|
ORTHC/PROSTC MGMT SBSQ ENC (W/ KX)
|
Facility
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97763 GO,KX
|
| Hospital Charge Code |
4690198
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$149.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Commercial |
$160.20
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: EmblemHealth Select Care |
$143.28
|
| Rate for Payer: Fidelis Medicare |
$75.84
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.63
|
| Rate for Payer: Humana Medicare |
$73.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.31
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$73.63
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
ORTHOPOXVIRUS AMP PRB EACH
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
4302027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$51.82
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP
|
| Hospital Charge Code |
4650027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59
|
| Hospital Charge Code |
4650373
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,59,KX
|
| Hospital Charge Code |
4650425
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GP,KX
|
| Hospital Charge Code |
4650318
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: WellCare Medicare |
$98.45
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Commercial |
$144.10
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.20
|
| Rate for Payer: EmblemHealth Medicaid |
$143.20
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$68.22
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.23
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
OP
|
$1,720.80
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
4401279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$1,385.24 |
| Rate for Payer: Aetna of NY Commercial |
$946.44
|
| Rate for Payer: Aetna of NY Medicare |
$791.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$636.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$860.40
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: CDPHP Commercial |
$1,385.24
|
| Rate for Payer: CDPHP Medicare |
$636.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,376.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicaid |
$1,376.64
|
| Rate for Payer: EmblemHealth Medicare |
$585.07
|
| Rate for Payer: EmblemHealth Select Care |
$131.56
|
| Rate for Payer: Fidelis Medicare |
$655.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,118.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$636.70
|
| Rate for Payer: Humana Medicare |
$636.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$946.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$791.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,290.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$968.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$668.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$193.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$131.56
|
| Rate for Payer: United Healthcare Commercial |
$193.68
|
| Rate for Payer: United Healthcare Medicare |
$636.70
|
| Rate for Payer: WellCare Medicare |
$946.44
|
|
|
ORTHOWEDGE LARGE
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
4471605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
ORTHOWEDGE MEDIUM
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
4471604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
ORTHOWEDGE SMALL
|
Facility
OP
|
$51.00
|
|
| Hospital Charge Code |
4471603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
ORTHOWEDGE XL
|
Facility
OP
|
$51.00
|
|
| Hospital Charge Code |
4471606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Aetna of NY Commercial |
$35.70
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.50
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Commercial |
$41.06
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.80
|
| Rate for Payer: EmblemHealth Medicaid |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$19.44
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.87
|
| Rate for Payer: Humana Medicare |
$18.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.81
|
| Rate for Payer: United Healthcare Medicare |
$18.87
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
OSELTAMIVIR PHOS 75 MG CAPSULE 75 mg, 10 eaches
|
Facility
OP
|
$46.38
|
|
| Hospital Charge Code |
4401315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Aetna of NY Commercial |
$32.47
|
| Rate for Payer: Aetna of NY Medicare |
$21.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.19
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: CDPHP Commercial |
$37.34
|
| Rate for Payer: CDPHP Medicare |
$17.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.10
|
| Rate for Payer: EmblemHealth Medicaid |
$37.10
|
| Rate for Payer: EmblemHealth Medicare |
$15.77
|
| Rate for Payer: EmblemHealth Select Care |
$33.39
|
| Rate for Payer: Fidelis Medicare |
$17.68
|
| Rate for Payer: Galaxy Health Commercial |
$30.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.16
|
| Rate for Payer: Humana Medicare |
$17.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.02
|
| Rate for Payer: United Healthcare Medicare |
$17.16
|
| Rate for Payer: WellCare Medicare |
$25.51
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAPS 10 EA
|
Facility
OP
|
$48.67
|
|
| Hospital Charge Code |
4400744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna of NY Commercial |
$34.07
|
| Rate for Payer: Aetna of NY Medicare |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.34
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: CDPHP Commercial |
$39.18
|
| Rate for Payer: CDPHP Medicare |
$18.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.94
|
| Rate for Payer: EmblemHealth Medicaid |
$38.94
|
| Rate for Payer: EmblemHealth Medicare |
$16.55
|
| Rate for Payer: EmblemHealth Select Care |
$35.04
|
| Rate for Payer: Fidelis Medicare |
$18.55
|
| Rate for Payer: Galaxy Health Commercial |
$31.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.01
|
| Rate for Payer: Humana Medicare |
$18.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.91
|
| Rate for Payer: United Healthcare Medicare |
$18.01
|
| Rate for Payer: WellCare Medicare |
$26.77
|
|
|
OSMOLALITY-SERUM
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
4300597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$29.25
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| 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: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.25
|
| 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 |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$33.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$33.75
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
OSMOLARITY URINE
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
4300598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
OSTOMY BAG
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
4479205
|
|
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
|
|
|
OT ADL/SELF CARE TR EA 15 M
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4650118
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M (MOD 59)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59
|
| Hospital Charge Code |
4650398
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M (MOD 59 W KX)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59,KX
|
| Hospital Charge Code |
4650450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M (W/ KX)
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,KX
|
| Hospital Charge Code |
4650346
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$46.23
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT APPLY LONG ARM SPLINT
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29105 GO
|
| Hospital Charge Code |
4690029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$363.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
OT APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 29126 GO
|
| Hospital Charge Code |
4690030
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$263.52
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO
|
| Hospital Charge Code |
4650052
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Commercial |
$108.68
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.00
|
| Rate for Payer: EmblemHealth Medicaid |
$108.00
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$51.45
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.95
|
| Rate for Payer: Humana Medicare |
$49.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.45
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$49.95
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59)
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59
|
| Hospital Charge Code |
4650385
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Commercial |
$108.68
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.00
|
| Rate for Payer: EmblemHealth Medicaid |
$108.00
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$51.45
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.95
|
| Rate for Payer: Humana Medicare |
$49.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.45
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$49.95
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59 W KX)
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59,KX
|
| Hospital Charge Code |
4650437
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Commercial |
$108.68
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.00
|
| Rate for Payer: EmblemHealth Medicaid |
$108.00
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$51.45
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.95
|
| Rate for Payer: Humana Medicare |
$49.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.45
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$49.95
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
