|
2.0MM DRILL
|
Facility
|
OP
|
$627.00
|
|
| Hospital Charge Code |
4471841
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$504.74 |
| Rate for Payer: Aetna of NY Commercial |
$438.90
|
| Rate for Payer: Aetna of NY Medicare |
$288.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$470.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$470.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$231.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$313.50
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: CDPHP Commercial |
$504.74
|
| Rate for Payer: CDPHP Medicare |
$231.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$501.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$501.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$501.60
|
| Rate for Payer: EmblemHealth Medicaid |
$501.60
|
| Rate for Payer: EmblemHealth Medicare |
$213.18
|
| Rate for Payer: EmblemHealth Select Care |
$451.44
|
| Rate for Payer: Fidelis Medicare |
$238.95
|
| Rate for Payer: Galaxy Health Commercial |
$407.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$231.99
|
| Rate for Payer: Humana Medicare |
$231.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$438.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$288.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$353.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$243.59
|
| Rate for Payer: United Healthcare Medicare |
$231.99
|
| Rate for Payer: WellCare Medicare |
$344.85
|
|
|
2.0MM DRILL
|
Facility
|
IP
|
$627.00
|
|
| Hospital Charge Code |
4471841
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$407.55 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Galaxy Health Commercial |
$407.55
|
|
|
22GA 6" SPINAL NEEDLE
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
4472101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.48
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
22GA 6" SPINAL NEEDLE
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
4472101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
|
|
22GA 8" SPINAL NEEDLE
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4472103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
22GA 8" SPINAL NEEDLE
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4472103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
22" QUICK-FIT BASIC KNEE SPLIN
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
4471600
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$39.20
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$40.32
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
22" QUICK-FIT BASIC KNEE SPLIN
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
4471600
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
24FR 5CC FOLEY
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4478210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
24FR 5CC FOLEY
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4478210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
2.5CM X 3.0CM GAMMA GRAFT
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4471881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.22 |
| Max. Negotiated Rate |
$912.06 |
| Rate for Payer: Aetna of NY Commercial |
$793.10
|
| Rate for Payer: Aetna of NY Medicare |
$521.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$419.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$566.50
|
| Rate for Payer: Cash Price |
$849.75
|
| Rate for Payer: CDPHP Commercial |
$912.06
|
| Rate for Payer: CDPHP Medicare |
$419.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$906.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$906.40
|
| Rate for Payer: EmblemHealth Medicaid |
$906.40
|
| Rate for Payer: EmblemHealth Medicare |
$385.22
|
| Rate for Payer: EmblemHealth Select Care |
$566.50
|
| Rate for Payer: Fidelis Medicare |
$431.79
|
| Rate for Payer: Galaxy Health Commercial |
$736.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$419.21
|
| Rate for Payer: Humana Medicare |
$419.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$793.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$521.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$736.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$736.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$440.17
|
| Rate for Payer: United Healthcare Medicare |
$419.21
|
| Rate for Payer: WellCare Medicare |
$623.15
|
|
|
2.5CM X 3.0CM GAMMA GRAFT
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4471881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.85 |
| Max. Negotiated Rate |
$793.10 |
| Rate for Payer: Aetna of NY Commercial |
$793.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$509.85
|
| Rate for Payer: Cash Price |
$849.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.50
|
| Rate for Payer: EmblemHealth Select Care |
$566.50
|
| Rate for Payer: Galaxy Health Commercial |
$736.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$793.10
|
| Rate for Payer: Multiplan Commercial |
$509.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$736.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$736.45
|
| Rate for Payer: WellCare Medicare |
$623.15
|
|
|
25GA 3CC SYRINGE & NEEDLE
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
4472098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
25GA 3CC SYRINGE & NEEDLE
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
4472098
|
|
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
|
|
|
25GA 6" SPINAL NEEDLE
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
4472009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
|
|
25GA 6" SPINAL NEEDLE
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
4472009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$7.00
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$7.20
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
2.5MM SMALL-JOINT FULL RADIUS
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
4471045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$145.70 |
| Rate for Payer: Aetna of NY Commercial |
$126.70
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$135.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$135.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$90.50
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Commercial |
$145.70
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$130.32
|
| Rate for Payer: Fidelis Medicare |
$68.98
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.97
|
| Rate for Payer: Humana Medicare |
$66.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$101.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$70.32
|
| Rate for Payer: United Healthcare Medicare |
$66.97
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
2.5MM SMALL-JOINT FULL RADIUS
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
4471045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
26FR 5CC FOLEY
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
4478209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
|
|
26FR 5CC FOLEY
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
4478209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$10.08
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
26ML CHLORAPREP
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
4471237
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
26ML CHLORAPREP
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
4471237
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
26ML CHLORAPREP WITH TINT#1238
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4479281
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
26ML CHLORAPREP WITH TINT#1238
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4479281
|
|
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
|
|
|
26" QUICK-FIT BASIC KNEE SPLIN
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
4471601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$55.54 |
| Rate for Payer: Aetna of NY Commercial |
$48.30
|
| Rate for Payer: Aetna of NY Medicare |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.50
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: CDPHP Commercial |
$55.54
|
| Rate for Payer: CDPHP Medicare |
$25.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$55.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$55.20
|
| Rate for Payer: EmblemHealth Medicaid |
$55.20
|
| Rate for Payer: EmblemHealth Medicare |
$23.46
|
| Rate for Payer: EmblemHealth Select Care |
$49.68
|
| Rate for Payer: Fidelis Medicare |
$26.30
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.53
|
| Rate for Payer: Humana Medicare |
$25.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.81
|
| Rate for Payer: United Healthcare Medicare |
$25.53
|
| Rate for Payer: WellCare Medicare |
$37.95
|
|
