|
26" QUICK-FIT BASIC KNEE SPLIN
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
4471601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Galaxy Health Commercial |
$44.85
|
|
|
2.7 LOCKING SCREW
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$810.60 |
| Rate for Payer: Aetna of NY Commercial |
$810.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$521.10
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$579.00
|
| Rate for Payer: EmblemHealth Select Care |
$579.00
|
| Rate for Payer: Galaxy Health Commercial |
$752.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$810.60
|
| Rate for Payer: Multiplan Commercial |
$521.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$752.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$752.70
|
| Rate for Payer: WellCare Medicare |
$636.90
|
|
|
2.7 LOCKING SCREW
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.72 |
| Max. Negotiated Rate |
$932.19 |
| Rate for Payer: Aetna of NY Commercial |
$810.60
|
| Rate for Payer: Aetna of NY Medicare |
$532.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$428.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$579.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: CDPHP Commercial |
$932.19
|
| Rate for Payer: CDPHP Medicare |
$428.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$579.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$926.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$926.40
|
| Rate for Payer: EmblemHealth Medicaid |
$926.40
|
| Rate for Payer: EmblemHealth Medicare |
$393.72
|
| Rate for Payer: EmblemHealth Select Care |
$579.00
|
| Rate for Payer: Fidelis Medicare |
$441.31
|
| Rate for Payer: Galaxy Health Commercial |
$752.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$428.46
|
| Rate for Payer: Humana Medicare |
$428.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$810.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$532.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$752.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$752.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$449.88
|
| Rate for Payer: United Healthcare Medicare |
$428.46
|
| Rate for Payer: WellCare Medicare |
$636.90
|
|
|
2.7 NON-LOCKING SCREW
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$472.54 |
| Rate for Payer: Aetna of NY Commercial |
$410.90
|
| Rate for Payer: Aetna of NY Medicare |
$270.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$264.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$264.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$217.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$293.50
|
| Rate for Payer: Cash Price |
$440.25
|
| Rate for Payer: CDPHP Commercial |
$472.54
|
| Rate for Payer: CDPHP Medicare |
$217.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$293.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$469.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$469.60
|
| Rate for Payer: EmblemHealth Medicaid |
$469.60
|
| Rate for Payer: EmblemHealth Medicare |
$199.58
|
| Rate for Payer: EmblemHealth Select Care |
$293.50
|
| Rate for Payer: Fidelis Medicare |
$223.71
|
| Rate for Payer: Galaxy Health Commercial |
$381.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$217.19
|
| Rate for Payer: Humana Medicare |
$217.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$410.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$270.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$381.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$228.05
|
| Rate for Payer: United Healthcare Medicare |
$217.19
|
| Rate for Payer: WellCare Medicare |
$322.85
|
|
|
2.7 NON-LOCKING SCREW
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.15 |
| Max. Negotiated Rate |
$410.90 |
| Rate for Payer: Aetna of NY Commercial |
$410.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$264.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$264.15
|
| Rate for Payer: Cash Price |
$440.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$293.50
|
| Rate for Payer: EmblemHealth Select Care |
$293.50
|
| Rate for Payer: Galaxy Health Commercial |
$381.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$410.90
|
| Rate for Payer: Multiplan Commercial |
$264.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$381.55
|
| Rate for Payer: WellCare Medicare |
$322.85
|
|
|
2.7X14MM LOCK SCREW
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
4471835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$569.94 |
| Rate for Payer: Aetna of NY Commercial |
$495.60
|
| Rate for Payer: Aetna of NY Medicare |
$325.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$354.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: CDPHP Commercial |
$569.94
|
| Rate for Payer: CDPHP Medicare |
$261.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$566.40
|
| Rate for Payer: EmblemHealth Medicaid |
$566.40
|
| Rate for Payer: EmblemHealth Medicare |
$240.72
|
| Rate for Payer: EmblemHealth Select Care |
$509.76
|
| Rate for Payer: Fidelis Medicare |
$269.82
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.96
|
| Rate for Payer: Humana Medicare |
$261.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$495.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$275.06
|
| Rate for Payer: United Healthcare Medicare |
$261.96
|
| Rate for Payer: WellCare Medicare |
$389.40
|
|
|
2.7X14MM LOCK SCREW
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
4471835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$460.20 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
|
|
2.7X16MM LOCK SCREW
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
4471836
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$460.20 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
|
|
2.7X16MM LOCK SCREW
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
4471836
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$569.94 |
| Rate for Payer: Aetna of NY Commercial |
$495.60
|
| Rate for Payer: Aetna of NY Medicare |
$325.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$354.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: CDPHP Commercial |
$569.94
|
| Rate for Payer: CDPHP Medicare |
$261.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$566.40
|
| Rate for Payer: EmblemHealth Medicaid |
$566.40
|
| Rate for Payer: EmblemHealth Medicare |
$240.72
|
| Rate for Payer: EmblemHealth Select Care |
$509.76
|
| Rate for Payer: Fidelis Medicare |
$269.82
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.96
|
| Rate for Payer: Humana Medicare |
$261.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$495.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$275.06
|
| Rate for Payer: United Healthcare Medicare |
$261.96
|
| Rate for Payer: WellCare Medicare |
$389.40
|
|
|
2.7X22MM LOCK SCREW
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
4471837
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$460.20 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
|
|
2.7X22MM LOCK SCREW
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
4471837
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$569.94 |
| Rate for Payer: Aetna of NY Commercial |
$495.60
|
| Rate for Payer: Aetna of NY Medicare |
$325.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$354.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: CDPHP Commercial |
$569.94
|
| Rate for Payer: CDPHP Medicare |
$261.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$566.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$566.40
|
| Rate for Payer: EmblemHealth Medicaid |
$566.40
|
| Rate for Payer: EmblemHealth Medicare |
$240.72
|
| Rate for Payer: EmblemHealth Select Care |
$509.76
|
| Rate for Payer: Fidelis Medicare |
$269.82
|
| Rate for Payer: Galaxy Health Commercial |
$460.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.96
|
| Rate for Payer: Humana Medicare |
$261.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$495.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$275.06
|
| Rate for Payer: United Healthcare Medicare |
$261.96
|
| Rate for Payer: WellCare Medicare |
$389.40
|
|
|
2" COBAN STERILE LF
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4471423
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
2" COBAN STERILE LF
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4471423
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
2D TTE W OR W/O FOL W/CON CO
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8923
|
| Hospital Charge Code |
4480105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,489.15 |
| Max. Negotiated Rate |
$1,489.15 |
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
|
|
2D TTE W OR W/O FOL W/CON CO
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C8923
|
| Hospital Charge Code |
4480105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$762.88 |
| Max. Negotiated Rate |
$1,844.26 |
| Rate for Payer: Aetna of NY Commercial |
$1,603.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,603.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,489.15
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,603.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,289.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$890.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,718.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$762.88
|
| Rate for Payer: United Healthcare Commercial |
$1,718.25
|
| Rate for Payer: United Healthcare Medicare |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
|
2D TTE W OR W/O FOL W/CON FU
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
4480104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$885.50 |
| Rate for Payer: Aetna of NY Commercial |
$770.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$407.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$550.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Commercial |
$885.50
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: EmblemHealth Select Care |
$715.00
|
| Rate for Payer: Fidelis Medicare |
$419.21
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$407.00
|
| Rate for Payer: Humana Medicare |
$407.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$770.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$825.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$619.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$427.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$825.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$825.00
|
| Rate for Payer: United Healthcare Medicare |
$407.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
2D TTE W OR W/O FOL W/CON FU
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
4480104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
2 FIBERWIRE SUTURE
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
4471715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Aetna of NY Commercial |
$47.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.60
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.00
|
| Rate for Payer: EmblemHealth Select Care |
$34.00
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.20
|
| Rate for Payer: WellCare Medicare |
$37.40
|
|
|
2 FIBERWIRE SUTURE
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
4471715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Aetna of NY Commercial |
$47.60
|
| Rate for Payer: Aetna of NY Medicare |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$34.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: CDPHP Commercial |
$54.74
|
| Rate for Payer: CDPHP Medicare |
$25.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$54.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.40
|
| Rate for Payer: EmblemHealth Medicaid |
$54.40
|
| Rate for Payer: EmblemHealth Medicare |
$23.12
|
| Rate for Payer: EmblemHealth Select Care |
$34.00
|
| Rate for Payer: Fidelis Medicare |
$25.91
|
| Rate for Payer: Galaxy Health Commercial |
$44.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.16
|
| Rate for Payer: Humana Medicare |
$25.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$47.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.42
|
| Rate for Payer: United Healthcare Medicare |
$25.16
|
| Rate for Payer: WellCare Medicare |
$37.40
|
|
|
2" SMOOTH CAST PADDING STERILE
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
4471792
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Commercial |
$22.54
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$20.16
|
| Rate for Payer: Fidelis Medicare |
$10.67
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
| Rate for Payer: Humana Medicare |
$10.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
2" SMOOTH CAST PADDING STERILE
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
4471792
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
2" STRETCH BANDAGE
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
4471767
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of NY Commercial |
$1.40
|
| Rate for Payer: Aetna of NY Medicare |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.00
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: CDPHP Commercial |
$1.61
|
| Rate for Payer: CDPHP Medicare |
$0.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1.60
|
| Rate for Payer: EmblemHealth Medicare |
$0.68
|
| Rate for Payer: EmblemHealth Select Care |
$1.44
|
| Rate for Payer: Fidelis Medicare |
$0.76
|
| Rate for Payer: Galaxy Health Commercial |
$1.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.74
|
| Rate for Payer: Humana Medicare |
$0.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.78
|
| Rate for Payer: United Healthcare Medicare |
$0.74
|
| Rate for Payer: WellCare Medicare |
$1.10
|
|
|
2" STRETCH BANDAGE
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
4471767
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Galaxy Health Commercial |
$1.30
|
|
|
2"X10YDS HYPAFIX
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
4471264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna of NY Commercial |
$14.00
|
| Rate for Payer: Aetna of NY Medicare |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: CDPHP Commercial |
$16.10
|
| Rate for Payer: CDPHP Medicare |
$7.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16.00
|
| Rate for Payer: EmblemHealth Medicare |
$6.80
|
| Rate for Payer: EmblemHealth Select Care |
$14.40
|
| Rate for Payer: Fidelis Medicare |
$7.62
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.40
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.77
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WellCare Medicare |
$11.00
|
|
|
2"X10YDS HYPAFIX
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
4471264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.00
|
|
