|
3M COBAN 4"X5YD
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
4471987
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$5.60
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$5.76
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
3M COBAN 6"X5YD
|
Facility
OP
|
$17.00
|
|
| Hospital Charge Code |
4471988
|
|
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
|
|
|
3" SCOTCH PLUS CAST TAPE
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
4472152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
3 STAGE BALLOON DILA 18-19-20
|
Facility
OP
|
$71.00
|
|
| Hospital Charge Code |
4471893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna of NY Commercial |
$49.70
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$35.50
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
3X3YD SPECIALIST EXTRA-FAST PL
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
4471915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
4-0 ETHILON 18" PS-4 CUTTING
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
4471171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
40MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML
|
Facility
OP
|
$8.76
|
|
| Hospital Charge Code |
4450030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna of NY Commercial |
$6.13
|
| Rate for Payer: Aetna of NY Medicare |
$4.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.38
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: CDPHP Commercial |
$7.05
|
| Rate for Payer: CDPHP Medicare |
$3.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.01
|
| Rate for Payer: EmblemHealth Medicaid |
$7.01
|
| Rate for Payer: EmblemHealth Medicare |
$2.98
|
| Rate for Payer: EmblemHealth Select Care |
$6.31
|
| Rate for Payer: Fidelis Medicare |
$3.34
|
| Rate for Payer: Galaxy Health Commercial |
$5.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.24
|
| Rate for Payer: Humana Medicare |
$3.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.13
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
| Rate for Payer: WellCare Medicare |
$4.82
|
|
|
40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML
|
Facility
OP
|
$11.85
|
|
| Hospital Charge Code |
4450031
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Aetna of NY Commercial |
$8.30
|
| Rate for Payer: Aetna of NY Medicare |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.92
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: CDPHP Commercial |
$9.54
|
| Rate for Payer: CDPHP Medicare |
$4.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.48
|
| Rate for Payer: EmblemHealth Medicaid |
$9.48
|
| Rate for Payer: EmblemHealth Medicare |
$4.03
|
| Rate for Payer: EmblemHealth Select Care |
$8.53
|
| Rate for Payer: Fidelis Medicare |
$4.52
|
| Rate for Payer: Galaxy Health Commercial |
$7.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.38
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.89
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.60
|
| Rate for Payer: United Healthcare Medicare |
$4.38
|
| Rate for Payer: WellCare Medicare |
$6.52
|
|
|
4.0MM 12 FLUTEBARREL BUR-HOLLO
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM 12 FLUTE ROUND BUR-HOLLO
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM 1/3 THREAD CANULATED SCREW 00-1147
|
Facility
OP
|
$262.00
|
|
| Hospital Charge Code |
4479266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$210.91 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$131.00
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Commercial |
$210.91
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: EmblemHealth Select Care |
$188.64
|
| Rate for Payer: Fidelis Medicare |
$99.85
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.94
|
| Rate for Payer: Humana Medicare |
$96.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$96.94
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
4.0MM AGRESSIVE PLUS CUTTER
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM CANCELLOUS SCREW, SMALL HEX RECESS
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna of NY Commercial |
$55.30
|
| Rate for Payer: Aetna of NY Medicare |
$36.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.50
|
| Rate for Payer: Cash Price |
$59.25
|
| Rate for Payer: CDPHP Commercial |
$63.60
|
| Rate for Payer: CDPHP Medicare |
$29.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.20
|
| Rate for Payer: EmblemHealth Medicaid |
$63.20
|
| Rate for Payer: EmblemHealth Medicare |
$26.86
|
| Rate for Payer: EmblemHealth Select Care |
$39.50
|
| Rate for Payer: Fidelis Medicare |
$30.11
|
| Rate for Payer: Galaxy Health Commercial |
$51.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.23
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.69
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
| Rate for Payer: WellCare Medicare |
$43.45
|
|
|
4.0MM CANCELLOUS SCREW SM HEX FULL RECES
|
Facility
OP
|
$105.00
|
|
| Hospital Charge Code |
4479265
|
|
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
|
|
|
4.0MM CANNULATED SCREW
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4472238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$555.45 |
| Rate for Payer: Aetna of NY Commercial |
$483.00
|
| Rate for Payer: Aetna of NY Medicare |
$317.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$255.30
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$345.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: CDPHP Commercial |
$555.45
|
| Rate for Payer: CDPHP Medicare |
$255.30
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$345.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$552.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$552.00
|
| Rate for Payer: EmblemHealth Medicaid |
$552.00
|
| Rate for Payer: EmblemHealth Medicare |
$234.60
|
| Rate for Payer: EmblemHealth Select Care |
$345.00
|
| Rate for Payer: Fidelis Medicare |
$262.96
|
| Rate for Payer: Galaxy Health Commercial |
$448.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$255.30
|
| Rate for Payer: Humana Medicare |
$255.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$483.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$317.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$448.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$268.06
|
| Rate for Payer: United Healthcare Medicare |
$255.30
|
| Rate for Payer: WellCare Medicare |
$379.50
|
|
|
4.0MM END CUTTER
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0MM RESECTOR CUTTER
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4.0 MM TOMCAT ARTHROSCOPY BLAD
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
4471241
|
|
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
|
|
|
4.0MM TOMCAT CUTTER
|
Facility
OP
|
$174.00
|
|
| Hospital Charge Code |
4471312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$140.07 |
| Rate for Payer: Aetna of NY Commercial |
$121.80
|
| Rate for Payer: Aetna of NY Medicare |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$130.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$64.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$87.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: CDPHP Commercial |
$140.07
|
| Rate for Payer: CDPHP Medicare |
$64.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.20
|
| Rate for Payer: EmblemHealth Medicaid |
$139.20
|
| Rate for Payer: EmblemHealth Medicare |
$59.16
|
| Rate for Payer: EmblemHealth Select Care |
$125.28
|
| Rate for Payer: Fidelis Medicare |
$66.31
|
| Rate for Payer: Galaxy Health Commercial |
$113.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$64.38
|
| Rate for Payer: Humana Medicare |
$64.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$121.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$97.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$67.60
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WellCare Medicare |
$95.70
|
|
|
4-0 MONOSOF P-12
|
Facility
OP
|
$31.00
|
|
| Hospital Charge Code |
4478150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$22.32
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
4-0 MONOSOF P-13
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
4478152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.40
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: EmblemHealth Select Care |
$23.04
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
4-0 VICRYL 18" FS-2 CUTTING
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
4471910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
4.3 X 48MM COMPRSION SCREW
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$304.29 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: CDPHP Commercial |
$304.29
|
| Rate for Payer: CDPHP Medicare |
$139.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$302.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$302.40
|
| Rate for Payer: EmblemHealth Medicaid |
$302.40
|
| Rate for Payer: EmblemHealth Medicare |
$128.52
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Fidelis Medicare |
$144.06
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.86
|
| Rate for Payer: Humana Medicare |
$139.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.85
|
| Rate for Payer: United Healthcare Medicare |
$139.86
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.3 X 50MM COMPRSION SCREW
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4471368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$304.29 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$139.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: CDPHP Commercial |
$304.29
|
| Rate for Payer: CDPHP Medicare |
$139.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$189.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$302.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$302.40
|
| Rate for Payer: EmblemHealth Medicaid |
$302.40
|
| Rate for Payer: EmblemHealth Medicare |
$128.52
|
| Rate for Payer: EmblemHealth Select Care |
$189.00
|
| Rate for Payer: Fidelis Medicare |
$144.06
|
| Rate for Payer: Galaxy Health Commercial |
$245.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$139.86
|
| Rate for Payer: Humana Medicare |
$139.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$173.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$245.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$146.85
|
| Rate for Payer: United Healthcare Medicare |
$139.86
|
| Rate for Payer: WellCare Medicare |
$207.90
|
|
|
4.5CM SMALL ANATOMY/PEDIATRICS
|
Facility
OP
|
$117.00
|
|
| Hospital Charge Code |
4471072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Aetna of NY Commercial |
$81.90
|
| Rate for Payer: Aetna of NY Medicare |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$58.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: CDPHP Commercial |
$94.18
|
| Rate for Payer: CDPHP Medicare |
$43.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$93.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$93.60
|
| Rate for Payer: EmblemHealth Medicaid |
$93.60
|
| Rate for Payer: EmblemHealth Medicare |
$39.78
|
| Rate for Payer: EmblemHealth Select Care |
$84.24
|
| Rate for Payer: Fidelis Medicare |
$44.59
|
| Rate for Payer: Galaxy Health Commercial |
$76.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.29
|
| Rate for Payer: Humana Medicare |
$43.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$81.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.45
|
| Rate for Payer: United Healthcare Medicare |
$43.29
|
| Rate for Payer: WellCare Medicare |
$64.35
|
|
