|
3-0 2.0 METRIC SILK
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4478156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
3-0 2.0 METRIC SILK
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4478156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
3-0 ETHILON 18" PS-2 CUTTING
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
4471172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
3-0 ETHILON 18" PS-2 CUTTING
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
4471172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$13.30
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$13.68
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
3-0 MONOSOF P-12
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
4478155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
3-0 MONOSOF P-12
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
4478155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
3-0 POLYSORB GL-126
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4478160
|
|
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
|
|
|
3-0 POLYSORB GL-126
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4478160
|
|
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
|
|
|
3-0PROLENE FS-1
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
4478158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
3-0PROLENE FS-1
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
4478158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
3-0 SURGIPRO 18" C-14 CUTTING
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4472085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
3-0 SURGIPRO 18" C-14 CUTTING
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4472085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
3-0 SURGIPRO II P-14
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4478161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
3-0 SURGIPRO II P-14
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4478161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
3-0 VICRYL MHV-26 SUTURE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
4471907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
3-0 VICRYL MHV-26 SUTURE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
4471907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
3.5MM CALCANEAL PLATE
|
Facility
|
OP
|
$1,574.00
|
|
| Hospital Charge Code |
4472232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.16 |
| Max. Negotiated Rate |
$1,267.07 |
| Rate for Payer: Aetna of NY Commercial |
$1,101.80
|
| Rate for Payer: Aetna of NY Medicare |
$724.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$582.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$787.00
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: CDPHP Commercial |
$1,267.07
|
| Rate for Payer: CDPHP Medicare |
$582.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$787.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,259.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,259.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,259.20
|
| Rate for Payer: EmblemHealth Medicare |
$535.16
|
| Rate for Payer: EmblemHealth Select Care |
$787.00
|
| Rate for Payer: Fidelis Medicare |
$599.85
|
| Rate for Payer: Galaxy Health Commercial |
$1,023.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$582.38
|
| Rate for Payer: Humana Medicare |
$582.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,101.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$724.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,023.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,023.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$611.50
|
| Rate for Payer: United Healthcare Medicare |
$582.38
|
| Rate for Payer: WellCare Medicare |
$865.70
|
|
|
3.5MM CALCANEAL PLATE
|
Facility
|
IP
|
$1,574.00
|
|
| Hospital Charge Code |
4472232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.30 |
| Max. Negotiated Rate |
$1,101.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,101.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$708.30
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$787.00
|
| Rate for Payer: EmblemHealth Select Care |
$787.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,023.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,101.80
|
| Rate for Payer: Multiplan Commercial |
$708.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,023.10
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,023.10
|
| Rate for Payer: WellCare Medicare |
$865.70
|
|
|
3.5MM CLOVERLEAF PLATE, 3-5 HOLES
|
Facility
|
IP
|
$979.00
|
|
| Hospital Charge Code |
4472230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.55 |
| Max. Negotiated Rate |
$685.30 |
| Rate for Payer: Aetna of NY Commercial |
$685.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$440.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$440.55
|
| Rate for Payer: Cash Price |
$734.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$489.50
|
| Rate for Payer: EmblemHealth Select Care |
$489.50
|
| Rate for Payer: Galaxy Health Commercial |
$636.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$685.30
|
| Rate for Payer: Multiplan Commercial |
$440.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$636.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$636.35
|
| Rate for Payer: WellCare Medicare |
$538.45
|
|
|
3.5MM CLOVERLEAF PLATE, 3-5 HOLES
|
Facility
|
OP
|
$979.00
|
|
| Hospital Charge Code |
4472230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.86 |
| Max. Negotiated Rate |
$788.10 |
| Rate for Payer: Aetna of NY Commercial |
$685.30
|
| Rate for Payer: Aetna of NY Medicare |
$450.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$440.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$440.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$362.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$489.50
|
| Rate for Payer: Cash Price |
$734.25
|
| Rate for Payer: CDPHP Commercial |
$788.10
|
| Rate for Payer: CDPHP Medicare |
$362.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$489.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$783.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$783.20
|
| Rate for Payer: EmblemHealth Medicaid |
$783.20
|
| Rate for Payer: EmblemHealth Medicare |
$332.86
|
| Rate for Payer: EmblemHealth Select Care |
$489.50
|
| Rate for Payer: Fidelis Medicare |
$373.10
|
| Rate for Payer: Galaxy Health Commercial |
$636.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$362.23
|
| Rate for Payer: Humana Medicare |
$362.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$685.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$450.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$636.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$636.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$380.34
|
| Rate for Payer: United Healthcare Medicare |
$362.23
|
| Rate for Payer: WellCare Medicare |
$538.45
|
|
|
3.5MM CLOVERLEAF PLATE, 5> HOLES
|
Facility
|
OP
|
$1,419.00
|
|
| Hospital Charge Code |
4472231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.46 |
| Max. Negotiated Rate |
$1,142.30 |
| Rate for Payer: Aetna of NY Commercial |
$993.30
|
| Rate for Payer: Aetna of NY Medicare |
$652.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$525.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$709.50
|
| Rate for Payer: Cash Price |
$1,064.25
|
| Rate for Payer: CDPHP Commercial |
$1,142.30
|
| Rate for Payer: CDPHP Medicare |
$525.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$709.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,135.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,135.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,135.20
|
| Rate for Payer: EmblemHealth Medicare |
$482.46
|
| Rate for Payer: EmblemHealth Select Care |
$709.50
|
| Rate for Payer: Fidelis Medicare |
$540.78
|
| Rate for Payer: Galaxy Health Commercial |
$922.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$525.03
|
| Rate for Payer: Humana Medicare |
$525.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$993.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$652.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$922.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$551.28
|
| Rate for Payer: United Healthcare Medicare |
$525.03
|
| Rate for Payer: WellCare Medicare |
$780.45
|
|
|
3.5MM CLOVERLEAF PLATE, 5> HOLES
|
Facility
|
IP
|
$1,419.00
|
|
| Hospital Charge Code |
4472231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.55 |
| Max. Negotiated Rate |
$993.30 |
| Rate for Payer: Aetna of NY Commercial |
$993.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$638.55
|
| Rate for Payer: Cash Price |
$1,064.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$709.50
|
| Rate for Payer: EmblemHealth Select Care |
$709.50
|
| Rate for Payer: Galaxy Health Commercial |
$922.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$638.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$922.35
|
| Rate for Payer: WellCare Medicare |
$780.45
|
|
|
3.5MM COMPRESSION PLATE, 12> HOLES
|
Facility
|
OP
|
$1,405.00
|
|
| Hospital Charge Code |
4472225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.70 |
| Max. Negotiated Rate |
$1,131.02 |
| Rate for Payer: Aetna of NY Commercial |
$983.50
|
| Rate for Payer: Aetna of NY Medicare |
$646.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$519.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$702.50
|
| Rate for Payer: Cash Price |
$1,053.75
|
| Rate for Payer: CDPHP Commercial |
$1,131.02
|
| Rate for Payer: CDPHP Medicare |
$519.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$702.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,124.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,124.00
|
| Rate for Payer: EmblemHealth Medicare |
$477.70
|
| Rate for Payer: EmblemHealth Select Care |
$702.50
|
| Rate for Payer: Fidelis Medicare |
$535.45
|
| Rate for Payer: Galaxy Health Commercial |
$913.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$519.85
|
| Rate for Payer: Humana Medicare |
$519.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$983.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$646.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$913.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$913.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$545.84
|
| Rate for Payer: United Healthcare Medicare |
$519.85
|
| Rate for Payer: WellCare Medicare |
$772.75
|
|
|
3.5MM COMPRESSION PLATE, 12> HOLES
|
Facility
|
IP
|
$1,405.00
|
|
| Hospital Charge Code |
4472225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.25 |
| Max. Negotiated Rate |
$983.50 |
| Rate for Payer: Aetna of NY Commercial |
$983.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$632.25
|
| Rate for Payer: Cash Price |
$1,053.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$702.50
|
| Rate for Payer: EmblemHealth Select Care |
$702.50
|
| Rate for Payer: Galaxy Health Commercial |
$913.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$983.50
|
| Rate for Payer: Multiplan Commercial |
$632.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$913.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$913.25
|
| Rate for Payer: WellCare Medicare |
$772.75
|
|
|
3.5MM COMPRESSION PLATE, 2-8 HOLES
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
4472223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna of NY Commercial |
$336.00
|
| Rate for Payer: Aetna of NY Medicare |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$177.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: CDPHP Commercial |
$386.40
|
| Rate for Payer: CDPHP Medicare |
$177.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$240.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$384.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$384.00
|
| Rate for Payer: EmblemHealth Medicaid |
$384.00
|
| Rate for Payer: EmblemHealth Medicare |
$163.20
|
| Rate for Payer: EmblemHealth Select Care |
$240.00
|
| Rate for Payer: Fidelis Medicare |
$182.93
|
| Rate for Payer: Galaxy Health Commercial |
$312.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$177.60
|
| Rate for Payer: Humana Medicare |
$177.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$336.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$220.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$312.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$186.48
|
| Rate for Payer: United Healthcare Medicare |
$177.60
|
| Rate for Payer: WellCare Medicare |
$264.00
|
|
