|
CL TX CALCANEAL FX; W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4856723
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX CALCANEAL FX; W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4856723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLTX CARPL BONE FX W MNP EA BONE
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
4856680
|
|
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
|
|
|
CLTX CARPL BONE FX W MNP EA BONE
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
4856680
|
|
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
|
|
|
CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
4602229
|
|
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
|
|
|
CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
4602229
|
|
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
|
|
|
CL TX CMC DISL W M EA
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
4850129
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX CMC DISL W M EA
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
4850129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CL TX DISTL FIB FX W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
4856676
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX DISTL FIB FX W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
4856676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CL TX D PHAL FX FGRR/THMB; W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
4850131
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX D PHAL FX FGRR/THMB; W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
4850131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
4600169
|
|
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
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
4600169
|
|
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
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W MNP
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
4850152
|
|
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
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W MNP
|
Facility
|
IP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
4602221
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W MNP
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
4602221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$3,942.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| 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: Cash Price |
$3,696.00
|
| 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 |
$1,206.00
|
| 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 |
$1,085.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,266.88
|
| 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 |
$2,069.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,971.20
|
| Rate for Payer: WellCare Medicare |
$2,710.40
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W MNP
|
Facility
|
OP
|
$4,928.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
4850152
|
|
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
|
|
|
CL TX FX GT PHALANX(S); W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
4850132
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX FX GT PHALANX(S); W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
4850132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CL TX FX PHALANX/PHALANG; W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
4850134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of NY Commercial |
$529.20
|
| 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: CDPHP Medicare |
$279.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$604.80
|
| 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 |
$544.32
|
| 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 |
$529.20
|
| 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: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.40
|
| Rate for Payer: United Healthcare Medicare |
$302.40
|
| Rate for Payer: WellCare Medicare |
$415.80
|
|
|
CL TX FX PHALANX/PHALANG; W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
4601001
|
|
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
|
|
|
CL TX FX PHALANX/PHALANG; W MANIP
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
4601001
|
|
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
|
|
|
CL TX FX PHALANX/PHALANG; W MANIP
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
4850134
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
|
OP
|
$4,802.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
4602241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.30 |
| Max. Negotiated Rate |
$3,841.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,208.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,920.80
|
| Rate for Payer: Cash Price |
$3,601.50
|
| Rate for Payer: Cash Price |
$3,601.50
|
| Rate for Payer: Cash Price |
$3,601.50
|
| Rate for Payer: CDPHP Medicare |
$1,776.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,841.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,841.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,841.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,632.68
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,920.80
|
| Rate for Payer: Galaxy Health Commercial |
$3,121.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,920.80
|
| Rate for Payer: Humana Medicare |
$1,920.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,208.92
|
| 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 |
$2,016.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$720.30
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,920.80
|
| Rate for Payer: WellCare Medicare |
$2,641.10
|
|
