|
CLONIDINE HCL 0.1MG/24HR PTCH 4 EA
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 597003134
|
| Hospital Charge Code |
4400138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.00
|
| Rate for Payer: Humana Medicare |
$18.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.75
|
| Rate for Payer: United Healthcare Medicare |
$18.00
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
CLONIDINE HCL 0.1MG/24HR PTCH 4 EA
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 597003134
|
| Hospital Charge Code |
4400138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
CLONIDINE HCL 0.1MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904565661
|
| 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
|
|
|
CLONIDINE HCL 0.1MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904565661
|
| Hospital Charge Code |
4400174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLOPIDOGREL BISULFATE 75MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904629461
|
| Hospital Charge Code |
4400626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLOPIDOGREL BISULFATE 75MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904629461
|
| 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
|
|
|
CLOSED TX ANKLE DISLOCATION
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
4600056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX ANKLE DISLOCATION
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
4600056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4853036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$3,942.40 |
| Rate for Payer: Aetna of NY Commercial |
$3,449.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,266.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,971.20
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: CDPHP Medicare |
$1,823.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,942.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,942.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,675.52
|
| Rate for Payer: EmblemHealth Select Care |
$3,548.16
|
| Rate for Payer: Fidelis Medicare |
$1,971.20
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,971.20
|
| Rate for Payer: Humana Medicare |
$1,971.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,449.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,266.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,696.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,774.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,069.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$739.20
|
| Rate for Payer: United Healthcare Medicare |
$1,971.20
|
| Rate for Payer: WellCare Medicare |
$2,710.40
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
4853036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,203.20 |
| Max. Negotiated Rate |
$3,203.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,203.20
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
4601201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
4601201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX ELBOW DISLOCATION
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
4600058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX ELBOW DISLOCATION
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
4600058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX INTERPHAL JT DISLOCATION
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
4600063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX INTERPHAL JT DISLOCATION
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
4600063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Facility
|
IP
|
$4,756.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
4600005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$3,091.40 |
| Rate for Payer: Cash Price |
$3,567.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,091.40
|
|
|
CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Facility
|
OP
|
$4,756.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
4600005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$713.40 |
| Max. Negotiated Rate |
$3,804.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,187.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,902.40
|
| Rate for Payer: Cash Price |
$3,567.00
|
| Rate for Payer: Cash Price |
$3,567.00
|
| Rate for Payer: Cash Price |
$3,567.00
|
| Rate for Payer: CDPHP Medicare |
$1,759.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,804.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,804.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,804.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,617.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,902.40
|
| Rate for Payer: Galaxy Health Commercial |
$3,091.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,902.40
|
| Rate for Payer: Humana Medicare |
$1,902.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,187.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,997.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$713.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,902.40
|
| Rate for Payer: WellCare Medicare |
$2,615.80
|
|
|
CLOSED TX OF ULNAR STYLOID FX
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
4601567
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX OF ULNAR STYLOID FX
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
4601567
|
|
Hospital Revenue Code
|
459
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,206.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$567.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$425.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX PATELLAR DISLOCATION
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4600064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX PATELLAR DISLOCATION
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4600064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX PROX HUMERAL FRACTUR
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
4600059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLOSED TX PROX HUMERAL FRACTUR
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
4600059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
|
|
CLOSED TX RADIAL HEAD W/MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
4600055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$302.40
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$604.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$604.80
|
| Rate for Payer: EmblemHealth Medicaid |
$604.80
|
| Rate for Payer: EmblemHealth Medicare |
$257.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$302.40
|
| Rate for Payer: Galaxy Health Commercial |
$491.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$302.40
|
| Rate for Payer: Humana Medicare |
$302.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$347.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$317.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
