|
CL TX METATARSAL FX; W MANIP
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
4856722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX METATARSAL FX; W MANIP
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
4602234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| 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 |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| 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 |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| 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 |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX METATARSAL FX; W MANIP
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
4850139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX PHALANG SHFT FX; W MANIP
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
4850143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX PHALANG SHFT FX; W MANIP
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
4855441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLTX POST HIP ARTHRP DISLC REQ ANES
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
4601199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| 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 |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| 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 |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
4601200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| 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 |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| 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 |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| 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 |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX SC/TX HUMERUS SHFT FX W MANIP
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
4850202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CL TX TIB SHFT FX W MANIP
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
4609661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| 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 |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| 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 |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CL TX TIB SHFT FX W MANIP
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
4850305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
4601202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| 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 |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| 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 |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
4602232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| 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 |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| 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 |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| 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 |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CL TX WB DSTL TIB FX W MANIP
|
Facility
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
4852001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CODEINE/ACETAMIN 12-120MG/5ML ELIX 100X5
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CODEINE/ACETAMIN 30-300MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CO DIFFUSING CAPACITY
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
4530010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$177.90 |
| Rate for Payer: Aetna of NY Commercial |
$154.70
|
| Rate for Payer: Aetna of NY Medicare |
$101.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$81.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$110.50
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: CDPHP Commercial |
$177.90
|
| Rate for Payer: CDPHP Medicare |
$81.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$176.80
|
| Rate for Payer: EmblemHealth Medicaid |
$176.80
|
| Rate for Payer: EmblemHealth Medicare |
$75.14
|
| Rate for Payer: Fidelis Medicare |
$84.22
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$81.77
|
| Rate for Payer: Humana Medicare |
$81.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$154.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$101.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$124.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$85.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.05
|
| Rate for Payer: United Healthcare Medicare |
$81.77
|
| Rate for Payer: WellCare Medicare |
$121.55
|
|
|
COLCHICINE 0.6 MG
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
4401282
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
COLD BIOPSY FORCEPS
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4471973
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
COLD PACK SUPPLY
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
4479125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
COLLAGENASE 250U/GM OINT 30 GM
|
Facility
OP
|
$759.37
|
|
| Hospital Charge Code |
4400688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$611.29 |
| Rate for Payer: Aetna of NY Commercial |
$531.56
|
| Rate for Payer: Aetna of NY Medicare |
$349.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$569.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$569.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$280.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$379.68
|
| Rate for Payer: Cash Price |
$569.53
|
| Rate for Payer: CDPHP Commercial |
$611.29
|
| Rate for Payer: CDPHP Medicare |
$280.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$607.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$607.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$607.50
|
| Rate for Payer: EmblemHealth Medicaid |
$607.50
|
| Rate for Payer: EmblemHealth Medicare |
$258.19
|
| Rate for Payer: EmblemHealth Select Care |
$546.75
|
| Rate for Payer: Fidelis Medicare |
$289.40
|
| Rate for Payer: Galaxy Health Commercial |
$493.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$280.97
|
| Rate for Payer: Humana Medicare |
$280.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$531.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$349.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$569.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$427.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$295.02
|
| Rate for Payer: United Healthcare Medicare |
$280.97
|
| Rate for Payer: WellCare Medicare |
$417.65
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN LRG
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
4479081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN MED
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
4479080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
COLLAR PHILADELPHIA 5 1/4 IN SM
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
4479079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
COLLECT BLOOD FROM PICC
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
4451252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.71 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.71
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
COLLES(COCK UP) SPLINT
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
4472168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$14.40
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
