|
SIMPLE REPAIR-2.5 OR LESS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
4600146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SIMPLE REPAIR-2.5 OR LESS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
4600146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SIMPLE REPAIR-2.6-5.0CM
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
4600148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SIMPLE REPAIR-2.6-5.0CM
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
4600148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SIMPLE REPAIR-2.6-7.5CM
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4600149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SIMPLE REPAIR-2.6-7.5CM
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4600149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SIMPLE REPAIR-7.6-12.5CM
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
4600154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
SIMPLE REPAIR-7.6-12.5CM
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
4600154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
|
|
SIMVASTATIN 10MG TABS 10X10EA
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 51079045401
|
| Hospital Charge Code |
4400701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Aetna of NY Medicare |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.25
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: CDPHP Commercial |
$6.84
|
| Rate for Payer: CDPHP Medicare |
$3.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.80
|
| Rate for Payer: EmblemHealth Medicaid |
$6.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.89
|
| Rate for Payer: EmblemHealth Select Care |
$6.12
|
| Rate for Payer: Fidelis Medicare |
$3.24
|
| Rate for Payer: Galaxy Health Commercial |
$5.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.14
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.30
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WellCare Medicare |
$4.68
|
|
|
SIMVASTATIN 10MG TABS 10X10EA
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 51079045401
|
| Hospital Charge Code |
4400701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Galaxy Health Commercial |
$5.52
|
| Rate for Payer: WellCare Medicare |
$4.68
|
|
|
SIMVASTATIN 20 MG
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 68084051201
|
| Hospital Charge Code |
4408940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SIMVASTATIN 20 MG
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 68084051201
|
| Hospital Charge Code |
4408940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$12.23 |
| Rate for Payer: Aetna of NY Commercial |
$10.63
|
| Rate for Payer: Aetna of NY Medicare |
$6.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.60
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: CDPHP Commercial |
$12.23
|
| Rate for Payer: CDPHP Medicare |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.15
|
| Rate for Payer: EmblemHealth Medicaid |
$12.15
|
| Rate for Payer: EmblemHealth Medicare |
$5.16
|
| Rate for Payer: EmblemHealth Select Care |
$10.94
|
| Rate for Payer: Fidelis Medicare |
$5.79
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.62
|
| Rate for Payer: Humana Medicare |
$5.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.90
|
| Rate for Payer: United Healthcare Medicare |
$5.62
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SIMVASTATIN 40MG TABS 10X10EA
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
4400702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SIMVASTATIN 40MG TABS 10X10EA
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
4400702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$12.23 |
| Rate for Payer: Aetna of NY Commercial |
$10.63
|
| Rate for Payer: Aetna of NY Medicare |
$6.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.60
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: CDPHP Commercial |
$12.23
|
| Rate for Payer: CDPHP Medicare |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.15
|
| Rate for Payer: EmblemHealth Medicaid |
$12.15
|
| Rate for Payer: EmblemHealth Medicare |
$5.16
|
| Rate for Payer: EmblemHealth Select Care |
$10.94
|
| Rate for Payer: Fidelis Medicare |
$5.79
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.62
|
| Rate for Payer: Humana Medicare |
$5.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.90
|
| Rate for Payer: United Healthcare Medicare |
$5.62
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
SINERGY EPSILON RULER SIA-E10
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
4479250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
SINERGY EPSILON RULER SIA-E10
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
4479250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna of NY Commercial |
$49.70
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.50
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
SINERGY INTRODUCER 17GX150 SII-17-1750
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
4479247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$326.83 |
| Rate for Payer: Aetna of NY Commercial |
$284.20
|
| Rate for Payer: Aetna of NY Medicare |
$186.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$304.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$304.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.00
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: CDPHP Commercial |
$326.83
|
| Rate for Payer: CDPHP Medicare |
$150.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$324.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$324.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$324.80
|
| Rate for Payer: EmblemHealth Medicaid |
$324.80
|
| Rate for Payer: EmblemHealth Medicare |
$138.04
|
| Rate for Payer: EmblemHealth Select Care |
$292.32
|
| Rate for Payer: Fidelis Medicare |
$154.73
|
| Rate for Payer: Galaxy Health Commercial |
$263.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.22
|
| Rate for Payer: Humana Medicare |
$150.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$186.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$228.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$157.73
|
| Rate for Payer: United Healthcare Medicare |
$150.22
|
| Rate for Payer: WellCare Medicare |
$223.30
|
|
|
SINERGY INTRODUCER 17GX150 SII-17-1750
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
4479247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Galaxy Health Commercial |
$263.90
|
|
|
SINERGY INTRODUCER 17X75MM SII-75-5
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
4479249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
|
|
SINERGY INTRODUCER 17X75MM SII-75-5
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
4479249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.36 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna of NY Commercial |
$142.80
|
| Rate for Payer: Aetna of NY Medicare |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$102.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: CDPHP Commercial |
$164.22
|
| Rate for Payer: CDPHP Medicare |
$75.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.20
|
| Rate for Payer: EmblemHealth Medicaid |
$163.20
|
| Rate for Payer: EmblemHealth Medicare |
$69.36
|
| Rate for Payer: EmblemHealth Select Care |
$146.88
|
| Rate for Payer: Fidelis Medicare |
$77.74
|
| Rate for Payer: Galaxy Health Commercial |
$132.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.48
|
| Rate for Payer: Humana Medicare |
$75.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$142.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$93.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$114.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$79.25
|
| Rate for Payer: United Healthcare Medicare |
$75.48
|
| Rate for Payer: WellCare Medicare |
$112.20
|
|
|
SINERGY PROBE 17GX75MMX4MM SIK-17-75-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
SINERGY PROBE 17GX75MMX4MM SIK-17-75-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
SINERGY STERILE PROBE TIP SIP-17-75-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
SINERGY STERILE PROBE TIP SIP-17-75-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
SINERGY SYSTEM 17GX150 SIK-17-150-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
