|
$117.00
|
|
| Hospital Charge Code |
4471072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
|
|
4.5CM SMALL ANATOMY/PEDIATRICS
|
Facility
|
OP
|
$117.00
|
|
| Hospital Charge Code |
4471072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Aetna of NY Commercial |
$81.90
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$58.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Commercial |
$94.18
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: EmblemHealth Select Care |
$84.24
|
| Rate for Payer: Fidelis Medicare |
$44.59
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.29
|
| Rate for Payer: Humana Medicare |
$43.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$81.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.45
|
| Rate for Payer: United Healthcare Medicare |
$43.29
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
|
4.5MM ANGLED AGGRESSIVE PLUS
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
4479237
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of NY Commercial |
$143.50
|
| Rate for Payer: Aetna of NY Medicare |
$94.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.50
|
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: CDPHP Commercial |
$165.02
|
| Rate for Payer: CDPHP Medicare |
$75.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$164.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.00
|
| Rate for Payer: EmblemHealth Medicaid |
$164.00
|
| Rate for Payer: EmblemHealth Medicare |
$69.70
|
| Rate for Payer: EmblemHealth Select Care |
$147.60
|
| Rate for Payer: Fidelis Medicare |
$78.13
|
| Rate for Payer: Galaxy Health Commercial |
$133.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.85
|
| Rate for Payer: Humana Medicare |
$75.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$143.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$115.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.64
|
| Rate for Payer: United Healthcare Medicare |
$75.85
|
| Rate for Payer: WellCare Medicare |
$112.75
|
|
|
4.5MM ANGLED AGGRESSIVE PLUS
|
Facility
|
IP
|
$205.00
|
|
| Hospital Charge Code |
4479237
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Galaxy Health Commercial |
$133.25
|
|
|
4.5" X 24" CERVICAL COLLAR
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4471888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
4.5" X 24" CERVICAL COLLAR
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4471888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
4" ACE BANDAGE
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
4471153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
|
|
4" ACE BANDAGE
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
4471153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$2.10
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$2.16
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
4" CANNULA FOR GPS III
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
4471611
|
|
Hospital Revenue Code
|
272
|
| 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" CANNULA FOR GPS III
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
4471611
|
|
Hospital Revenue Code
|
272
|
| 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" COBAN STERILE LF
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
4471424
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
4" COBAN STERILE LF
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
4471424
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
|
|
4" ECONOMY COTTON STOCKINETTE
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4471873
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
4" ECONOMY COTTON STOCKINETTE
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4471873
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
4MM BOW PLATE
|
Facility
|
IP
|
$7,259.00
|
|
| Hospital Charge Code |
4473000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.55 |
| Max. Negotiated Rate |
$5,081.30 |
| Rate for Payer: Aetna of NY Commercial |
$5,081.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,266.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,266.55
|
| Rate for Payer: Cash Price |
$5,444.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,629.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,629.50
|
| Rate for Payer: Galaxy Health Commercial |
$4,718.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,081.30
|
| Rate for Payer: Multiplan Commercial |
$3,266.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,718.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,718.35
|
| Rate for Payer: WellCare Medicare |
$3,992.45
|
|
|
4MM BOW PLATE
|
Facility
|
OP
|
$7,259.00
|
|
| Hospital Charge Code |
4473000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,468.06 |
| Max. Negotiated Rate |
$5,843.50 |
| Rate for Payer: Aetna of NY Commercial |
$5,081.30
|
| Rate for Payer: Aetna of NY Medicare |
$3,339.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,266.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,266.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,685.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,629.50
|
| Rate for Payer: Cash Price |
$5,444.25
|
| Rate for Payer: CDPHP Commercial |
$5,843.50
|
| Rate for Payer: CDPHP Medicare |
$2,685.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,629.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,807.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,807.20
|
| Rate for Payer: EmblemHealth Medicaid |
$5,807.20
|
| Rate for Payer: EmblemHealth Medicare |
$2,468.06
|
| Rate for Payer: EmblemHealth Select Care |
$3,629.50
|
| Rate for Payer: Fidelis Medicare |
$2,766.40
|
| Rate for Payer: Galaxy Health Commercial |
$4,718.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,685.83
|
| Rate for Payer: Humana Medicare |
$2,685.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5,081.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$3,339.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,718.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,718.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,820.12
|
| Rate for Payer: United Healthcare Medicare |
$2,685.83
|
| Rate for Payer: WellCare Medicare |
$3,992.45
|
|
|
4MM ROW II LOCK PLATE
|
Facility
|
OP
|
$5,942.00
|
|
| Hospital Charge Code |
4471838
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,020.28 |
| Max. Negotiated Rate |
$4,783.31 |
| Rate for Payer: Aetna of NY Commercial |
$4,159.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,733.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,456.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,456.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,198.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,971.00
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: CDPHP Commercial |
$4,783.31
|
| Rate for Payer: CDPHP Medicare |
$2,198.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,753.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,753.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,753.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,753.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,020.28
|
| Rate for Payer: EmblemHealth Select Care |
$4,278.24
|
| Rate for Payer: Fidelis Medicare |
$2,264.50
|
| Rate for Payer: Galaxy Health Commercial |
$3,862.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,198.54
|
| Rate for Payer: Humana Medicare |
$2,198.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,159.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,733.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,456.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,345.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,308.47
|
| Rate for Payer: United Healthcare Medicare |
$2,198.54
|
| Rate for Payer: WellCare Medicare |
$3,268.10
|
|
