|
CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
4853039
|
|
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&ULNAR SHAFT FRACTURES W/MANJ
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
4853039
|
|
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 RAD/ULN SHAF W/MANI
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
4600065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLOSED TX RAD/ULN SHAF W/MANI
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
4600065
|
|
Hospital Revenue Code
|
450
|
| 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 SHOULDER DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
4600060
|
|
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 SHOULDER DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
4600060
|
|
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 TEMPMAND DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
4600061
|
|
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 TEMPMAND DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
4600061
|
|
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 THUMB DISLOCATION
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
4600062
|
|
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 THUMB DISLOCATION
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
4600062
|
|
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
|
|
|
CLOTRIMAZOLE 0.01 CRM 15 GM
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
NDC 00904782236
|
| Hospital Charge Code |
4400177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Aetna of NY Commercial |
$12.08
|
| Rate for Payer: Aetna of NY Medicare |
$7.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.62
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: CDPHP Commercial |
$13.89
|
| Rate for Payer: CDPHP Medicare |
$6.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.80
|
| Rate for Payer: EmblemHealth Medicaid |
$13.80
|
| Rate for Payer: EmblemHealth Medicare |
$5.86
|
| Rate for Payer: EmblemHealth Select Care |
$12.42
|
| Rate for Payer: Fidelis Medicare |
$6.57
|
| Rate for Payer: Galaxy Health Commercial |
$11.21
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.38
|
| Rate for Payer: Humana Medicare |
$6.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.70
|
| Rate for Payer: United Healthcare Medicare |
$6.38
|
| Rate for Payer: WellCare Medicare |
$9.49
|
|
|
CLOTRIMAZOLE 0.01 CRM 15 GM
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
NDC 00904782236
|
| Hospital Charge Code |
4400177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$11.21 |
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Galaxy Health Commercial |
$11.21
|
| Rate for Payer: WellCare Medicare |
$9.49
|
|
|
CLOTRIMAZOLE 10MG LOZG 70 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00574010777
|
| Hospital Charge Code |
4400180
|
|
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
|
|
|
CLOTRIMAZOLE 10MG LOZG 70 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00574010777
|
| Hospital Charge Code |
4400180
|
|
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
|
|
|
CLOTRIMAZOLE/BETAMETH DIP 1-0.05% CRM 15
|
Facility
|
OP
|
$105.58
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
4400181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$84.99 |
| Rate for Payer: Aetna of NY Commercial |
$73.91
|
| Rate for Payer: Aetna of NY Medicare |
$48.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.79
|
| Rate for Payer: Cash Price |
$79.19
|
| Rate for Payer: CDPHP Commercial |
$84.99
|
| Rate for Payer: CDPHP Medicare |
$39.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.46
|
| Rate for Payer: EmblemHealth Medicaid |
$84.46
|
| Rate for Payer: EmblemHealth Medicare |
$35.90
|
| Rate for Payer: EmblemHealth Select Care |
$76.02
|
| Rate for Payer: Fidelis Medicare |
$40.24
|
| Rate for Payer: Galaxy Health Commercial |
$68.63
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.06
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.02
|
| Rate for Payer: United Healthcare Medicare |
$39.06
|
| Rate for Payer: WellCare Medicare |
$58.07
|
|
|
CLOTRIMAZOLE/BETAMETH DIP 1-0.05% CRM 15
|
Facility
|
IP
|
$105.58
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
4400181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.07 |
| Max. Negotiated Rate |
$68.63 |
| Rate for Payer: Cash Price |
$79.19
|
| Rate for Payer: Galaxy Health Commercial |
$68.63
|
| Rate for Payer: WellCare Medicare |
$58.07
|
|
|
CLOTTING: FACTOR VIII VW FACTOR AG
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
4301043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$204.47 |
| Rate for Payer: Aetna of NY Commercial |
$165.10
|
| Rate for Payer: Aetna of NY Medicare |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$190.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$190.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$127.00
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: CDPHP Commercial |
$204.47
|
| Rate for Payer: CDPHP Medicare |
$93.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$152.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$203.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$203.20
|
| Rate for Payer: EmblemHealth Medicaid |
$203.20
|
| Rate for Payer: EmblemHealth Medicare |
$86.36
|
| Rate for Payer: EmblemHealth Select Care |
$152.40
|
| Rate for Payer: Fidelis Medicare |
$96.80
|
| Rate for Payer: Galaxy Health Commercial |
$165.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.98
|
| Rate for Payer: Humana Medicare |
$93.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$165.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$116.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$143.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$98.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$190.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$190.50
|
| Rate for Payer: United Healthcare Medicare |
$93.98
|
| Rate for Payer: WellCare Medicare |
$139.70
|
|
|
CLOTTING: FACTOR VIII VW FACTOR AG
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
4301043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Galaxy Health Commercial |
$165.10
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
4853037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$540.00
|
| 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 |
$486.00
|
| 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 |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
4853037
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CLTX BIMALLEOLAR ANKLE FRACT W MNP
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4609648
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,702.20 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,115.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,701.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,299.50
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: CDPHP Commercial |
$3,702.20
|
| Rate for Payer: CDPHP Medicare |
$1,701.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,679.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,679.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.66
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$1,752.68
|
| Rate for Payer: Galaxy Health Commercial |
$2,989.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,701.63
|
| Rate for Payer: Humana Medicare |
$1,701.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,115.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,786.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,531.33
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$1,701.63
|
| Rate for Payer: WellCare Medicare |
$2,529.45
|
|
|
CLTX BIMALLEOLAR ANKLE FRACT W MNP
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4609648
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
CL TX CALCANEAL FX; W MANIP
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4856723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$472.50
|
| Rate for Payer: Aetna of NY Medicare |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$249.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$337.50
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: CDPHP Commercial |
$543.38
|
| Rate for Payer: CDPHP Medicare |
$249.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$540.00
|
| 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 |
$486.00
|
| 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 |
$472.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$310.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$380.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$262.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.69
|
| Rate for Payer: United Healthcare Medicare |
$249.75
|
| Rate for Payer: WellCare Medicare |
$371.25
|
|
|
CL TX CALCANEAL FX; W MANIP
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4856723
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CLTX CARPL BONE FX W MNP EA BONE
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
4856680
|
|
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
|
|
