|
3-0 MONOSOF P-12
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
4478155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
3-0PROLENE FS-1
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
4478158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
3-0 SURGIPRO 18" C-14 CUTTING
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4472085
|
|
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
|
|
|
3-0 SURGIPRO II P-14
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4478161
|
|
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
|
|
|
3-0 VICRYL MHV-26 SUTURE
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
4471907
|
|
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
|
|
|
3.5MM CALCANEAL PLATE
|
Facility
OP
|
$1,574.00
|
|
| Hospital Charge Code |
4472232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.16 |
| Max. Negotiated Rate |
$1,267.07 |
| Rate for Payer: Aetna of NY Commercial |
$1,101.80
|
| Rate for Payer: Aetna of NY Medicare |
$724.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$582.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$787.00
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: CDPHP Commercial |
$1,267.07
|
| Rate for Payer: CDPHP Medicare |
$582.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$787.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,259.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,259.20
|
| Rate for Payer: EmblemHealth Medicare |
$535.16
|
| Rate for Payer: EmblemHealth Select Care |
$787.00
|
| Rate for Payer: Fidelis Medicare |
$599.85
|
| Rate for Payer: Galaxy Health Commercial |
$1,023.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$582.38
|
| Rate for Payer: Humana Medicare |
$582.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,101.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$724.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,023.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,023.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$611.50
|
| Rate for Payer: United Healthcare Medicare |
$582.38
|
| Rate for Payer: WellCare Medicare |
$865.70
|
|
|
3.5MM CLOVERLEAF PLATE, 3-5 HOLES
|
Facility
OP
|
$979.00
|
|
| Hospital Charge Code |
4472230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.86 |
| Max. Negotiated Rate |
$788.10 |
| Rate for Payer: Aetna of NY Commercial |
$685.30
|
| Rate for Payer: Aetna of NY Medicare |
$450.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$440.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$440.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$362.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$489.50
|
| Rate for Payer: Cash Price |
$734.25
|
| Rate for Payer: CDPHP Commercial |
$788.10
|
| Rate for Payer: CDPHP Medicare |
$362.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$489.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$783.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$783.20
|
| Rate for Payer: EmblemHealth Medicaid |
$783.20
|
| Rate for Payer: EmblemHealth Medicare |
$332.86
|
| Rate for Payer: EmblemHealth Select Care |
$489.50
|
| Rate for Payer: Fidelis Medicare |
$373.10
|
| Rate for Payer: Galaxy Health Commercial |
$636.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$362.23
|
| Rate for Payer: Humana Medicare |
$362.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$685.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$450.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$636.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$636.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$380.34
|
| Rate for Payer: United Healthcare Medicare |
$362.23
|
| Rate for Payer: WellCare Medicare |
$538.45
|
|
|
3.5MM CLOVERLEAF PLATE, 5> HOLES
|
Facility
OP
|
$1,419.00
|
|
| Hospital Charge Code |
4472231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.46 |
| Max. Negotiated Rate |
$1,142.30 |
| Rate for Payer: Aetna of NY Commercial |
$993.30
|
| Rate for Payer: Aetna of NY Medicare |
$652.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$525.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$709.50
|
| Rate for Payer: Cash Price |
$1,064.25
|
| Rate for Payer: CDPHP Commercial |
$1,142.30
|
| Rate for Payer: CDPHP Medicare |
$525.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$709.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,135.20
|
| Rate for Payer: EmblemHealth Medicare |
$482.46
|
| Rate for Payer: EmblemHealth Select Care |
$709.50
|
| Rate for Payer: Fidelis Medicare |
$540.78
|
| Rate for Payer: Galaxy Health Commercial |
$922.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$525.03
|
| Rate for Payer: Humana Medicare |
$525.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$993.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$652.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$922.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$551.28
|
| Rate for Payer: United Healthcare Medicare |
$525.03
|
| Rate for Payer: WellCare Medicare |
$780.45
|
|
|
3.5MM COMPRESSION PLATE, 12> HOLES
|
Facility
OP
|
$1,405.00
|
|
| Hospital Charge Code |
4472225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.70 |
| Max. Negotiated Rate |
$1,131.02 |
| Rate for Payer: Aetna of NY Commercial |
$983.50
|
| Rate for Payer: Aetna of NY Medicare |
$646.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$519.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$702.50
|
| Rate for Payer: Cash Price |
$1,053.75
|
| Rate for Payer: CDPHP Commercial |
$1,131.02
|
| Rate for Payer: CDPHP Medicare |
$519.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$702.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicare |
$477.70
|
| Rate for Payer: EmblemHealth Select Care |
$702.50
|
| Rate for Payer: Fidelis Medicare |
$535.45
|
| Rate for Payer: Galaxy Health Commercial |
$913.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$519.85
|
| Rate for Payer: Humana Medicare |
$519.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$983.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$646.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$913.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$913.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$545.84
|
| Rate for Payer: United Healthcare Medicare |
$519.85
|
| Rate for Payer: WellCare Medicare |
$772.75
|
|
|
3.5MM COMPRESSION PLATE, 2-8 HOLES
|
Facility
OP
|
$480.00
|
|
| Hospital Charge Code |
4472223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna of NY Commercial |
$336.00
|
| Rate for Payer: Aetna of NY Medicare |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$177.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: CDPHP Commercial |
$386.40
|
| Rate for Payer: CDPHP Medicare |
$177.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$240.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$384.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$384.00
|
| Rate for Payer: EmblemHealth Medicaid |
$384.00
|
| Rate for Payer: EmblemHealth Medicare |
$163.20
|
| Rate for Payer: EmblemHealth Select Care |
$240.00
|
| Rate for Payer: Fidelis Medicare |
$182.93
|
| Rate for Payer: Galaxy Health Commercial |
$312.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$177.60
|
| Rate for Payer: Humana Medicare |
$177.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$336.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$220.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$312.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$186.48
|
| Rate for Payer: United Healthcare Medicare |
$177.60
|
| Rate for Payer: WellCare Medicare |
$264.00
|
|
|
3.5MM COMPRESSION PLATE, 9-12 HOLES
|
Facility
OP
|
$547.00
|
|
| Hospital Charge Code |
4472224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.98 |
| Max. Negotiated Rate |
$440.34 |
| Rate for Payer: Aetna of NY Commercial |
$382.90
|
| Rate for Payer: Aetna of NY Medicare |
$251.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$246.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$246.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$202.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$273.50
|
| Rate for Payer: Cash Price |
$410.25
|
| Rate for Payer: CDPHP Commercial |
$440.34
|
| Rate for Payer: CDPHP Medicare |
$202.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$273.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$437.60
|
| Rate for Payer: EmblemHealth Medicare |
$185.98
|
| Rate for Payer: EmblemHealth Select Care |
$273.50
|
| Rate for Payer: Fidelis Medicare |
$208.46
|
| Rate for Payer: Galaxy Health Commercial |
$355.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$202.39
|
| Rate for Payer: Humana Medicare |
$202.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$382.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$251.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$355.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$355.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$212.51
|
| Rate for Payer: United Healthcare Medicare |
$202.39
|
| Rate for Payer: WellCare Medicare |
$300.85
|
|
|
3.5MM CORTICAL SCREW,SF-TAP SMALL HEX RE
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna of NY Commercial |
$68.60
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Commercial |
$78.89
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: EmblemHealth Select Care |
$49.00
|
| Rate for Payer: Fidelis Medicare |
$37.35
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.26
|
| Rate for Payer: Humana Medicare |
$36.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$63.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.07
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
3.5MM CORTICAL SCREW, SLF TAPPING SM HEX
|
Facility
OP
|
$105.00
|
|
| Hospital Charge Code |
4479264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
3.5MM CORTICAL SHAFT SCREW, NON SF-TAP
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna of NY Commercial |
$60.20
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: EmblemHealth Select Care |
$43.00
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$60.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
3.5MM RECON PLATE, STRAIGHT, 3-7 HOLES
|
Facility
OP
|
$1,082.00
|
|
| Hospital Charge Code |
4472233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.88 |
| Max. Negotiated Rate |
$871.01 |
| Rate for Payer: Aetna of NY Commercial |
$757.40
|
| Rate for Payer: Aetna of NY Medicare |
$497.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$486.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$486.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$400.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$541.00
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: CDPHP Commercial |
$871.01
|
| Rate for Payer: CDPHP Medicare |
$400.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$541.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$865.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$865.60
|
| Rate for Payer: EmblemHealth Medicaid |
$865.60
|
| Rate for Payer: EmblemHealth Medicare |
$367.88
|
| Rate for Payer: EmblemHealth Select Care |
$541.00
|
| Rate for Payer: Fidelis Medicare |
$412.35
|
| Rate for Payer: Galaxy Health Commercial |
$703.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$400.34
|
| Rate for Payer: Humana Medicare |
$400.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$757.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$497.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$703.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$703.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$420.36
|
| Rate for Payer: United Healthcare Medicare |
$400.34
|
| Rate for Payer: WellCare Medicare |
$595.10
|
|
|
3.5MM RECON PLATE, STRAIGHT 7> HOLES
|
Facility
OP
|
$1,405.00
|
|
| Hospital Charge Code |
4472234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.70 |
| Max. Negotiated Rate |
$1,131.02 |
| Rate for Payer: Aetna of NY Commercial |
$983.50
|
| Rate for Payer: Aetna of NY Medicare |
$646.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$519.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$702.50
|
| Rate for Payer: Cash Price |
$1,053.75
|
| Rate for Payer: CDPHP Commercial |
$1,131.02
|
| Rate for Payer: CDPHP Medicare |
$519.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$702.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicare |
$477.70
|
| Rate for Payer: EmblemHealth Select Care |
$702.50
|
| Rate for Payer: Fidelis Medicare |
$535.45
|
| Rate for Payer: Galaxy Health Commercial |
$913.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$519.85
|
| Rate for Payer: Humana Medicare |
$519.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$983.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$646.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$913.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$913.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$545.84
|
| Rate for Payer: United Healthcare Medicare |
$519.85
|
| Rate for Payer: WellCare Medicare |
$772.75
|
|
|
3.5MM SURFAS SUCT#1246
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
4479280
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$62.90
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Commercial |
$136.85
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: EmblemHealth Select Care |
$122.40
|
| Rate for Payer: Fidelis Medicare |
$64.79
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$62.90
|
| Rate for Payer: Humana Medicare |
$62.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.04
|
| Rate for Payer: United Healthcare Medicare |
$62.90
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
3.5MM T-PLATE, 3-5 HOLE SHAFT
|
Facility
OP
|
$467.00
|
|
| Hospital Charge Code |
4472227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.78 |
| Max. Negotiated Rate |
$375.94 |
| Rate for Payer: Aetna of NY Commercial |
$326.90
|
| Rate for Payer: Aetna of NY Medicare |
$214.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$210.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$210.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$172.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$233.50
|
| Rate for Payer: Cash Price |
$350.25
|
| Rate for Payer: CDPHP Commercial |
$375.94
|
| Rate for Payer: CDPHP Medicare |
$172.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$233.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$373.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$373.60
|
| Rate for Payer: EmblemHealth Medicaid |
$373.60
|
| Rate for Payer: EmblemHealth Medicare |
$158.78
|
| Rate for Payer: EmblemHealth Select Care |
$233.50
|
| Rate for Payer: Fidelis Medicare |
$177.97
|
| Rate for Payer: Galaxy Health Commercial |
$303.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$172.79
|
| Rate for Payer: Humana Medicare |
$172.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$326.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$214.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$303.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$181.43
|
| Rate for Payer: United Healthcare Medicare |
$172.79
|
| Rate for Payer: WellCare Medicare |
$256.85
|
|
|
3.5MM T-PLATE, 5> HOLE SHAFT
|
Facility
OP
|
$662.00
|
|
| Hospital Charge Code |
4472228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.08 |
| Max. Negotiated Rate |
$532.91 |
| Rate for Payer: Aetna of NY Commercial |
$463.40
|
| Rate for Payer: Aetna of NY Medicare |
$304.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$297.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$297.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$244.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$331.00
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Commercial |
$532.91
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$331.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$529.60
|
| Rate for Payer: EmblemHealth Medicaid |
$529.60
|
| Rate for Payer: EmblemHealth Medicare |
$225.08
|
| Rate for Payer: EmblemHealth Select Care |
$331.00
|
| Rate for Payer: Fidelis Medicare |
$252.29
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$244.94
|
| Rate for Payer: Humana Medicare |
$244.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$463.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$304.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$430.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$430.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$257.19
|
| Rate for Payer: United Healthcare Medicare |
$244.94
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
3.5MM T-PLATE OBLIQUE
|
Facility
OP
|
$695.00
|
|
| Hospital Charge Code |
4472229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.30 |
| Max. Negotiated Rate |
$559.48 |
| Rate for Payer: Aetna of NY Commercial |
$486.50
|
| Rate for Payer: Aetna of NY Medicare |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$257.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$347.50
|
| Rate for Payer: Cash Price |
$521.25
|
| Rate for Payer: CDPHP Commercial |
$559.48
|
| Rate for Payer: CDPHP Medicare |
$257.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$347.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$556.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$556.00
|
| Rate for Payer: EmblemHealth Medicaid |
$556.00
|
| Rate for Payer: EmblemHealth Medicare |
$236.30
|
| Rate for Payer: EmblemHealth Select Care |
$347.50
|
| Rate for Payer: Fidelis Medicare |
$264.86
|
| Rate for Payer: Galaxy Health Commercial |
$451.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$257.15
|
| Rate for Payer: Humana Medicare |
$257.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$486.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$319.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$451.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$270.01
|
| Rate for Payer: United Healthcare Medicare |
$257.15
|
| Rate for Payer: WellCare Medicare |
$382.25
|
|
|
3" CAST PADDING
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
4471956
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
3D RENDER W/INTRP W/POSTPROCES
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
4230210
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$200.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$200.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Commercial |
$214.94
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: Fidelis Medicare |
$101.75
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.79
|
| Rate for Payer: Humana Medicare |
$98.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.73
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$98.79
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
|
3D RENDER W/INTRP W/POSTPROCES
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
4220001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$31.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$666.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: CDPHP Commercial |
$69.23
|
| Rate for Payer: CDPHP Medicare |
$31.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$68.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.80
|
| Rate for Payer: EmblemHealth Medicaid |
$68.80
|
| Rate for Payer: EmblemHealth Medicare |
$29.24
|
| Rate for Payer: Fidelis Medicare |
$32.77
|
| Rate for Payer: Galaxy Health Commercial |
$55.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$31.82
|
| Rate for Payer: Humana Medicare |
$31.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$39.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.00
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare |
$31.82
|
| Rate for Payer: WellCare Medicare |
$47.30
|
|
|
3" ECONOMY COTTON STOCKINETTE
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4472038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
3M COBAN 3"X5YD
|
Facility
OP
|
$17.00
|
|
| Hospital Charge Code |
4471986
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
