|
OMEGA-3-ACID ETHYL ESTERS 1GM GCAP 120 E
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
4400470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$5.71
|
| Rate for Payer: WellCare Medicare |
$4.83
|
|
|
OMEGA-3-ACID ETHYL ESTERS 1GM GCAP 120 E
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
4400470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna of NY Commercial |
$6.15
|
| Rate for Payer: Aetna of NY Medicare |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.25
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.40
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: CDPHP Commercial |
$7.08
|
| Rate for Payer: CDPHP Medicare |
$3.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.03
|
| Rate for Payer: EmblemHealth Medicaid |
$7.03
|
| Rate for Payer: EmblemHealth Medicare |
$2.99
|
| Rate for Payer: EmblemHealth Select Care |
$6.33
|
| Rate for Payer: Fidelis Medicare |
$3.35
|
| Rate for Payer: Galaxy Health Commercial |
$5.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.25
|
| Rate for Payer: Humana Medicare |
$3.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.41
|
| Rate for Payer: United Healthcare Medicare |
$3.25
|
| Rate for Payer: WellCare Medicare |
$4.83
|
|
|
OMNIPAQUE / LOCM 200-299MG/ML IODINE,1ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
4211264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of NY Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Galaxy Health Commercial |
$0.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.55
|
| Rate for Payer: WellCare Medicare |
$0.55
|
|
|
OMNIPAQUE / LOCM 200-299MG/ML IODINE,1ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
4211264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of NY Commercial |
$0.55
|
| Rate for Payer: Aetna of NY Medicare |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.50
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: CDPHP Commercial |
$0.81
|
| Rate for Payer: CDPHP Medicare |
$0.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.80
|
| Rate for Payer: EmblemHealth Medicaid |
$0.80
|
| Rate for Payer: EmblemHealth Medicare |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Fidelis Medicare |
$0.38
|
| Rate for Payer: Galaxy Health Commercial |
$0.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.61
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WellCare Medicare |
$0.55
|
|
|
ONDANSETRON 4 MG TABLET
|
Facility
|
IP
|
$76.48
|
|
|
Service Code
|
NDC 00904655161
|
| Hospital Charge Code |
4401246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Galaxy Health Commercial |
$49.71
|
| Rate for Payer: WellCare Medicare |
$42.06
|
|
|
ONDANSETRON 4 MG TABLET
|
Facility
|
OP
|
$76.48
|
|
|
Service Code
|
NDC 00904655161
|
| Hospital Charge Code |
4401246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$61.57 |
| Rate for Payer: Aetna of NY Commercial |
$53.54
|
| Rate for Payer: Aetna of NY Medicare |
$35.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.24
|
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: CDPHP Commercial |
$61.57
|
| Rate for Payer: CDPHP Medicare |
$28.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$61.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.18
|
| Rate for Payer: EmblemHealth Medicaid |
$61.18
|
| Rate for Payer: EmblemHealth Medicare |
$26.00
|
| Rate for Payer: EmblemHealth Select Care |
$55.07
|
| Rate for Payer: Fidelis Medicare |
$29.15
|
| Rate for Payer: Galaxy Health Commercial |
$49.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.30
|
| Rate for Payer: Humana Medicare |
$28.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.54
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.71
|
| Rate for Payer: United Healthcare Medicare |
$28.30
|
| Rate for Payer: WellCare Medicare |
$42.06
|
|
|
ONDANSETRON 4MG TDIS 30 EA
|
Facility
|
IP
|
$68.75
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
4400590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$44.69 |
| Rate for Payer: Cash Price |
$51.56
|
| Rate for Payer: Galaxy Health Commercial |
$44.69
|
| Rate for Payer: WellCare Medicare |
$37.81
|
|
|
ONDANSETRON 4MG TDIS 30 EA
|
Facility
|
OP
|
$68.75
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
4400590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$55.34 |
| Rate for Payer: Aetna of NY Commercial |
$48.12
|
| Rate for Payer: Aetna of NY Medicare |
$31.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.38
|
| Rate for Payer: Cash Price |
$51.56
|
| Rate for Payer: CDPHP Commercial |
$55.34
|
| Rate for Payer: CDPHP Medicare |
$25.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.00
|
| Rate for Payer: EmblemHealth Medicaid |
$55.00
|
| Rate for Payer: EmblemHealth Medicare |
$23.38
|
| Rate for Payer: EmblemHealth Select Care |
$49.50
|
| Rate for Payer: Fidelis Medicare |
$26.20
|
| Rate for Payer: Galaxy Health Commercial |
$44.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.44
|
| Rate for Payer: Humana Medicare |
$25.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.56
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.71
|
| Rate for Payer: United Healthcare Medicare |
$25.44
|
| Rate for Payer: WellCare Medicare |
$37.81
|
|
|
ONDANSETRON HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
4400589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ONDANSETRON HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
4400589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$3.30
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$0.10
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
ONE STEP INTRODUCER
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4472114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Galaxy Health Commercial |
$131.95
|
|
|
ONE STEP INTRODUCER
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4472114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna of NY Commercial |
$142.10
|
| Rate for Payer: Aetna of NY Medicare |
$93.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$152.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.50
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: CDPHP Commercial |
$163.42
|
| Rate for Payer: CDPHP Medicare |
$75.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$162.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$162.40
|
| Rate for Payer: EmblemHealth Medicaid |
$162.40
|
| Rate for Payer: EmblemHealth Medicare |
$69.02
|
| Rate for Payer: EmblemHealth Select Care |
$146.16
|
| Rate for Payer: Fidelis Medicare |
$77.36
|
| Rate for Payer: Galaxy Health Commercial |
$131.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.11
|
| Rate for Payer: Humana Medicare |
$75.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.87
|
| Rate for Payer: United Healthcare Medicare |
$75.11
|
| Rate for Payer: WellCare Medicare |
$111.65
|
|
|
ONE-THIRD TUBULAR PLATE WITH COLLAR
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4479267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna of NY Commercial |
$44.80
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.86
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
ONE-THIRD TUBULAR PLATE WITH COLLAR
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4479267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,421.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
|
|
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 25608
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,421.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
|
|
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,816.33
|
|
|
Service Code
|
CPT 27829
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$6,816.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,973.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,716.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,421.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6,816.33
|
| Rate for Payer: United Healthcare Commercial |
$2,304.00
|
|
|
OPERATING RM 1/2 HOUR
|
Facility
|
OP
|
$1,863.00
|
|
| Hospital Charge Code |
4000104
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$633.42 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$856.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,397.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,397.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$689.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$931.50
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: CDPHP Commercial |
$1,499.72
|
| Rate for Payer: CDPHP Medicare |
$689.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,490.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,490.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,490.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,490.40
|
| Rate for Payer: EmblemHealth Medicare |
$633.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,341.36
|
| Rate for Payer: Fidelis Medicare |
$709.99
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$689.31
|
| Rate for Payer: Humana Medicare |
$689.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$856.98
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,397.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,048.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$723.78
|
| Rate for Payer: United Healthcare Medicare |
$689.31
|
| Rate for Payer: WellCare Medicare |
$1,024.65
|
|
|
OPERATING RM 1/2 HOUR
|
Facility
|
IP
|
$1,863.00
|
|
| Hospital Charge Code |
4000104
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,210.95 |
| Max. Negotiated Rate |
$1,210.95 |
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,210.95
|
|
|
OPERATING RM 1/4 HOUR
|
Facility
|
IP
|
$1,283.00
|
|
| Hospital Charge Code |
4000103
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$833.95 |
| Max. Negotiated Rate |
$833.95 |
| Rate for Payer: Cash Price |
$962.25
|
| Rate for Payer: Galaxy Health Commercial |
$833.95
|
|
|
OPERATING RM 1/4 HOUR
|
Facility
|
OP
|
$1,283.00
|
|
| Hospital Charge Code |
4000103
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$436.22 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$590.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$962.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$962.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$474.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$641.50
|
| Rate for Payer: Cash Price |
$962.25
|
| Rate for Payer: Cash Price |
$962.25
|
| Rate for Payer: CDPHP Commercial |
$1,032.82
|
| Rate for Payer: CDPHP Medicare |
$474.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,026.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,026.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,026.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,026.40
|
| Rate for Payer: EmblemHealth Medicare |
$436.22
|
| Rate for Payer: EmblemHealth Select Care |
$923.76
|
| Rate for Payer: Fidelis Medicare |
$488.95
|
| Rate for Payer: Galaxy Health Commercial |
$833.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$474.71
|
| Rate for Payer: Humana Medicare |
$474.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$590.18
|
| Rate for Payer: Multiplan Commercial |
$1,026.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$962.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$722.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$498.45
|
| Rate for Payer: United Healthcare Medicare |
$474.71
|
| Rate for Payer: WellCare Medicare |
$705.65
|
|
|
OPTICAL ACCESS KII THREADED
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
4471764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
|
|
OPTICAL ACCESS KII THREADED
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
4471764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$82.92 |
| Rate for Payer: Aetna of NY Commercial |
$72.10
|
| Rate for Payer: Aetna of NY Medicare |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$77.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.50
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: CDPHP Commercial |
$82.92
|
| Rate for Payer: CDPHP Medicare |
$38.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.40
|
| Rate for Payer: EmblemHealth Medicaid |
$82.40
|
| Rate for Payer: EmblemHealth Medicare |
$35.02
|
| Rate for Payer: EmblemHealth Select Care |
$74.16
|
| Rate for Payer: Fidelis Medicare |
$39.25
|
| Rate for Payer: Galaxy Health Commercial |
$66.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.11
|
| Rate for Payer: Humana Medicare |
$38.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$72.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.02
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: WellCare Medicare |
$56.65
|
|
|
OR 1 1/2 HOUR OPERATION
|
Facility
|
OP
|
$4,183.00
|
|
| Hospital Charge Code |
4000108
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,422.22 |
| Max. Negotiated Rate |
$3,367.32 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,924.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,137.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,137.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,547.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,091.50
|
| Rate for Payer: Cash Price |
$3,137.25
|
| Rate for Payer: Cash Price |
$3,137.25
|
| Rate for Payer: CDPHP Commercial |
$3,367.32
|
| Rate for Payer: CDPHP Medicare |
$1,547.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,346.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,346.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,346.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,346.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,422.22
|
| Rate for Payer: EmblemHealth Select Care |
$3,011.76
|
| Rate for Payer: Fidelis Medicare |
$1,594.14
|
| Rate for Payer: Galaxy Health Commercial |
$2,718.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,547.71
|
| Rate for Payer: Humana Medicare |
$1,547.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,924.18
|
| Rate for Payer: Multiplan Commercial |
$3,346.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,137.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,355.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,625.10
|
| Rate for Payer: United Healthcare Medicare |
$1,547.71
|
| Rate for Payer: WellCare Medicare |
$2,300.65
|
|
|
OR 1 1/2 HOUR OPERATION
|
Facility
|
IP
|
$4,183.00
|
|
| Hospital Charge Code |
4000108
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,718.95 |
| Max. Negotiated Rate |
$2,718.95 |
| Rate for Payer: Cash Price |
$3,137.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,718.95
|
|
