|
CLONIDINE HCL 0.1MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904565661
|
| Hospital Charge Code |
4400174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLOPIDOGREL BISULFATE 75MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
4400626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLOPIDOGREL BISULFATE 75MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
4400626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLOSED TX ANKLE DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
4600056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX ANKLE DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
4600056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4853036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,989.35 |
| Max. Negotiated Rate |
$2,989.35 |
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4853036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: EmblemHealth Select Care |
$3,311.28
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
4601201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
4601201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX ELBOW DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
4600058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX ELBOW DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
4600058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX INTERPHAL JT DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
4600063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX INTERPHAL JT DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
4600063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Facility
|
IP
|
$4,364.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
4600005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,836.60 |
| Max. Negotiated Rate |
$2,836.60 |
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,836.60
|
|
|
CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Facility
|
OP
|
$4,364.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
4600005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,513.02 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,007.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,614.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,182.00
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: CDPHP Commercial |
$3,513.02
|
| Rate for Payer: CDPHP Medicare |
$1,614.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,491.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,491.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,491.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,483.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$1,663.12
|
| Rate for Payer: Galaxy Health Commercial |
$2,836.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,614.68
|
| Rate for Payer: Humana Medicare |
$1,614.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,007.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,695.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,453.05
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,614.68
|
| Rate for Payer: WellCare Medicare |
$2,400.20
|
|
|
CLOSED TX OF ULNAR STYLOID FX
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
4601567
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$506.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX OF ULNAR STYLOID FX
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
4601567
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX PATELLAR DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4600064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX PATELLAR DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4600064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX PROX HUMERAL FRACTUR
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
4600059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX PROX HUMERAL FRACTUR
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
4600059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX RADIAL HEAD W/MANIP
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
4600055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$540.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.00
|
| Rate for Payer: EmblemHealth Medicaid |
$540.00
|
| Rate for Payer: EmblemHealth Medicare |
$229.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$257.24
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$249.75
|
| Rate for Payer: Humana Medicare |
$249.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLOSED TX RADIAL HEAD W/MANIP
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
4600055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Galaxy Health Commercial |
$438.75
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
4852014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,531.33 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$3,219.30
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: EmblemHealth Select Care |
$3,311.28
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,219.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,589.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
4852014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,989.35 |
| Max. Negotiated Rate |
$2,989.35 |
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
|
